Therapeutics in Dermatology
A reference textbook in dermatology

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12 July 2012, by PENSO-ASSATHIANY D.

Warts (verrucae vulgaris) are benign tumors on the skin caused by infection with Human Papilloma Virus (HPV). There are about 120 subtypes of HPV which determine the clinical appearance and site of the wart: common warts, condyloma acuminata or anogenital warts, mucosal warts and a very particular clinical picture known as verruciform epidermodysplasia. This chapter will only deal with common warts, which can occur anywhere on the body, but mainly on the hands, feet and face.

The different varieties of HPV warts are described by their shape (exophytic, known as common warts or verrucae vulgaris, plane, filiform, myrmecia, mosaic) and also by their location (plantar, digital, genital, periungual, etc.). In difficult cases, histology and PCR can help establish the clinical diagnosis.

Warts can occur at any age but are most common in children and young adults, with an estimated incidence of 10%. They are even more frequent in certain settings such as renal transplantation, where the incidence reaches 40%. Atopy also appears to be an important predisposing factor [1]. Warts are spread primarily by human to human transmission and the virus enters the body through microscopic broken skin. Transmission at swimming pools and gyms appears less frequent than within families [2]. Some occupations such as butchers and fishmongers have a higher prevalence.

Warts are benign lesions which may be painful when pressure is applied, but the main problem they pose is a cosmetic one. Spontaneous regression of warts, which must be kept in mind when choosing a treatment and when interpreting clinical trials, is quite variable. Approximately 65% of adults will lose their warts within two years, with 42% cured within two months and 53% within six months [3]. Approximately 10% of warts are resistant, meaning that they persist for more than two years.

The natural course of a wart is to spontaneously regress. This, together with the benign nature of the lesion, should always be kept in mind in order to prevent physicians from prescribing treatments that are more harmful or restrictive than the wart itself, especially since there is no method currently available that can completely eradicate the virus, thus explaining the high frequency of recurrence or incomplete removal [4].

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