- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Rachael Morris-Jones, FRCP, PhD, PCME
Rachael Morris-Jones, FRCP, PhD, PCME
- Dermatology Consultant and Associate Clinical Dean
- King's College Hospital and King's College London
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Associate Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Professor of Medicine
- Dell Medical School/University of Texas, Austin
- Ted Rosen, MD
Ted Rosen, MD
- Section Editor — Infections and Infestations
- Professor, Department of Dermatology
- Baylor College of Medicine
Human papillomaviruses (HPV) infect epithelial tissues of skin and mucous membranes. The most common clinical manifestations of HPV infection are warts (verrucae). There are over 150 distinct HPV subtypes; some tend to infect specific body sites. As an example, HPV type 1 commonly infects the soles of the feet and produces plantar warts, while HPV types 6 and 11 infect the anogenital area and cause anogenital warts. (See "Condylomata acuminata (anogenital warts) in adults".)
The clinical findings and management of cutaneous warts will be reviewed here. Anogenital warts (condylomata acuminata) are reviewed separately. (See "Condylomata acuminata (anogenital warts) in adults" and "Treatment of vulvar and vaginal warts" and "Condylomata acuminata (anogenital warts) in children".)
EPIDEMIOLOGY AND TRANSMISSION
Cutaneous warts occur most commonly in children and young adults . They are also more common among certain occupations such as handlers of meat, poultry, and fish. Predisposing conditions for more extensive or recalcitrant involvement include atopic dermatitis and conditions associated with decreased cell-mediated immunity (eg, acquired immune deficiency syndrome [AIDS], organ transplantation) [2,3].
Infection with HPV occurs by direct skin contact, with maceration or sites of trauma (Koebner phenomenon) predisposing patients to inoculation. Latent HPV infection also may occur in normal skin. The reservoir for HPV appears to be individuals with clinical or subclinical infection. Transmission via inanimate objects has been proposed; however, this has not been definitively proven. The incubation period is approximately two to six months.
Spontaneous remission of warts occurs in up to two-thirds of children within two years; spontaneous resolution in adults tends to be slower and may take up to several years or longer . Warts in patients with intact cellular immunity are the most likely to regress without therapy [5,6]. Recurrence is common.
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- EPIDEMIOLOGY AND TRANSMISSION
- CLINICAL FEATURES
- DIFFERENTIAL DIAGNOSIS
- Patient education
- Common warts and plantar warts
- - First-line treatment
- Salicylic acid
- - Severe or refractory warts
- Topical immunotherapy with contact allergens
- Intralesional bleomycin
- - Other treatments
- Trichloroacetic acid
- Duct tape
- Pulsed dye laser
- Intralesional immunotherapy
- Oral cimetidine
- Flat warts
- Filiform warts
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS