Diagnosis: Warts
Watercolour drawing of a male patient with a melanotic wart on the left side of his nose. The wart was first noticed six years before admission. It was said to be slowly growing.. Clinical photograph sourced from Wikimedia Commons (CC BY 4.0). Attribution: Godart, Thomas.
Common warts: firm, rough, dome-shaped papules with black dots (thrombosed capillaries). Plantar warts: endophytic, painful with walking. Flat warts: smooth, flat-topped papules on face/hands. Genital warts: soft papillomatous growths.
Immunosuppression increases risk and recalcitrance. Children and young adults most commonly affected. Swimming pools and shared showers are common transmission sites. May spontaneously resolve (65% within 2 years in immunocompetent patients).
First-line: cryotherapy with liquid nitrogen, salicylic acid (OTC). Second-line: imiquimod, cantharidin, intralesional bleomycin, 5-FU. Recalcitrant: pulsed dye laser, immunotherapy (intralesional Candida antigen). HPV vaccination prevents genital and some cutaneous types.
Seborrheic keratosis, Squamous cell carcinoma, Molluscum contagiosum, Callus, Acrochordon
Paring down the surface before cryotherapy improves efficacy. The 'black dots' are thrombosed capillaries, not seeds. HPV vaccination (9-valent) prevents types 6, 11, 16, 18, and others. Always biopsy atypical or resistant warts to exclude SCC.
Tags: warts, verruca, HPV, viral, papilloma