Subungual wart - Nail and Distal Digit
Warts involving the nails are fairly common in children. Warts of all kinds reach their peak prevalence in childhood and adolescence. Risk factors include atopic dermatitis, immunosuppression, nail biting, and nail picking.
In adults, warts are especially common among transplant patients and in individuals who are immunosuppressed due to HIV infection, malignancy, or medications. They are also common in adults who do wet work, as well as in nail biters and nail pickers. There is a subset of ungual warts due to HPV 16 and 18 that are at higher risk of transforming into squamous cell carcinoma.
Ungual warts are characterized as periungual, those that occur around the nail unit, or subungual, those that occur beneath the nail unit. A given patient may have both periungual warts and subungual warts. Subungual warts typically present as nodular lesions that uplift the nail plate or as linear growths that penetrate underneath the nail plate, producing a longitudinal band of onycholysis and splinter hemorrhages. Subungual warts may be painful, and the pain may be so severe that it mimics the pain of a glomus tumor. Subungual warts rarely resolve spontaneously.
Complications of ungual warts include bone erosions, spreading to the lips in nail biters, and, rarely, progression to squamous cell carcinoma. Progression to squamous cell carcinoma is more common in immunosuppressed individuals.
B07.8 – Other viral warts
240535006 – Subungual wart
Differential Diagnosis & Pitfalls