Cutaneous Warts

Question 1

Definition

Answer 1

Benign skin growths typically caused by human papillomavirus (HPV) 2 and 4.
Whereas HPV 6 and 11 cause genital warts

Question 2

Epidemiology

Answer 2

Use of public showers
Close contact with a person with warts
Skin trauma
Immunosupression
Meat handlers
Caucasian ethnicity

Question 3

Pathophysiology

Answer 3

• The virus invades the skin through small cuts or abrasions and causes rapid growth of cells on the outer layer of the skin, leading to the formation of a wart.

Question 4

Classification of warts based on shape and location

Answer 4

• Common warts (verruca vulgaris): papular growth with an irregular contour and surface, mostly seen on the extremities
• Plantar warts (verruca plantaris): often simply termed ‘verruca’, these lesions only exist on the feet
• Flat warts (verruca plana): fleshy warts that may number in the hundred and can occur on the face
• Filiform warts: often termed digitate or facial warts, these long, thin projections typically appear around the eyes or lips.

Question 5

Signs

Answer 5

• Film, rough papules or nodules
• Interrupted skin lines over the warts
• Black dots within the wart: thrombosed capillaries

Question 6

Symptoms

Answer 6

• Often symptomatic
• Occasionally tender, particularly verrucas

Question 7

Diagnosis

Answer 7

Warts are typically diagnosed based on their characteristic clinical appearance:
- Biopsy: rarely needed but can be performed in the diagnosis is unclear or if the wart doesn’t respond to standard treatments.

Question 8

Treatment

Answer 8

FIRST LINE:
- Watchful waiting: warts often resolve spontaneously within months to years due to the immune response, particularly in children
- Topical salicylic acid: first line treatment for cutaneous warts. It works by causing the cells of the wart to shed.
Second line:
- Cryotherapy: this involves freezing the wart with liquid nitrogen and is typically used if topical salicylic acid is ineffective.
- Immunotherapy: topical immunotherapy agents e.g. imiquimod or diphencyprone, may be used for recalcitrant or multiple warts.

Question 9

Complications

Answer 9

• Spread of warts to other areas of the body or to other people
• Pain or discomfort
• Scarring or changes in skin colour following treatment
• Transformation into squamous cell carcinoma: very rare, and occurring in immunosuppressed patients