Warts (Verruca Vulgaris)

Key Points

Benign (noncancerous) growths of the skin caused by infection with a virus
Often multiple; vary in appearance and location
Treatment options are numerous because no one type of treatment works well

Warts (verruca vulgares) are universal, caused by infection by viruses from the family of human papilloma virus. They may occur on any part of the body, but predominate on areas typically exposed to repeated minor trauma, such as the hands, feet, knees and elbows. Occurring either singly or more frequently in multiples, they are flesh colored to pink and present with a rough scaly surface. Most people contract wart virus during their youth. They are harmless, although at times may be quite a nuisance because of physical discomfort or objectionable because of their appearance. Untreated,viral Warts may persist for years, but usually do eventually regress. Warts in the groin area are known as condyloma accuminatum or genital warts.

Differential Diagnosis: (Other conditions with similar appearance)
Callouses/corns
Lichen planus
Squamous cell carcinoma

Common Warts are usually easily recognizable, but when located on a palm or sole and covered with thick scale may resemble a callous or corn. The possibility of squamous cell carcinoma should be entertained for a lesion that enlarging, crusted, ulcerated, bleeding or recalcitrant to repeated attempts at therapy. Planar (flat) warts on the face may simulate whiteheads and if present on the forearms, wrists, or legs may mimic lichen planus.

Treatment

Warts are notoriously difficult to treat; this is why there are so many treatment options available. This recalcitrance to therapy is also the reason that so many “alternative” and home remedies exist. When considering therapeutic options, one must keep in mind that Warts are benign, that they will (eventually!) go away on their own, and that some treatments may be associated with the risk of scarring. Typical treatments include:

Cryotherapy (freezing) with liquid nitrogen
Application of slicylic acid at home or in the office
Immunotherapy (Injections directly into the Warts performed in the office designed to stimulate a person’s own immune response against the virus)
Prescription medications applied topically in the office (podophyllum; cantharidin) or at home (imiquomod; flourouracil; tretinoin)
Surgical therapies, including electrodessication and curretage; laser
Injections with bleomycin in the office
Topical immunotherapy/sensitization therapy
Oral cimetidine or vitamin A ( as prescribed by your physician)