Nongenital cutaneous warts are commonly seen in general practice with an overall prevalence of 7–10% and a peak age of presentation of 12–16 years old. They are most commonly found on the hands and feet but can also be found on the face, eyelids and toe. The most common causative agent is human papilloma virus (HPV). Without treatment, ⅓ of cutaneous warts will resolve spontaneously within 3 months and ⅔ within 2 years.
There are various types of warts. Warts are benign lesions, non-cancerous growth on your skin surface. Warts are very common in many infected lives. There are 5 main types of warts:
1. Common warts (aka verruca vulgaris)
A raised wart with roughened surface, most common on hands, but can grow anywhere on the body such as the fingers, elbows, knees, or the face. Also known as a Junior wart or Palmer wart. Usually it will be grayish-yellow or brown in color.
2. Foot warts (aka plantar warts)
Usually hard, painful, small calluses often with multiple black specks in the center of the warts; can be found on pressure points on the soles of the feet.
3. Flat warts
It is small, smooth and flattened surface, flesh-coloured, which can occur in large numbers; most common on the face, hands, neck, wrists and knees.
4. Filiform warts
It is a projection of finger-like wart, which can be found on the facial region on the lip and eyelids.
5. Genital warts
A cauliflower structure warts on genital region.
It typically starts with a minor breach in the epithelial surface, HPV enters the epithelial cells via putative surface receptors and proliferates. This results in persistent viral infection with metaplasia of keratinocytes, which gradually accumulate keratohyalin granules and are sloughed off. As these virally infected keratinocytes are not destroyed, the HPV virions are rarely exposed to the Langerhans cells of the skin, and therefore evade being cleared by systemic immunity. This facilitates the viral persistence and continual growth of the wart.
Type of warts for different strain of HPV:
| Common warts | types 2 and 4 (most common); also types 1, 3, 26, 29, and 57 and others. |
| Cancers and genital dysplasia | 16, 18 (cause the most cervical cancer); also 31, 33, 35, 39, 45, 52, 58, 59, and others. |
| Plantar warts | type 1 (most common); also types 2, 3, 4, 27, 28, and 58 and others. |
| Anogenital warts (condylomata acuminata or venereal warts) | types 6 and 11 (most common); also types 42, 44 and others. |
| flat warts | types 3, 10, and 28 |
| Butcher’s warts (meat handling professionals) | type 7 |
Choice of treatment:
- Salicylic acid
- Liquid nitrogen cryotherapy
- Intralesional MMR vaccine
- Topical imiquimod
- Duct tape
- Laser (CO2 and YAG)
- Electrosurgery (electrodessication, electrocoagulation and cautery)
- Surgical excision
