Verruca Vulgaris (Common Warts)
Verruca vulgaris is a benign proliferation of the skin and mucosa caused by the Human Papillomavirus (HPV), most commonly types 1, 2, 4, 27, and 57.
Key Clinical Features
- Morphology: Firm, hyperkeratotic, exophytic papules or nodules with a rough, “cauliflower-like” surface.
- Pathognomonic Sign: “Thrombosed capillaries” (black dots) are often visible on the surface, representing pinpoint bleeding when the hyperkeratotic layer is pared down.
- Distribution: Most commonly found on hands, fingers, and knees.
Management Options
| Method | Mechanism/Notes |
|---|---|
| Cryotherapy | Liquid nitrogen (standard office-based treatment). |
| Topical Keratolytics | Salicylic acid (first-line for home therapy). |
| Immunotherapy | Intralesional Candida antigen or Imiquimod for refractory cases. |
High-Yield Exam Pearl:
- Diagnosis: Usually clinical. If the lesion has a verrucous surface but is on the genitalia, suspect Condyloma Acuminatum (HPV 6, 11).
- Spontaneous Resolution: Up to two-thirds of warts will resolve spontaneously within two years due to a host cell-mediated immune response.