Viral warts are common skin growths caused by human papillomavirus (HPV) infection. There are over 100 subtypes of HPV that can cause warts. HPV enters the superficial layers of the epidermis and causes overgrowth of skin cells, forming the wart. Warts are transmitted through direct skin contact. They most often appear on hands and feet but can also affect mucous membranes. Warts are generally diagnosed based on their appearance and may be confirmed via biopsy. Treatment options include topical salicylic acid or cryotherapy to remove the warts.

1. HPV

2. Viral Warts
◦ A viral wart is a very common growth of the skin caused by infection with
human papillomavirus (HPV). A wart is also called a verruca,
and warty lesions may be described as verrucous.
◦ Warts are due to infection by the human papillomavirus (HPV),
a DNA virus. More than 100 HPV subtypes are known, giving rise to a
variety of presentations. Infection occurs in the superficial layers of
the epidermis, causing proliferation of the keratinocytes (skin cells)
and hyperkeratosis — the wart. The most common subtypes of HPV are
types 2, 3, 4, 27, 29, and 57.
◦ HPV is spread by direct skin-to-skin contact or autoinoculation. This
means if a wart is scratched or picked, the viral particles may be spread to
another area of skin. The incubation period can be as long as twelve
months.

3. Etiology
◦ Warts are due to infection by the human papillomavirus (HPV),
a DNA virus. More than 100 HPV subtypes are known, giving rise to a
variety of presentations. Infection occurs in the superficial layers of
the epidermis, causing proliferation of the keratinocytes (skin cells)
and hyperkeratosis — the wart. The most common subtypes of HPV
are types 2, 3, 4, 27, 29, and 57.
◦ HPV is spread by direct skin-to-skin contact or autoinoculation. This
means if a wart is scratched or picked, the viral particles may be spread
to another area of skin. The incubation period can be as long as twelve
months.

4. Clinical features
◦ Cutaneous warts have a hard, keratinous
surface. A tiny black dot may be observed in
the middle of each scaly spot, due to
an intracorneal haemorrhage.
◦ Common wart
◦ Common warts present as papules with a
rough, papillomatous and hyperkeratotic surfa
ce ranging in size from 1 mm to larger than 1
cm. They arise most often on the backs of
fingers or toes, around the nails—where they
can distort nail growth—and on the knees.
Sometimes they resemble a cauliflower; these
are known as butcher’s warts.

5. ◦ Mucosal wart
◦ Oral warts can affect the lips
and even inside the cheeks,
where they may be
called squamous cell papillo
mas. They are softer than
cutaneous warts. See
also anogenital warts.

6. Diagnosis
◦ Pinpoint dots (clotted capillaries) are
revealed when the top of the wart is
removed.
◦ A dermatoscopic examination is
sometimes helpful to distinguish viral
warts from other verrucous lesions
such as seborrhoeic keratosis and skin
cancer.
◦ Sometimes, viral warts are diagnosed
on skin biopsy.
The histopathological features of
verruca vulgaris differ from that

7. Treatment
◦ Topical treatment includes wart paints containing salicylic acid or similar
compounds, which work by removing the dead surface skin cells.
◦ The paint is applied once daily. Treatment with wart paint usually makes the wart
smaller and less uncomfortable; 70% of warts resolve within twelve weeks of daily
applications.
◦ Soften the wart by soaking in a bath or bowl of hot soapy water.
◦ Rub the wart surface with a piece of pumice stone or emery board.
◦ Apply wart paint or gel accurately, allowing it to dry.
◦ Cover with plaster or duct tape.
◦ If the wart paint makes the skin sore, stop treatment until the discomfort has
settled, then recommence as above. Take care to keep the chemical off normal
skin.
◦ Cryotherapy

8. Condyloma acumitatum
◦ Condyloma acuminatum is the name given
to anogenital warts. They are usually
sexually transmitted and are caused by
human papillomavirus (HPV).
◦ As anogenital warts are sexually acquired
during close skin contact, they are most
commonly observed in young adults
between the ages of 15 and 30 years. They
are highly contagious, and occur in equal
numbers in unvaccinated males and
females. However, they are rare in people
that have been vaccinated against HPV in
childhood before beginning sexual activity.

9. Clinical features
◦ An anogenital wart is a flesh coloured papule a few
millimetres in diameter. Warts may join together to
form plaques up to several centimetres across.
◦ They may occur in the following sites: Vulva , Vagina
, Cervi , rethra , PeSc , Scrotum , Anus.
◦ Warts due to the same types of HPV can also
arise on the lips or within the oral mucosa.

10. Treatment
◦ Genital warts are usually diagnosed clinically.
◦ Biopsy is sometimes necessary to confirm the diagnosis or viral wart or to
diagnose an associated cancer.
◦ The primary goal of treatment is to eliminate warts that cause physical or
psychological symptoms such as: Pain , ,Bleeding , Itch , Embarrassment.
Options include:
◦ No treatment
◦ Self-applied treatments at home
◦ Treatment at a doctor's surgery or medical clinic.

11. Warning!
◦ The HPV types that cause external visible warts (HPV Types 6 and 11)
rarely cause cancer. Other HPV types (most often Types 16, 18, 31, 33
and 35) are less common in visible warts but are strongly associated
with anogenital cancer,
◦ HPV also causes some cases of oral and nasopharyngeal cancer.
◦ Only a small percentage of infected people develop genital cancer. This
is because HPV infection is only one factor in the process;
cigarette smoking and how well the immune system is working are also
important.