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Periungual wart - Nail and Distal Digit
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Periungual wart - Nail and Distal Digit

Contributors: Shari Lipner MD, PhD, Bertrand Richert MD, Robert Baran MD, Susan Burgin MD
Other Resources UpToDate PubMed


Warts are infections of the epidermis with human papillomavirus (HPV). Warts that involve the periungual skin or subungual area are typically associated with HPV subtypes 1, 2, 4, 27, and 57. Butcher's warts may also affect the nail apparatus and are due to HPV 2 and 7. Warts are the most common nail tumor and affect fingernails more frequently than toenails. Warts are spread by human contact or indirectly via fomites on surfaces. Infection is more likely to occur when the skin is macerated or traumatized.

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.


B07.8 – Other viral warts

43021004 – Periungual wart

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Last Reviewed:05/13/2018
Last Updated:06/20/2018
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Patient Information for Periungual wart - Nail and Distal Digit
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Contributors: Medical staff writer


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.


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.
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Periungual wart - Nail and Distal Digit
A medical illustration showing key findings of Periungual wart : Hyperkeratotic cuticle, Nail fold tumor, Periungual fingers, Verrucous scaly papule
Clinical image of Periungual wart - imageId=1667003. Click to open in gallery.  caption: 'Verrucous papules at the proximal and lateral nailfold.'
Verrucous papules at the proximal and lateral nailfold.
Copyright © 2023 VisualDx®. All rights reserved.