FFinalistSouthampton · 2027
Dermatology
AKT · Dermatology/Infections & infestations

Cutaneous warts

Human papillomavirus (HPV) — keratinocyte infection

Overview

Benign epidermal proliferations caused by human papillomavirus. Common warts (firm hyperkeratotic papules on hands), plantar warts/verrucae (inward-growing, painful on pressure), and plane warts (flat). Most are self-limiting and resolve over months to a couple of years, especially in children.

Recognise

  • Common wart: firm, rough, hyperkeratotic papule, often on hands/fingers, with thrombosed capillaries seen as black dots
  • Verruca (plantar): grows inward, painful on weight-bearing, interrupts skin lines (vs a corn)
  • Plane warts: small flat skin-coloured papules, often face/dorsum of hands; Koebnerises along scratch lines

Red flags

  • Atypical, rapidly growing, bleeding or non-healing "wart" in an adult → consider SCC (biopsy); immunosuppression → numerous/persistent warts

Differentials & how to tell them apart

Corn/calluspreserves skin lines, no thrombosed capillaries, over a pressure point
Squamous cell carcinomaan enlarging, bleeding, non-healing keratotic lesion in older/sun-damaged skin — biopsy
Molluscum contagiosumumbilicated dome-shaped papules, poxvirus, not hyperkeratotic
Seborrhoeic keratosis"stuck-on" warty plaque in older adults, not HPV

Clinical image

We can't host this one — the image is DermNet's and their licence doesn't cover us republishing it. Their page for it is free to view.

Cutaneous warts — clinical imagesDermNet

Investigations

Clinical diagnosis. Paring a verruca reveals thrombosed capillaries (black dots) and interrupted dermatoglyphics (a corn preserves them).

Management

Reassure (many self-resolve) ± topical salicylic acid as first-line treatment

  1. 1Reassure that most warts clear spontaneously (especially in children). If treatment is wanted → topical salicylic acid daily (with paring) over weeks to months.Gate: A solitary, enlarging, bleeding or non-healing keratotic lesion in an older/sun-damaged or immunosuppressed patient is NOT simply a wart → biopsy to exclude squamous cell carcinoma
  2. 2Persistent → cryotherapy (often combined with salicylic acid); refractory/extensive or immunosuppressed → specialist options.
Topical salicylic acid — first-line — daily application with paring; weeks to months
Cryotherapy (liquid nitrogen) — alternative/adjunct, repeated every few weeks
No treatment — reasonable — most resolve spontaneously, especially in children

Key points

Genital warts (condylomata acuminata, HPV 6/11) are managed via sexual health (see the GUM page). A "wart" that bleeds and will not heal in sun-damaged skin is SCC until proven otherwise.

Monitor & prognosis

Resolution over months; review atypical lesions.

Most resolve within 2 years; treatment shortens the course.

Source: NICE CKS Warts and verrucae; DermNet