Warts is a topic covered in the 5-Minute Emergency Consult.

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  • Warts are caused by the human papillomaviruses (HPV)
  • Causes cellular proliferation and vascular growth
  • Lesions are typically verrucous and hyperkeratotic
  • Lesions resolve spontaneously in most cases:
    • 1/3 within 6 mo
    • 2/3 within 2 yr
    • 90% within 5 yr
    • Likely due to cell-mediated immune response
  • Cutaneous warts:
    • Verrucae vulgaris (common warts):
      • Dorsum of hands
      • Sides of fingers
      • Adjacent to nails
      • Usually asymptomatic
    • Verrucae plantaris (plantar warts):
      • Weight-bearing parts of sole: Heels, metatarsal heads
      • Often symptomatic and painful
      • More common in adolescents and young adults
    • Flat (juvenile) warts:
      • Primarily on light-exposed areas
      • Head, face, neck, legs, dorsum of hands
      • Small in size
      • Range from a few to hundreds
  • Anogenital warts:
    • Known as condyloma acuminata or venereal warts
    • Most are asymptomatic and may go unrecognized
    • HPV types 6 and 11 account for 90% of anogenital warts
  • HPV types 16 and 18 account for 70% of cervical cancers


  • HPV is host-specific to humans
    • Cause infection of epithelial tissues and mucous membranes
    • Infects the basal layer of skin or mucosa
  • There are >100 types of HPV that variably infect different body sites
  • HPV transmission is:
    • Direct: Skin to skin
    • Indirect: Contaminated surface to skin
    • Autoinoculation: Scratching, sucking (especially in young children)
  • Incubation period can range from weeks to >1 yr

Pediatric Considerations
  • 10–20% of children will have warts
  • Peak incidence between 12 and 16 yr
  • May produce laryngeal papillomatosis in infants from viral exposure at birth
  • Must consider sexual abuse in children with anogenital warts

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