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A Handout for the Non-Dermatologist


The Common Wart (Verruca Vulgaris)

The common wart is a discrete, benign, epithelial hyperplasia that tends to manifest as papule and plaques with cleft surfaces. They are caused by certain types of human papilloma virus (HPV) that commonly infect keratinized skin, usually at sites of minor trauma.
Immunocompromise such as HIV disease or during immunosuppression following organ transplantation is associated with an increased incidence of and more widespread cutaneous warts.


Firm papules, 1-10 mm, rarely larger. The surface may be cleft or warty. Plantar warts (on the soles of the foot) are usually flat; they may coalesce into patches.

Warts usually cause the normal skin lines to deviate around them.
Characteristic red dots that represent thrombosed capillaries within the wart. May require paring to see.
Sites of predilection, sites of trauma: hands, fingers, knees.

Duct tape occlusion QHS.
Liquid nitrogen to wart q4-6 weeks until resolution.
40% salicylic acid plaster (Mediplast, available OTC). Have patient apply it continuously for 3 of every 4 days.

If no resolution after several months, additional modalities as follows:

40% salicylic acid plaster under duct tape occlusion QHS.

Liquid nitrogen and after thaws, apply cantharidin collodion 0.7% application to lesions; cover with moleskin and keep dry for 3 days (if possible). Note: Cantharidin collodion may be available on a named-patient basis; contact our office for information on ordering it.

Topical imiquimod (Aldara) QHS under occlusion in addition to liquid nitrogen therapy q4-6 weeks.

As a last resort for resistant lesions, candidal antigen injections can be performed, as well as electrosurgery (risk of increased scarring), and surgical excision (risk of increased scarring). Such treatments are performed only on highly selected patients in the Dermatology Department. Contact our chief nurse if you believe one of your patients qualifies; do not send a consult (see SPECIAL NOTE below).

Warts are gone when skin lines are not deviated. For plantar warts, proper assessment may require paring to avoid unnecessarily treating dead wart tissue.

To preserve appointments for patients who need dermatologic consultations, UM Dermatology does not accept patients for wart therapy. Patients’ personal physicians are the best source for treatment of warts.