Periungual wart - Nail and Distal Digit
Alerts and Notices
Synopsis
Warts involving the nails are fairly common in children. Warts of all kinds reach their peak prevalence in childhood and adolescence. Risk factors include atopic dermatitis, immunosuppression, nail biting, and nail picking.
In adults, warts are especially common among transplant patients and in individuals immunosuppressed due to human immunodeficiency virus infection (HIV), malignancy, or medications. They are also common in adults who do wet work, as well as in nail biters and nail pickers. There is a subset of ungual warts due to HPV 16 and 18 that are at higher risk of transforming into squamous cell carcinoma.
Codes
ICD10CM:B07.8 – Other viral warts
SNOMEDCT:
43021004 – Periungual wart
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Periungual callosities
- Acquired digital fibrokeratoma
- Bowen disease (squamous cell carcinoma in situ)
- Squamous cell carcinoma
- Tuberculosis verrucosa (prosector's wart, butcher's nodule)
- Epidermal nevi
- Lichen planus
- Foreign body granuloma
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Management Pearls
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Therapy
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References
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Last Reviewed:05/13/2018
Last Updated:06/20/2018
Last Updated:06/20/2018
Patient Information for Periungual wart - Nail and Distal Digit
Overview
Periungual warts are common warts on and around the fingernails and, less commonly, the toenails. They are usually caused by human papillomavirus that can be spread by contact with infected persons or shared surfaces. The warts may take months to develop after exposure to the virus, and they may go away on their own over a period of months to years. However, there is a chance of the warts enlarging or multiplying. Prompt treatment may minimize spread and facilitate healing.Who’s At Risk
Children and adolescents have the highest incidence of any kind of warts, including warts around the fingernails, some complicated by nail biting.Adults who have had transplant surgery or who have human immunodeficiency virus (HIV) or other immune deficiency disorders may commonly develop warts. People in certain occupations, such as butchers and meat packers, and individuals with systemic skin disorders may have more persistent wart infections that are more difficult to treat.
Signs & Symptoms
Periungual warts look like round or oval, raised, rough, scaly skin lesions around the fingernails. They can occur singly or in groups. You may see tiny dark pinpoint marks, or seeds, on the warts. Watch for warts under the nails, which can damage the nailbed.Self-Care Guidelines
There are a number of self-care remedies available over the counter, such as salicylic acid pads, that can be attempted at home. Since warts are viral and can be spread by human contact, keep hands clean and avoid spread to others.When to Seek Medical Care
If you have concerns about periungual warts interfering with daily functioning, or if your warts are painful or unsightly, contact your physician about medical treatment. Immunocompromised individuals and people with treatment-resistant warts should seek medical care.Treatments
Your health care provider may offer you the option of waiting for natural healing, which often will occur within 1-2 years or longer.Wart removal treatments treatments include salicylic acid, cryotherapy, laser therapy, and others. Individuals with immune disorders may require more aggressive treatment, which may have only limited success.
Your doctor may perform a biopsy on a wart that resists treatment to rule out malignancy.
Periungual wart - Nail and Distal Digit