skin health

Symptoms Warts

Related articles: Warts

Definition

Warts are skin lesions of viral origin. In particular, they represent the consequence of epidermal infections caused by some human papillomavirus (HPV) strains.

Warts differ in clinical appearance, affected body site and responsible viral strain. Common (or vulgar), plantar, flat, filiform, mosaic, periungual and genital warts can be distinguished.

Warts can appear on any part of the body. Their transmission occurs by direct contact or by self-inoculation. The virus penetrates even through minimal abrasions of the epidermis. Trauma and skin maceration facilitate initial inoculation. Favorable conditions for the survival of the virus in active form are created in highly frequented places, where the climate is hot and humid (eg showers, gyms and swimming pools). Warts affect children most often, while they are unusual in the elderly. Their diffusion is influenced by local and systemic immunological factors.

Most common symptoms and signs *

  • Nodule
  • papules

Further indications

Common warts (vulgar warts) are asymptomatic benign lesions; they can cause a slight pain only when they are located on a surface subject to load (eg sole of the foot).

Common warts have the appearance of detected nodules, with a rough surface and a solid consistency. They are lesions with a diameter of about 2-10 mm, greyish, yellow or brown. The shape of the warts can be roundish, with clearly delimited margins, or irregular (for example, they can be pedunculated or similar to cauliflower). They appear more frequently in areas prone to trauma, especially on fingers, elbows, knees and face.

The flat warts are small smooth, flat or slightly raised papules, yellow-brown in color. Most often they are located on the face and back of the hands. Flat warts are usually asymptomatic, but can be particularly stubborn to treat.

Palm and plantar warts, instead, they are flattened and surrounded by horny epithelium (they are similar to callosities). They are located on the palms of the hands and on the soles of the feet and can be distinguished from the calluses because of their tendency to bleed if the surface is removed. Often, they cause pain, hampering dembulation.

Genital warts are usually asymptomatic; they appear as distinct papules, with a smooth surface - velvety and flat base, located in the perineal, perirectal, labial and penile areas.

Filiform warts are long and narrow growths, usually located on the face and neck.

Mosaic warts are painful plaques formed by the confluence of small plantar warts, very close together.

Finally, periungual warts arise around the nail bed. They have a cauliflower appearance, with thickened and fissured skin.

The diagnosis of warts is based on the clinical aspect. Rarely, a biopsy is required. The differential diagnosis is compared to horns and corns, lichen planus, seborrheic keratoses and squamous cell carcinomas. A fundamental sign to distinguish warts is the absence of cutaneous lines transversal to the surface. Moreover, they can present at the apical end of the dark dots that represent the thrombosed capillaries due to the stretching of the papillae.

Many warts regress spontaneously; others persist for years or recur. The treatment involves different approaches, such as excision, cauterization, cryotherapy, electrocoagulation and laser therapy. Furthermore, it is possible to use topical drugs (eg salicylic acid, trichloroacetic acid, tretinoin, cantharidin, etc.) or injectables.