Verruca Vulgaris (and Variants)

 Palmoplantar warts show especially prominent keratohyaline inclusions



• Lesions may be irritated and inflamed, often associated with reactive atypia




Top Differential Diagnoses




• Verrucous keratosis

• Seborrheic keratosis

• Lichen simplex chronicus

• Hypertrophic lichen planus

• Verrucous carcinoma

• Epidermodysplasia verruciformis

image
Clinical Photograph of Verrucae
Clinical photograph shows multiple verrucae on the dorsal hand and fingers. (Courtesy J. Wu, MD.)


image
Verruca Vulgaris
This verruca vulgaris (VV) shows dense hyperkeratosis image, parakeratosis, acanthosis, and marked papillomatosis image. Most lesions show few or no dermal changes.

image
Palmoplantar Wart With Prominent Papillomatosis
Scanning magnification of a palmoplantar wart (myrmecia) shows prominent papillomatosis image with thick overlying hyperkeratosis and parakeratosis with areas of hemorrhage image.

image
Palmoplantar Wart With Prominent Keratohyaline Granules
Palmoplantar warts (myrmecia) often show especially prominent koilocytes with perinuclear halos image and large, dense keratohyaline inclusions image.


TERMINOLOGY


Abbreviations




• Verruca vulgaris (VV)


Synonyms




• Common warts
• Variants

image Palmoplantar warts (myrmecia)

image Flat warts (verruca plana)


Definitions




• Human papillomavirus (HPV)-related benign epidermal proliferation


ETIOLOGY/PATHOGENESIS


Infectious Agents




• Causal relationship established with numerous HPV types, including HPV-1, 2, 3, 4, 7, 10, 27, 29, and 57
image Most common types include 1, 2, 3, 4, 7, 10


CLINICAL ISSUES


Epidemiology




• Incidence
image Very common lesions

• Age
image Common in children and young adults, but can occur at any age


Site




• Common sites include fingers and dorsal hands (VV), palms and soles (palmoplantar warts), face and dorsal hands (flat warts)


Presentation




• Small papular to plaque-like lesions


Natural History




• Grow rapidly, then stabilize

• Some lesions may regress


Treatment




• Surgical approaches
image Complete excision is curative, but not necessary in most cases

• Drugs
image Topical therapy with podophyllin or other antiviral medications


Prognosis




• Excellent, unless immunosuppressed
image Rare cases of cutaneous carcinoma are associated with various HPV types, especially in immunosuppressed patients


MACROSCOPIC


General Features




• Often exophytic-appearing scaly (hyperkeratotic) lesion


Size




• May be small (several mm) papules to large plaques (several cm)


MICROSCOPIC


Histologic Features




• Exophytic and endophytic papillomatous epidermal proliferation
image Epidermal acanthosis with hypergranulosis, dense overlying hyperkeratosis, and tiers of parakeratosis (church spires)

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Apr 24, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Verruca Vulgaris (and Variants)

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