Common warts, also known as verrucae vulgaris, are caused by human papillomavirus infection and affect most people during their lifetimes. They are most common in children and young adults.
Common warts should be distinguished from serious conditions that mimic them, such as squamous cell carcinoma, especially in immunocompromised patients.
The goals of treatment are to destroy the lesion, induce cytotoxicity against infected cells, and promote antiviral immune responsiveness to prevent recurrence.
Best outcomes are achieved with a combination of destructive and immune sensitization approaches.
Most common warts in healthy people resolve spontaneously. Clearance rates in children from time of diagnosis to clearance are 23% at 2 months, 30% at 3 months, 65% to 78% at 2 years, and 90% at 5 years.
History and exam
Key diagnostic factors
- presence of risk factors
- lesion growth over weeks to months
- round, raised papule
- tiny black dots on surface of lesion
Other diagnostic factors
- satellite lesions
- fingers or nail fold lesions
- facial lesions
- grayish-white or light brown color
- filiform papule with sharp spikes
- water immersion
- occupations involving handling of meat or fish
- nail biting
- age under 35 years
1st investigations to order
- no initial test
Investigations to consider
- skin biopsy
- immunoperoxidase stain
- skin culture
common wart: immunocompetent
common wart: immunocompromised
- Flat warts
- Palmoplantar warts
- Seborrheic keratosis
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