Verruca Vulgaris


I. Pathophysiology

A. Verruca vulgaris warts are benign, usually self-regressing papilloma of the skin and adjacent mucous membranes caused by the human papilloma virus (HPV).

B. The peak incidence of warts occurs during the second decade of life, with about 10% of teenagers having them.

C. Warts can occur at every location on the skin, but warts in different locations often assume different appearances:

1. Plantar or mosaic warts on the soles are hyperkeratotic.

2. Common warts on the hands have a dome shape and velvety surface.

3. Flat warts occur over the face, arms, or around the knees.

4. Anogenital warts, called condylomata acuminata, occur on the genitalia or anorectal area.

5. Buschke-Lowenstein tumor or verrucous carcinoma appears as a persistent, large wart of the foot or anogenital region; it can become malignant.

II. Differential Diagnosis

A. Molluscum contagiosum is a shiny, dome-shaped, papilla. It can be differentiated from a wart by its umbilicated center.

B. Calluses can look like warts, but they lack the thrombosed punctate capillaries of warts.

III. Treatment of Verruca Vulgaris

A. Cryotherapy and Chemical Agents

1. Chemicals such as cantharidin or liquid nitrogen are favored over electrodesiccation which can scar. Cryosurgery with liquid nitrogen should freeze the wart and about 1 mm of surrounding tissue.

2. Over-the-counter Wart Preparations. Mediplast is for plantar use and salicylic acid plaster for home use.

3. Prescription Wart Preparations. Duofilm, Occlusal, OcclusaI-HP, Podofilox (Condylox), Viranol (gel), cantharidin alone or in combination (Cantharone, Cantharone Plus, Verrusol).

4. Trans-Ver-Sal: Salicylic acid 15%, apply at night and remove the following morning.

B. Vaccines prepared from wart tissue are not advisable because of the oncogenicity of HPV.