For decades, the black dots characteristically seen in warts were thought to be thrombosed capillaries. This has turned out not to be the case. They actually represent intracorneal hemorrhages. One should note that paring removes them before the dermis is reached.
Warts or verrucae are skin lesions caused by infection by human papillomavirus (HPV).
Warts come in many shapes and sizes. The most common is the hyperkeratotic, verrucous papule on the hands or feet of a child. Flat warts are slightly raised, flat papules or small plaques. Occasionally, they may resemble nevi. Many warts are exophytic (stick out), but lesions on the soles are usually endophytic (extend into the skin) because of the constant pressure. Warts commonly occur about the nails, especially in children who bite or pick their nails. Warts do not show fingerprints, in contrast to calluses.
Darker-skinned patients get warts less commonly which is fortunate given that cryotherapy easily induces white spots after therapy.
If located on the sole, be sure to confirm the diagnosis by paring. A wart has black dots; a corn has a clear center. Verrucous lesions that resist treatment should be biopsied. Occasionally a squamous cell carcinoma or even an amelanotic melanoma may be found. Subungual lesions in an adult should raise particular concern and prompt biopsy sooner rather than later to rule out squamous cell carcinoma).
When the immune system finally wins and kills the wart, it dries up, turns brown/black and falls off.
Warts may be spread through autoinnoculation.
A subungual wart. For longstanding lesions, especially in older patients, a biopsy to rule out squamous cell carcinoma may be in order.
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