Common wart in Adult
Verruca manifest as skin-colored, hyperkeratotic papules. They may be pruritic, and scratching can produce a linear array of lesions via autoinoculation. Verruca vulgaris lesions are more prevalent in children and in immunocompromised patients; widespread, persistent lesions may be a clue to an underlying inherited or acquired immunodeficiency.
For unknown reasons, the incidence of common warts is approximately twice as high in White patients as in individuals of African descent and 10 times more common in Hispanic patients than individuals of African descent. In persons of African descent, the majority of warts are solitary, while most Hispanic patients present with multiple warts.
Immunocompromised patients often demonstrate larger confluent verruca that are more resistant to standard therapies. The presence of warts per se is not a reason for expensive immunological testing, however.
B07.8 – Other viral warts
57019003 – Verruca vulgaris
Differential Diagnosis & Pitfalls
- Seborrheic keratosis – Has a characteristic "stuck-on," waxy appearance.
- Clavus / corn – A painful hyperkeratotic lesion with a central core that lacks the pinpoint thrombosed capillaries and retains normal skin dermatoglyphics. Clavi occur in sites of pressure and repeated friction.
- Foreign body reaction – May have a history of trauma or inoculation.
- Molluscum contagiosum – Lesions are smooth, dome-shaped papules with a central umbilication.
- Actinic keratosis – Tends to be a scaly, erythematous papule on sun-exposed areas of elderly individuals.
- Lichen planus – Lesions are typically more planar, violaceous, and pruritic.
- Keratoacanthoma – Has a central keratin crater.
- Squamous cell carcinoma – Can arise in preexisting warts and may be recalcitrant to therapy.
- Prurigo nodularis – Characterized by pruritic papules and nodules.
- Perforating folliculitis – Tends to be follicularly based with a central core.
- Cutaneous horn – Can arise from warts, hypertrophic actinic keratoses, seborrheic keratoses, and squamous cell carcinomas.
- Lichen nitidus – Characterized by discrete, dome-shaped papules.
Drug Reaction Data