Pathophysiology
- HPV: DNA virus infecting basal keratinocytes through micro-abrasions. Stimulates rapid cell proliferation
- Virus remains within the epidermis (does not enter bloodstream)
- Common warts (verruca vulgaris): Raised, rough, dome-shaped. Hands and fingers
- Plantar warts (verruca plantaris): Grow inward on soles due to weight-bearing. May be painful
- Flat warts (verruca plana): Smooth, flat-topped, small. Face or dorsal hands. Occur in clusters
- Genital warts (condylomata acuminata): HPV types 6 and 11. Soft, moist, pink
- Koebnerization: New warts along lines of skin trauma (scratches, shaving)
- Most resolve spontaneously in 1-2 years as immune system clears the virus
Signs and Symptoms
Hallmark Indicators
- Common warts: Raised, rough, "cauliflower-like" surface. Skin-colored to grayish-brown
- Plantar warts: Flat/slightly raised. Black dots (thrombosed capillaries, not "seeds"). Painful with lateral compression
- Flat warts: Small (2-4 mm), smooth, flat-topped. Flesh-colored. Often in groups
- Typically painless except plantar warts (painful with standing/walking)
- Thrombosed capillaries visible as small black dots within the wart
Red Flags and Rule-Outs
- Contagious via direct contact and autoinoculation — local contraindication
- Plantar wart vs. callus: Plantar wart hurts with lateral compression (squeeze test). Callus hurts with direct pressure
- Persistent, spreading, or painful warts: Refer for medical management (cryotherapy, salicylic acid)
- Rapidly growing or bleeding lesion: Consider differential — may not be a wart. Refer
MT Considerations
- Local contraindication: Avoid direct contact with any wart. Cover with bandage if client wishes to proceed
- Contagious: HPV spreads via direct skin contact and contaminated surfaces. IPAC protocols apply
- Plantar warts: Avoid deep pressure on sole over a plantar wart — significant pain
- Autoinoculation: Advise clients not to pick, scratch, or shave over warts
- Fomite precaution: Sanitize equipment contacting the wart area. Hot-water launder linens
- Referral: Persistent, spreading, or painful warts need medical management
- Gloves: Consider wearing gloves if working near (not over) a wart site
CMTO Exam Relevance
- Warts are caused by HPV — viral infection of the epidermis
- Contagious — local contraindication
- Plantar warts hurt with lateral compression. Calluses hurt with direct pressure
- Black dots are thrombosed capillaries, not "seeds"
- Most resolve spontaneously within 1-2 years
Key Takeaways
- Warts are benign epidermal growths caused by HPV infection of keratinocytes
- Contagious through direct contact and autoinoculation — local contraindication
- Different HPV types cause common warts (hands), plantar warts (feet), flat warts (face), genital warts
- Plantar warts hurt with lateral compression. Calluses hurt with direct pressure
- Most resolve spontaneously in 1-2 years. Persistent cases need medical referral