Verruca vulgaris B07

Ciuffo, 1907 (description of the viral genesis)

Worldwide spread, common infectious disease caused by human papillomaviruses (for classification see also Warts/Overview) with formation of mainly acrally localized, regressible, hemispherical or flat, hyperkeratotic roughened papules and/or nodules on the skin and mucous membrane.

Human papillomaviruses (DNA virus); most frequently HPV1, 2, 4, 27, 57 - less frequently HPV7 (butchers/fish sellers).

In pediatric populations, the subtypes HPV 2, HPV 27, HPV 57 and HPV 63 are particularly common (Bristow I 2023).

The following types can be distinguished:

• Vulgar warts (prickly warts)
• Butcher's warts (butcher's warts)
• plantar warts (verrucae plantares, plantar warts)
• Mosaic warts (beet-like formations)
• Plantar warts (prickly warts, endophytic growing plantar warts)

The most common form of wart caused by the virus. Transmission from person to person or by autoinoculation. Incubation period of up to 20 months. The risk is increased if other family members have also suffered from warts ( odds ratio 1.9).

Verrucae vulgares/plantares occur mainly in children and adolescent adults. In children, most papillomas heal spontaneously within months of the initial infection, regardless of treatment. Infection is most common in the second decade of life and affects over 40% of children (Bristow I 2023).

Occurs mainly in children, adolescents, young adults, often in acrocyanosis. Predisposing factors are hyperhidrosis, immunosuppression or atopic diathesis (children with atopic dermatitis seem to be more susceptible to viral inoculation). Autoinoculation is a typical phenomenon in children.

Mainly localized on the hands and feet (poor circulation), see Verruca plantaris, see also Verruca perionychialis. Infestation of the entire integument is possible in immunosuppressed patients. On the head, vulgar warts often manifest themselves in the form of verrucae digitatae, on the capillitium with filiform or finger-shaped extensions.

Solitary but also to beds aggregated, hemispherical, 0.2-0.8 cm large, coarse, mostly skin-coloured or grey-yellowish papules, nodules or plaques with a verrucous, fissured surface. Development of daughter warts in the surrounding area by autoinoculation is possible. The clinical morphology is significantly influenced by the location of the warts, e.g. warts around the nose often appear as pedunculated or thread-like lesions. Warts located periungual (and subungual) often lead to onychodystrophies. They can lead to extensive tumorous vegetation. Such formations are therapeutically particularly problematic.

See below Warts (viral warts).

Healing without scarring after weeks to years. Spontaneous healing is reported between 25% and 60% of cases, depending on the location and duration of the disease. Caution. Scarring due to surgical therapy is possible.

In butchers' warts, HPV-7 can often be detected in warts, a virus that occurs very rarely in the rest of the population. HPV-7 belongs to the alpha papilloma viruses and has been isolated from the oral mucosa of HIV-infected persons, from condylomas of immunocompromised persons and in China from warts between the toes.

1. Betlloch I et al. (2002) Verruca vulgaris surrounding a total graft following a burn in a child. Pediatr Dermatol19:369-370
2. Bristow I (2023) Paediatric Cutaneous Warts and Verrucae: An Update. Int J Environ Res Public Health 19:16400.
3. Ciuffo G (1907) Imnesto positiv con filtrado di verrucae volgare. Giorn Ital Mal Venereol 48: 12-17
4. Iraji F et al. (2002) Histopathology of skin lesions with warty appearance in renal allograft recipients. Am J Dermatopathol 24:324-325
5. Khanna N, Joshi A (2004) Extensive verruca vulgaris at unusual sites in an immunocompetent adult. J Eur Acad Dermatol Venereol 18:102-103
6. Muzio G et al. (2002) Treatment of non-genital warts with topical imiquimod 5% cream. Eur J Dermatol 12:347-349
7. Penso-Assathiany D et al. (1999) Warts, swimming pools and atopy: a case control study conducted in a private dermatology practice. Ann Dermatol Venereol 126:696-698
8. Rübben A (2011) Clinical algorithm for the treatment of cutaneous, extragenital HPV-induced warts. Dermatologist 62: 6-16