Viral warts
Also called verruca, warts, HPV infection of skin
HPV teaching keratinocytes to overbuild: rough papules with thrombosed capillary dots where the virus keyed into a break in the skin. Self-limited in the immunocompetent, which makes patience a legitimate treatment; stubborn, spreading, or atypical warts change the plan.
How it looks
Multiple hyperkeratotic, dome-shaped papules with a verrucous surface and punctate black capillary dots over the dorsal fingers and periungual folds.
Rose is the lesion, grey the pattern the lesions make, green where on the body it lives.
Across skin tones
Plane warts in deeply pigmented skin present as hyperpigmented flat papules easily confused with other facial papules, and destructive treatments carry a higher price in post-inflammatory dyspigmentation, which shifts the balance toward patience and topical therapy.
Forms & variants
Verruca vulgaris (common wart)
Hyperkeratotic papules with black thrombosed-capillary dots, favouring hands, knees, and periungual skin.
Verruca plana (plane warts)
Subtle, flat-topped, skin-coloured papules in dozens on the face and hand backs, often lining up along scratch marks (Koebner).
Verruca plantaris (plantar warts)
Inward-growing warts on pressure points of the sole, tender on squeezing more than direct pressure; the capillary dots separate them from callus.
Condyloma acuminata (anogenital warts)
Soft papillomatous anogenital papules from low-risk HPV types; vaccination prevents them, and their presence prompts a sexual-health screen.
Symptoms & course
- Usually painless; plantar lesions hurt with walking
- Spread by scratching, shaving, nail-biting, and wet floors
Diagnostic approach
- Clinical; paring reveals capillary dots and erases skin lines, unlike callus
- Biopsy only the atypical, the immunosuppressed, or the treatment-defiant
Differential, and how to separate them
- Molluscum contagiosum
Favours it: Multiple small papules in a child
Against it: Molluscum is smooth, dome-shaped, and umbilicated; warts are rough with capillary dots
- Seborrheic keratosis
Favours it: Warty stuck-on papules
Against it: SKs arrive with age on the trunk and never show thrombosed capillaries
- Squamous cell carcinoma
Favours it: A keratotic acral papule
Against it: A 'wart' that grows, ulcerates, or persists atypically in an older or immunosuppressed patient earns a biopsy, not another freeze
Management principles
- Honest option one: nothing, most resolve within two years in the immunocompetent
- Daily salicylic acid with paring, the best-evidenced active treatment
- Cryotherapy for the motivated; anogenital disease gets its own pathways and a vaccination conversation
Clinical pearl: Squeeze, don't press: a plantar wart hurts on lateral squeeze while a callus hurts on direct pressure, and only the wart interrupts the skin lines.
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