dermatologic disorders
Warts
Symptoms and Signs of Warts
Warts are named by their clinical appearance and location; different forms are linked to different HPV types (for unusual manifestations, see table). Most types are usually asymptomatic. However, some warts are tender, so those on weight-bearing surfaces (eg, bottom of the feet) may cause mild pain. Common warts (verrucae vulgaris) are caused by HPV types 1, 2, 4, and 7 and occasionally other types in immunosuppressed patients (eg, 75 to 77). They are usually asymptomatic but sometimes cause mild pain when they are located on a weight-bearing surface (eg, bottom of the feet). Common warts are sharply demarcated, rough, round or irregular, firm, and light gray, yellow, brown, or gray-black nodules 2 to 10 mm in diameter. They appear most often on sites subject to trauma (eg, fingers, elbows, knees, face) but may spread elsewhere. Variants of unusual shape (eg, pedunculated or resembling a cauliflower) appear most frequently on the head and neck, especially the scalp and beard area. These warts are caused by HPV types 1, 2, and 4. They occur on the palms and soles. Palmar and plantar warts are flattened by pressure and surrounded by cornified epithelium. They are often tender, and plantar warts can make walking and standing uncomfortable. They can be distinguished from Calluses and Corns by their tendency to pinpoint bleeding when the surface is pared away. Flat warts are caused by HPV types 3 and 10 and occasionally 26 to 29 and 41. They are more common among children and young adults and develop by autoinoculation. These warts are smooth, flat-topped, yellow-brown, pink, or skin-colored papules, most often located on the face and along scratch marks. They generally cause no symptoms but are usually difficult to treat. Mosaic warts are plaques formed by the coalescence of myriad smaller, closely set plantar warts. As with other plantar warts, they are often tender. These warts are long, narrow, frondlike growths, usually located on the eyelids, face, neck, or lips. They are usually asymptomatic. This morphologically distinct variant of the common wart is benign and easy to treat. Periungual warts are caused by HPV types 1, 2, 4, and 7. These warts appear as thickened, fissured, cauliflower-like skin around the nail plate. They are usually asymptomatic, but the fissures cause pain as the warts enlarge. Patients frequently lose the cuticle and are susceptible to Acute Paronychia . Periungual warts are more common among patients who bite their nails or who have occupations where their hands are chronically wet such as dishwashers and bartenders. Human Papillomavirus (HPV) Infection are caused by HPV type 6 or 11 (most commonly) and by types 1a, 2, 4, 7, 16, 18, 27b, 27, 33, 38, 40, 42, 43, 44, 54, 57b, 57c, 61, 72, 81, and 89 ( These warts manifest as discrete flat to broad-based smooth to velvety papules to rough and pedunculated excrescences on the perineal, perirectal, labial, and penile areas. They are usually asymptomatic, but perirectal warts often itch. Infection with high-risk HPV types (most notably types 16 and 18 but also types 31, 33, 35, and 39) is the main cause of Cervical Cancer . This photo shows the typical rough, pedunculated appearance of genital warts on the glans. © Springer Science+Business Media This photo shows pink and raised genital warts (arrows) at the coronal sulcus of the penis. © Springer Science+Business Media Genital warts on the vulva may be raised and light-colored with an irregular, rough surface. Image courtesy of Joe Millar via the Public Health Image Library of the Centers for Disease Control and Prevention. 1.Al-Awadhi R, Al-Mutairi N, Albatineh AN, Chehadeh W: Association of HPV genotypes with external anogenital warts: A cross sectional study.BMC Infect Dis19(1):375, 2019. doi: 10.1186/s12879-019-4005-4 