![]() ![]() It is known that nearly two-thirds of warts spontaneously disappear within 24 months. Observation is also a part of the treatment and should always be considered. The more expensive and invasive treatments are usually reserved for multiple recurrent warts. In general, one should try the least expensive and least painful treatment first. Even though there are many treatments for warts, none is very effective, and recurrences are common with each of them. Once the diagnosis is made, the treatment depends on symptoms, patient preferences, and cost. These small lesions appear as whitish papules, measuring 1-5 mm in size and arranged in groups.Ĭystic warts tend to appear on weight-bearing surfaces like the sole and have a smooth appearance. These warts tend to have a cauliflower-like appearance and tend to be large.įocal epithelial hyperplasia includes warts that occur in the oral cavity. They tend to be deep and painful when palpated.įlat warts appear as fleshy growths ranging in size from 1-7 mm and may number hundreds in number.īutcher's warts are seen in individuals who handle raw meat products. Those on the plantar surface may be mistaken for a callous. The majority of common warts are seen on the lower and upper extremities.Ĭommon warts around the lips and eyelids may be thin and long. They may range in size from 1 mm to several centimeters. On physical exam, the common wart may appear as a papular growth with an irregular contour and surface. If the plantar wart is large, it can even impair a patient's ambulation and ability to wear shoes. Plantar warts can be painful because of compression and extensive friction that can lead to bleeding. However, they do cause cosmetic disfigurement and, in a rare patient, may cause localized pain. The majority of warts do not cause symptoms. The cyst may rupture causing a foreign body granuloma. Many epithelial cells have large nuclei and clear cytoplasm with eosinophilic inclusion bodies. The wall is composed of basal, granular, and squamous cells. These are referred to as "owl's eye cells."Ī cyst wart is filled with horny material. Cells with prominent perinuclear vacuolization around pyknotic, basophilic, centrally located nuclei can be in the granular layer. ![]() Basophilic parakeratotic cells loaded with virions and basophilic nuclear inclusions and may be in the upper layers of the epidermis.įlat warts are similar to common warts in light microscopy. The endophytic epidermal growth has the distinctive feature of polygonal, refractile-appearing, eosinophilic, cytoplasmic inclusions made up of keratin filaments, forming ringlike structures. Some may have prominent keratohyalin granules, and vacuolated cells may be present.ĭeep palmoplantar warts are similar to common warts except the lesion lies deep to the plane of the skin surface. Small vacuolized cells are seen, and centrally located shrunken nuclei may be identified in clusters within the granular layer rete ridges.įiliform warts appear similar to common warts, but they may have prominent papillomatosis.įocal Epithelial Hyperplasia (Heck disease)įocal epithelial hyperplasia is characterized by acanthosis, blunting, hyperplastic mucosa with thin parakeratotic stratum corneum, anastomosis of rete ridges, and whiteness of epidermal cells due to intracellular edema. Koilocytic cells are pathognomonic.īutcher's warts have acanthosis, hyperkeratosis, and papillomatosis. In the granular layer, cells infected with HPV have coarse keratohyalin granules and vacuoles surrounding wrinkled-appearing nuclei. Elongated rete ridges may point radially toward the center of the lesion. Histopathologic features include acanthosis, digitated epidermal hyperplasia, papillomatosis, compact orthokeratosis, hypergranulosis, tortuous capillaries within the dermal papillae, and vertical tiers of parakeratotic cells with red blood cells entrapped above the tips of the digitations. ![]()
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