Flat wart - External and Internal Eye
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Synopsis

Flat warts (also known as verruca plana and plane warts) are 1-3 mm, round or oval, slightly raised, smooth papules induced by human papillomavirus (HPV) types 3, 10, 28, and 49. Flat warts are commonly painless and can be yellowish-brown, flesh-colored, or pink. They may appear singularly, in clusters, or in a linear arrangement. Flat warts typically present on areas of the body that have contact with other people and objects, such as the face, arms, hands, and feet; however, they can appear anywhere on the body. Flat warts are commonly seen on the face and near the eye due to autoinoculation. Hands commonly touch the periorbital skin, which can lead to the spread of flat warts.
The warts arise from benign strains of HPV and are not known to cause cancer. They are contagious and spread easily over the body. Transmission is commonly via person-to-person contact or via fomite. Existing skin trauma (ie, cuts, scratches, burns, eczema) predisposes patients to contracting HPV. A person with flat warts may spread the warts to a different part of the body (autoinoculation) through trauma to the skin such as scratching or shaving.
Children, young adults, and immunocompromised patients are most susceptible.
While warts are normally self-limited in children, they may be difficult to treat in adults. Longer periods of treatment are usually necessary for adults.
The warts arise from benign strains of HPV and are not known to cause cancer. They are contagious and spread easily over the body. Transmission is commonly via person-to-person contact or via fomite. Existing skin trauma (ie, cuts, scratches, burns, eczema) predisposes patients to contracting HPV. A person with flat warts may spread the warts to a different part of the body (autoinoculation) through trauma to the skin such as scratching or shaving.
Children, young adults, and immunocompromised patients are most susceptible.
While warts are normally self-limited in children, they may be difficult to treat in adults. Longer periods of treatment are usually necessary for adults.
Codes
ICD10CM:
B07.8 – Other viral warts
SNOMEDCT:
240539000 – Flat wart
B07.8 – Other viral warts
SNOMEDCT:
240539000 – Flat wart
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Around the eye:
- Common wart – Can appear around the eyes, may have filiform appearance.
- Seborrheic keratosis
- Actinic keratosis
- Molluscum contagiosum – The lesions of molluscum contagiosum are commonly found in children like flat warts, but they are typically more raised (dome-shaped) and appear umbilicated.
- Epidermodysplasia verruciformis – A genetic disorder characterized by diffuse flat warts and a high potential for squamous cell carcinoma transformation. Consider this when evaluating a patient with diffuse flat warts. Evaluate for a family history.
- Syringoma – Flesh-colored papules around the eyes.
- Trichilemmoma
- Trichoepithelioma
- Hidrocystoma (see apocrine hidrocystoma, eccrine hidrocystoma)
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References
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Last Reviewed:04/02/2018
Last Updated:04/19/2018
Last Updated:04/19/2018

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Flat wart - External and Internal Eye
See also in: Overview