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Verrucae

What is it, how to treat?

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Plantar wart

  • Cutaneous warts are small, rough growths that are caused by infection of keratinocytes with human papilloma virus (HPV). They can appear anywhere on the skin but are commonly seen on the hands and feet.

    • A verruca (also known as a plantar wart) is a wart on the sole of the foot.

  • Warts may clear spontaneously at any time, or persist for years. Prognosis varies from person to person and resolution is usually more rapid in children.

  • Benign warts in immunocompetent people almost never undergo malignant change.

  • Although warts can be cosmetically unsightly, they are not harmful, usually do not cause symptoms, and most resolve without treatment.

  • Advice should be offered on reducing the risk of transmission and limiting personal spread of warts. 

Causes and treatment

  • Cutaneous warts are common and can occur at any age, but are unusual in infants and very young children.

    • Incidence is thought to increase during school years reaching a peak in adolescence and early adulthood before declining in later adulthood.

  • Warts are usually spread by direct skin-to-skin contact, or indirectly via contact with contaminated floors or surfaces (for example in swimming pools or communal washing areas).  

  • Treatment should be considered if a wart is painful, cosmetically unsightly, persistent, or the person requests treatment.

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Presentations

  • Warts are diagnosed from their typical appearance:

    • Common warts are firm and raised with a rough surface that resembles a cauliflower (common on knuckles, knees, and fingers).

    • Periungual warts are common warts around the nails that can be painful and disturb nail growth — nail biting is a risk factor.

    • Plane warts are usually round, flat-topped, and skin coloured or greyish yellow (common on the backs of hands).

    • Filiform warts have a finger-like appearance and may have a stalk (more common on the face and neck).

    • Palmar and plantar warts grow on the palms and the soles of the feet (verrucae). They often have central dark dots (thrombosed capillaries) and may be painful.

    • Mosaic warts occur when palmar or plantar warts coalesce into larger plaques on the hands and feet.

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