Differential diagnoses: Warts

Dr Nigel Stollery compares four types of warts and offers clues for their diagnosis.

Filiform warts

Presentation

  • Long, narrow, protruding warts with finger-like appearance
  • Less common than other forms of viral wart
  • Most commonly found on the head, especially eyelids and lips
  • Caused by HPV types 1, 2, 4, 27 and 29

Management

  • Topical treatment less effective
  • Location often means topical salicylic acid not advisable
  • Small prominent warts can be tied or snipped, but may recur
  • Shave and cautery or cryotherapy are options
  • Given time, lesions often clear without treatment

Seborrhoeic warts

Presentation

  • The most common benign tumour in older patients
  • Incidence increases with age
  • Typical 'stuck on' appearance
  • Variations in colour from white to black
  • No aetiological factors identified, but more common on sun-exposed areas
  • Not contagious
  • Family trait in about half of those affected
  • Occur on any site of the body except palms and soles

Management

  • Treatment not usually required
  • For symptomatic warts, cryotherapy or curettage and cautery are options

Molluscum contagiosum

Presentation

  • Very common in children
  • Often multiple papules with umbilicated centre
  • Contagious and autoinoculation may occur to other areas
  • Worse in children with eczema
  • Caused by the DNA pox virus
  • In adults, may be sexually transmitted

Management

  • Treatment usually ineffective
  • Topical imiquimod may be helpful in severe cases
  • Usually resolves without treatment, but can take months
  • Mean duration of an outbreak is eight to 18 months
  • Treat any eczema with topical steroids to reduce scratching

Common warts

Presentation

  • Affect 7-12% of the population
  • Increased incidence in immunosuppressed individuals
  • Twice as common in white skin, compared to darker skin
  • Occur as nodules with hyperkeratotic surface
  • Most common on the hands
  • Caused by HPV virus

Management

  • Treatment not always required
  • In children, 50% will resolve by six months
  • Overall, 65% will disappear without treatment in two years
  • Options include keratolytics, electrocautery and cryotherapy
  • In severe, persistent cases, bleomycin injections may help

Dr Stollery is a GP in Kibworth, Leicestershire, and clinical assistant in dermatology at Leicester Royal Infirmary

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus