Verruca (Plantar Wart)

by Carlo Raj, MD

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    00:02 Our topic here is a verruca.

    00:04 You’ll know this as being warts.

    00:07 And with your wart, you should be thinking about your virus, HPV.

    00:13 We have verruca vulgaris, HPV 2 You have verruca plana, which is HPV 3 and 10.

    00:21 HPV 1, such as verruca plantar.

    00:25 And if it’s condyloma, the one that you’re oh so familiar with, condyloma acuminata, you’re referring to your low strain of HPV 6 and 11.

    00:34 But, let me show something to you in which you may or may not be familiar with that all of these HPVs that I’m showing you here are low strain.

    00:44 And each one of these HPVs are then given you a different type of wart presentation.

    00:50 Verruca vulgaris, verruca plana, verruca plantar, and condyloma acuminata.

    00:58 The genital warts with high risk of malignancy, of course, then referring to your HPV 16, 18, 31, 33.

    01:05 And verruca vulgaris, very common in kids.

    01:08 And the vulgaris is the one in which it’s associated with HPV 2.

    01:12 And if it helps you, think about terrible twos, HPV 2, may result in verruca vulgaris.

    01:20 It can be severe and recalcitrant in immunocompromised, meaning to say your individuals who might have HIV or who are on immunosuppressant therapy may present with HPV that is not responding to medications, recalcitrant.

    01:40 Morphology: And what are you going to find? Well, you know what warts look like, I’ll show you a picture.

    01:44 It varies with location with HPV type.

    01:47 Here for example, in the vaginal area, I’m showing you what’s known as your HPV 6 and 11.

    01:54 This will be low strain type of HPV and this then refers to as being your condyloma acuminata.

    02:02 Verruca: So morphology or pathology, what are we looking for? So obviously, this is undergoing destruction.

    02:09 If anything, there is acanthotic epidermis.

    02:11 In other words, there’s acanthosis.

    02:14 In addition, there’s papillomatosis and hyperkeratosis.

    02:17 And here will be hypergranulosis in the epidermis.

    02:22 And this will be opposite – Give me one condition that we’ve talked about in dermatology in which the granular layer is actually absent or thinned out.

    02:29 Now, if you would tell me by reflex that this was psoriasis.

    02:33 But in this case, it’s hypergranulosis, referring to your wart.

    02:39 Dilated and tortous vessels in the dermis.

    02:42 Obviously because of thickening taking place.

    02:47 Now, verruca in children: Most warts will resolve with time.

    02:50 Treatment focused on your hastening resolution.

    02:53 And remember that destruction may be taking place and so therefore, the areas that you’re worried about would include some of your cantharidin areas -- podophyllin, or you have your cantharidin, and LN2, destruction taking place.

    03:09 Here, the drug or management that you want to know will be Imiquimod cream approved for genital warts.

    03:20 Treatment can be problematic in immunocompromised patient as we had referred to and please keep in mind for microbiology that obviously here, with warts and HPV, and especially the higher strain and such that you have vaccinations that are now available so that you can then combat some of the HPV, and of course referring to your Gardasil.

    03:42 Differential diagnoses for verruca: Wherever verruca may be located, it might look like squamous cells cancer.

    03:49 However, in squamous cell cancer, there’s usually – There is going to be history of sun-exposed area, usually elderly individuals.

    03:58 And generally larger with squamous cell carcinoma as I will show you pictures of.

    04:03 And another important one is called a corn or clavus.

    04:07 And this occurs over the pressure area versus verruca, not necessarily predisposed by pressure.

    04:14 It does not interrupt natural skin lines.

    04:17 In other words, referring to as being your dermatoglyphs.

    04:22 And do not contain central thrombosed capillaries.

    04:26 Corn, clavus.

    04:27 Other differentials, as soon as you hear the term seborrheic dermatitis, you should be thinking about that greasy, yellow, maybe perhaps waxy type of appearance.

    04:36 And if it’s condyloma lata, not to be confused with condyloma acuminata, which is the verruca.

    04:44 Lata would be referring to your secondary syphilis.

    04:48 And your condyloma lata, here the serologic test obviously would demonstrate the organism and may be perhaps having positive for RPR for syphilis.

    04:56 Usually where you would find this would be mostly in the areas that are moist, paramucosal lesion, and this would be the lata.

    05:06 Make sure that you take a moment and you have already properly organized your lata as being part of your syphilis or if you want, maybe it’s silly, “I want a lata syphilis.” And not that anyone really wants that.

    05:20 Or you’re accumulating, from microbiology, your condylama accumulating or acuminata, koilocytes, if that helps you.

    05:27 Just quick little revisions of micro that you’ve looked at some point in time.

    About the Lecture

    The lecture Verruca (Plantar Wart) by Carlo Raj, MD is from the course Infectious Skin Diseases.

    Included Quiz Questions

    1. 16, 18
    2. 1, 2
    3. 6, 11
    4. 22, 24
    5. 12, 13
    1. Thinning of the granular layer
    2. Acanthotic epidermis
    3. Marked hyperkeratosis
    4. Marked papillomatosis
    5. Dilated blood vessels within the papillary dermis
    1. Corns
    2. Squamous cell carcinoma
    3. Verruca vulgaris
    4. Seborrheic keratosis
    5. Condyloma lata

    Author of lecture Verruca (Plantar Wart)

     Carlo Raj, MD

    Carlo Raj, MD

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