Flat wart in Adult
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Synopsis
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 fomites. 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. Widespread or extensive warts are often presenting signs of an immunocompromised state. Warts may be more numerous and more difficult to treat in immunocompromised patients. Excessive sun exposure can lead to exacerbation.
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
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Common wart
- Seborrheic keratosis
- Actinic keratosis
- Lichen planus
- Lichen nitidus
- Molluscum contagiosum
- Epidermodysplasia verruciformis – A genetic disorder characterized by diffuse flat warts and a high potential for squamous cell carcinoma transformation. Consider this diagnosis when evaluating a patient with widespread flat warts.
- Multinucleate cell angiohistiocytoma
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Therapy
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References
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Last Reviewed:04/02/2018
Last Updated:04/19/2018
Last Updated:04/19/2018
Patient Information for Flat wart in Adult
Overview
Warts are growths of the skin and mucous membranes (the mouth or genitals) that are caused by over 100 types of the human papillomavirus (HPV). The virus causes thickening of the top skin layer. Flat warts tend to stay small in size but can be numerous in quantity. They are usually painless and go away on their own, sometimes taking a few months to resolve (but can take up to 2 years).Warts are usually acquired from person-to-person contact. The virus is not highly contagious but can cause an infection by entering through a small break in the skin. In the same way, warts can be spread to other places on your own body. The virus is rarely transferred by touching an object used by an infected person.
Who’s At Risk
Warts can affect people of any age, but they are most common in those between 12 and 16 years old. It is estimated that 20% of schoolchildren and about 10% of the general population have warts. Those with HIV or organ transplants or on chemotherapy have a higher incidence of warts because of their weakened immune system.Signs & Symptoms
The most common locations for flat warts include:- Face, especially in children
- Legs, especially in women
- Beard area, especially in men
- Backs of hands
- Arms
Infection with flat warts can be described as:
- Mild - one or a few painless warts
- Moderate - 10-100 lesions, which are painless
- Severe - more than 100 lesions, which cause enough pain to limit normal life activities
Self-Care Guidelines
Because warts can resolve on their own, it is not necessary to treat all warts. Additionally, treating warts may not always destroy them, nor will it necessarily keep other warts from appearing. Treatment can be painful and cause scars and might need to be repeated, so it should only be done in cases where the warts are highly bothersome or interfere with daily life.- Over-the-counter wart removers have a high percentage of salicylic acid and work by dissolving away the layer of skin infected with the virus. This needs to be used daily and can sometimes be irritating if it touches unaffected skin around it.
- Duct tape applied daily to the affected area seems to work for unknown reasons. The tape should be very sticky and kept on for a few days.
- Over-the-counter freezing medications are available but have not been found to be very effective.
- Coupled with the above therapies, the wart should be soaked in warm water, and any loose skin should be removed every few days with a mild abrasive, like a pumice stone.
- Family members should avoid sharing personal items such as towels.
When to Seek Medical Care
Make an appointment with a dermatologist or another physician if you have:- Painful or bleeding warts
- Warts on the face
- Rapidly spreading or multiplying warts
- Warts that interfere with daily life and are not responsive to self-care
Treatments
Once you have been diagnosed with flat warts, your physician may try one or more of the following treatments:- Freezing with liquid nitrogen (cryosurgery)
- Burning with an electric needle (electrocautery)
- Using a laser to disrupt the blood supply of the warts
- Application of cantharidin, podophyllin, tretinoin, or salicylic acid
- Injection with bleomycin, a chemotherapy drug, directly into the warts
- Application of imiquimod, a cream that induces your immune system to destroy the wart
References
Bolognia, Jean L., ed. Dermatology, pp.1223, 1226-1227. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.2121, 2123-2124, 2128-2129. New York: McGraw-Hill, 2003.
Flat wart in Adult
See also in: External and Internal Eye