Verruca Vulgaris

Common Warts — Benign epidermal proliferation caused by Human Papillomavirus (HPV) infection, typically affecting the skin of the hands and fingers.

Aetiology

• Caused by HPV (most commonly type 2, less often types 1, 4, 27, 57)

• Transmission:
• Direct skin-to-skin contact
• Indirect contact via contaminated surfaces
• Autoinoculation (scratching or biting nails spreads lesions)

• Immunosuppression

• Skin trauma/abrasions

• Moist environments (pools, lockers)

Pathophysiology

• Virus enters through microabrasions in the skin.

• Infects basal keratinocytes.

• Promotes proliferation → hyperkeratosis, acanthosis, papillomatosis.

• Forms exophytic growth with a rough, verrucous surface.

Clinical Presentation

• Firm, rough, hyperkeratotic papules or nodules

• Irregular, dome-shaped surface

• Common on hands, fingers, periungual area, knees, elbows

• Black dots (thrombosed capillaries) visible after paring

• Usually painless unless located on pressure areas

• Periungual warts – around nails, may distort nail

• Filiform warts – fingerlike projections often on face/neck

• Plantar warts – on soles, painful due to inward growth (HPV 1)

Investigations

• Dermoscopy: red/black dots (dilated capillaries)

• Biopsy (rare) → shows papillomatosis, hyperkeratosis, koilocytosis

Management

1. Topical keratolytic
• Salicylic acid 10–40% (first line, daily application)

2. Cryotherapy with liquid nitrogen
• Every 2–3 weeks for several sessions

3. Electrocautery or curettage
• For resistant lesions (risk of scarring)

4. Laser therapy (CO₂ or pulsed dye)

5. Immunotherapy for recalcitrant cases
• Intralesional Candida antigen
• Imiquimod cream
• Topical 5-FU

6. Duct tape occlusion therapy (home remedy with some efficacy)