Alternate Names: Plane juvenile warts; Periungual warts; Subungual warts; Plantar warts; Verruca; Verrucae planae juveniles; Filiform warts; Verruca vulgaris

Causes and Risks: Warts are an infectious disease of low infectivity caused by a virus. They may occur anywhere on the body but are frequently seen on the hands, feet, and face (areas of frequent contact). Warts may be named by their location and appearance. On the soles of the feet they are called plantar warts. Around and under the fingernails or toenails they are periungual or subungual warts, respectively. Common warts on the hands, arms, legs, and elsewhere are verrucae vulgaris, but often just called common warts. Numerous very small smooth flat warts (pinhead size) often seen in large numbers on children’s faces, foreheads, arms and legs are called verrucae planae juveniles. These are seen less often in adolescents and seldom in healthy adults.

The typical wart is a rough round or oval raised lump on the skin that may be lighter or darker than the surrounding normal skin, skin colored or even (rarely) black. Most parents are familiar with the look of a typical wart and have little trouble in diagnosing the condition. Warts with a smooth surface and the small flat warts in children may cause some difficulty in diagnosis for the average parent. Common warts cause no discomfort unless they are in areas of repeated trauma.

Plantar warts are no different than the common wart but, because of their location on the soles of the feet, they can become extremely painful. Large numbers of plantar warts on the foot may cause difficulty running and walking and can be debilitating.

Warts around and under the fingernail are similar to the common wart, but much more difficult to cure.

The common wart may disappear spontaneously, often within 2 years of its appearance. Because people generally consider warts unsightly and there appears to be a social stigma (among school children) associated with having warts, parents often seek treatment. Treatment of warts has improved significantly in the last 10 years, but even with effective treatment recurrence is not uncommon.

Prevention: Avoid direct skin contact with another wart.

Symptoms:

• small, hard flat to raised skin lesion or lump
  • skin colored, lighter or darker than surrounding skin, sometimes with dark speckles
  • skin abnormally dark or light may occur in a small area
• numerous small, smooth, flat (pinhead sized) lesions on forehead, cheeks, arms, or legs
• rough round or oval lesions on soles of feet, flat to slightly raised and painful to pressure
• rough growths around fingernails or toenails or protruding from beneath them

Signs and Tests: The diagnosis is based on the appearance of the skin lump. A skin biopsy may be needed to confirm the diagnosis in some cases.

Treatment: Treatment, although not always necessary, is often desired by both the affected child and the parent. Over-the-counter medications can be effective in removal of warts. These topically applied chemicals frequently consist of various mixtures of salicylic acid and lactic acid and are applied on a daily basis for several weeks. Stronger (prescription) medications may be required for removal of persistent warts. Surgical removal or removal by freezing (cryotherapy), burning (electrocautery), or laser treatment may be needed. Immunotherapy, done by causing a localized allergic reaction, is also used.

Prognosis: Warts are benign growths that often disappear spontaneously within 2 years. They are contagious but of a very low order. Warts may be unsightly or cause discomfort, especially on the feet.

Complications:

• spread or recurrence of warts
• minor scar formation if the wart is removed
• formation of keloids after removal

Call for an appointment with your health care provider if warts are present and there are signs of complications, or if warts do not respond to over-the-counter treatment and removal is desired.

Also call if new symptoms develop, including change in the appearance, or the development of pain, bleeding, ulceration, or color changes of a wart or any skin lesion.