Viral Warts Hatlan Alhatlan

211525898

Contents

• Warts • HPV warts • General characteristics• Common warts• Plantar warts • Flat warts• Genital warts • Others • Investigations

Warts

• Warts are benign epidermal neoplasms caused by viruses of the human papillomavirus (HPV) group.

• There are a number of different strains of HPV that produce different clinical types of warts.

• HPV is spread by direct or indirect contact.• Resist desiccation, freezing, and prolonged

storage outside of host cells.• Incubation period 1-6 months,latency up to 3yrs.• Mostly clinically diagnosed• + Pseudokoebner’s phenomenon .

HPV Warts

General Warts Characters

• There are usually little black dots near the surface of the wart, representing thrombosed capillaries in elongated dermal papillae.

• In Immunocompromised, risk for squamous cell carcinoma.

• There is epidermal thickening, with particular increase in the granular cell layer, which also shows a characteristic basophilic stippled appearance.

Common Warts

• These are raised, cauliflower;like lesions that occur most frequently on the hands.

• Common in children + early adulthood.• They may be scattered, grouped or periungual in

distribution.• Common warts in children usually resolve

spontaneously.• Ttt: salicylic acid(12-20%), or lactic acid(4-20%) for

3 months , if no response cryotherapy with liquid nitrogen.

Common Warts

• They appear as hyperkeratotic papules with a rough, irregular surface. They range from smaller than 1 mm to larger than 1 cm.

Plantar Warts

• Plantar warts may be solitary, scattered over the sole of the foot, or grouped together.

• Painful.• Ttt : salicylic acid(12-20%), Lactic acid(4-20%)

or cryotherapy +keratolytics.

Plantar Warts

• They begin as small shiny papules and progress to deep endophytic, sharply defined, round lesions with a rough keratotic surface, surrounded by a smooth collar of calloused skin.

Plane Warts

• These are tiny, flat-topped, flesh-coloured warts which usually occur on the dorsa of the hands and the face.

• They often occur in lines due to inoculation of the virus into scratches and abrasions.

• Difficult to treat, but resolves spontaneously , so better leave it heals.

Plane Warts

• Flat or slightly elevated flesh-colored papules that may be smooth or slightly hyperkeratotic. They range from 1-5 mm or more, and numbers range from a few to hundreds of lesions that may become grouped or confluent.

Genital warts

• Known also as condylomata acuminata.• HPV 6 & 11• Sexually transmitted.• Highly infectious.• No cure , may resolve in its own or ablation

(cryotherapy, excision) and topicals (Podophyllotoxin)

Genital warts

• Soft pink elongated pednculated with moist surface

Other Warts • Butcher's warts:• Raw meat handlers , hands mostly.

• Mosaic warts: • Plaque of closely grouped warts.

When the surface is pared, the angular outlines of tightly compressed individual warts can be seen. (soles +palms)

Other Warts • Filiform warts :• Long slender growths, usually seen

on the face around the lips, eyelids, or nares.

• Focal epithelial hyperplasia (Heck disease)

• HPV infection occurring in the oral cavity.

• Multiple flat-topped or dome-shaped pink-white papules.

• 1-5 mm• Can be plaque

HistopatholgyFindings Wart

1-Digitated epidermal hyperplasia,2-Acanthosis, papillomatosis

3-Compact orthokeratosis4-Hypergranulosis

 5-Dilated dermal tortuous capillaries 

Common Warts

Appear similar to common warts except that most of the lesion lies deeper.

Plantar warts

Resemble common warts on light microscopy but tend to be muted.

Flat Warts

1-Acanthosis ,2-Hyperkeratosis ,

3-Papillomatosis.

Butcher's warts:

As common but with prominent papillomatosis

Filiform warts

hyperplastic mucosa with thin parakeratotic stratum corneum, acanthosis, blunting and anastomosis of rete ridges, and pale cells of epidermis

Heck disease

Sources

1. Nongenital Warts Author: Philip D Shenefelt, MD, MS; Chief Editor:

William D James, MD.2. Lecture notes dermatology , 10th edition.3. ROXBURGH’S Common Skin Diseases, 17th

edition.

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