Warts

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 Editor: Luc Thomas

 Author(s): Amélie Boespflug, Luc Thomas
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Infection by human papillomavirus may lead to keratinocyte proliferation, that is responsible when located near the nail or peri-ungual and subungual warts[1]. Nail dermoscopy can help diagnose subclinical subungual and peri-ungual warts that appear on the hyponychium, the proximal nail fold and can extend to the nail bed.

Subungueal wart - clinical aspect 1097d.JPG.jpg

Clinically they appear as red scally papules. Dermoscopy shows a punctate rough surface and dilated capillaries of the papillary dermis[2], on a yellow structureless background with red or black dots with short lines that correspond to past hemorrhages and vessels that are important to differentiate these lesions with corn, callus, or a clavus[3].

Subungueal wart clinical aspect Subungueal wart -dermoscopic aspect


Trans-illumination can also help the diagnosis of patients with a subungual wart[4].


Important differential diagnosis are squamous cell carcinoma[5], melanoma[6], Bowen’s disease[7]subungual exostosis [8]



References

  1. Tschandl P, Rosendahl C, Kittler H. Cutaneous Human Papillomavirus Infection: Manifestations and Diagnosis. vol. 45, 2014, p. 92–7.
  2. Piraccini BM, Bruni F, Starace M. Dermoscopy of non-skin cancer nail disorders. Dermatologic Therapy 2012;25:594–602.
  3. Bae JM, Kang H, Kim HO, Park YM. Differential diagnosis of plantar wart from corn, callus and healed wart with the aid of dermoscopy. The British Journal of Dermatology 2009;160:220–2.
  4. Ashique KT, Kaliyadan F. Transillumination: A simple tool to assess subungual extension in periungual warts. Indian Dermatology Online Journal 2013;4:131–2.
  5. Robinette J, Day F, Hahn P. Subungual squamous cell carcinoma mistaken for a verruca. Journal of the American Podiatric Medical Association 1999;89:435–7.
  6. Arpaia N, Filotico R, Mastrandrea V, Cassano N, Vena GA. Acral viral wart showing a parallel ridge pattern on dermatoscopy. European Journal of Dermatology : EJD n.d.;19:381–2.
  7. Ramirez-Fort MK, Ramirez-Fort MK. Human papillomavirus-induced periungual pigmented Bowen’s disease. Dermatology Practical & Conceptual 2012;2.
  8. Daragad M, Srinivas S, Varghese J. Exostosis masquerading as a subungual wart. Indian Dermatology Online Journal 2014;5:92.