Warts are viral infection caused by human pappiloma virus characterised by papules or plaques in various parts of body

Common Wart

  • HPV types-1,2,4,27 and 57
  • Commonly seen in young children and adults.
  • Meat butchers, frequent immersion of hand in water are risk factors
  • Papules with verrucous surface.
  • Commonest site-Hands
  • (Fingers and palms)
  • Warts do not have dermatoglyphics

Verruca Plana

HPV types-3, 10, 28 and 41

  • Risk factors-sun exposure, swimmers
  • Common sites-Face, lower legs
  • Few milimetres brown or skin coloured flat topped papules
  • Koebnerisation seen

Palmo-Plantar warts

  • HPV types-1, 2, 4, 27
  • Seen at pressure points
  • If paring is done-multiple small black points seen (dilated capillary loops)
  • Myrmecia
  • Mosaic type
  • Differentiate from corn and callosity

Filiform and digitate warts

  • Finger like projection

Periungual warts

  • Seen in nail biters
  • Recalcitrant to treatment

Genital Warts

  • Low risk genital HPV types-6 and 11
  • High risk genital HPV types-16 and 18
  • Condyloma acuminata
  • Few mm to cms in size
  • Lobulated papules usually multifocal, cauliflower like mass may be seen in moist occluded areas
  • Sites- intraurethral in men, mucosal surface of cervix or vulva, perianal skin, vulva
  • Giant Condyloma acuminata (Buschke Lowenstein tumor)
  • Verrucous carcinoma, may invade and metastasize to LN

Bowenoid paulosis

  • Hyperpigmented papules or flat surface
  • HPV types-16,18
  • Sites- Penis, Perianal area, vulva
  • Secondary infection
  • Bleeding
  • Ulceration

Human Papilloma Virus

  • More than 100 types of HPV
  • Genome of HPV-Early genes (E1-E7), Late genes (L1-L2)
  • Avoid shaving over a wart
  • Break the habit of biting your nails or picking at cuticles
  • Dont share towel, washclothes , clothing, nail clippers , razors or other personal items
  • Transmission : direct or indirect contact (nail biters, shaving, occupational, swimming pool)
  • Sexual transmission : genital / perianal wart
  • Autoinoculation

How is it diagnosed?

  • Clinically
  • Histopathology-Papillomatosis, acanthosis
  • DNA hybridisation, Immunohistochemistry

How is it treated?

  • Salicylic Acid, Lactic acid / Salicylic Acid combination
  • Chemical cautery : Podophyllin, TCA (35%-85%)
  • Imiquimod, Green Tea Extract (Sinecatechins), 5FU
  • Cryotherapy
  • Electrocautery
  • Radiosurgery
  • CO2 Laser
  • Newer therapies - Mycobacterium W vaccine, MMR vaccine

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