Diagnosis: Flat warts (verruca plana)
A 15-year-old male presents with multiple skin-colored flat-topped papules on his right cheek, persisting for several months. The lesions are asymptomatic but cause cosmetic concern, prompting evaluation by a dermatologist.
The patient is a 15-year-old male with a 6-month history of multiple skin-colored, flat-topped papules located predominantly on the right cheek. The lesions are smooth and slightly elevated, measuring approximately 1-3 mm in diameter. The patient reports no associated symptoms such as itching or pain but expresses concern regarding their appearance.Location: Right cheek, with some lesions extending to the periorbital area.Number of lesions: Approximately 10-15 discrete papules.Surface texture: Smooth, flat-topped, and well-defined borders.Skin color: Skin-colored, with no erythema or scaling.Other findings: No signs of inflammation or secondary infection.
The lesions began insidiously approximately 6 months prior to presentation, with no known triggering events. The patient denies any history of trauma to the area or prior dermatologic treatments. There is no significant past medical history, and he has no known allergies. Family history is unremarkable for dermatologic conditions. The patient is otherwise healthy and participates actively in sports.Onset: Gradual onset over 6 months.Triggers: No known triggers or preceding injuries.Prior treatments: No previous treatments attempted.Past medical history: No significant medical issues.Family history: No family history of similar skin lesions.
Acute / First-Line ManagementTopical salicylic acid: Apply 15-40% solution daily to affected areas, with occlusion as needed, for up to 12 weeks.Topical imiquimod: Apply 5% cream three times weekly for up to 16 weeks as an alternative treatment.Cryotherapy: Liquid nitrogen application for 10-30 seconds, repeated every 2-3 weeks as necessary.Workup and Diagnostic ConfirmationClinical diagnosis: Diagnosis is primarily clinical based on characteristic appearance and patient history.Histopathology: Biopsy is rarely necessary but may show koilocytic changes if performed.Long-Term ManagementFollow-up: Monitor for resolution or recurrence at 3-6 month intervals.Patient education: Inform the patient about the benign nature of the lesions and the potential for spontaneous resolution.Psychosocial support: Address cosmetic concerns and reassure regarding the benign prognosis.
Seborrheic keratosis: Typically presents as well-defined, waxy lesions with a stuck-on appearance, more common in older individuals.Keratosis pilaris: Characterized by small, rough papules, often on extensor surfaces, associated with dry skin.Acne vulgaris: Can present with papules or comedones but is usually accompanied by inflammation and pustules.Atopic dermatitis: May present with papules in flexural areas, often associated with pruritus and a history of atopy.Basal cell carcinoma: Rarely presents as flat lesions in young patients; typically has a pearly appearance and may exhibit telangiectasia.Actinic keratosis: More common in sun-exposed areas of older individuals; presents as scaly, erythematous lesions.Condyloma acuminatum: Genital warts that can also appear in other areas; typically have a cauliflower-like appearance.
High-Yield PearlsCommonality: Flat warts are particularly prevalent in adolescents and young adults due to increased exposure to HPV.Diagnosis: The diagnosis is typically clinical; histopathological confirmation is rarely required.Treatment options: Multiple first-line treatments are available, including topical therapy and cryotherapy, depending on patient preference and lesion burden.Recurrence: Warts can recur after treatment; patient education regarding this possibility is essential.Spontaneous resolution: Many flat warts resolve spontaneously over time, particularly in younger patients.Flat warts are benign lesions caused by HPV, most commonly affecting adolescents and often resolving spontaneously.
Tags: flat warts, verruca plana, pediatric