filiform/digitate warts

Pediatric Warts: 2023 Update


Mahan Maazi, MEng,1 Joseph M. Lam, MD, FRCPC,2

1 Faculty of Medicine, University of British Columbia.
2Department of Pediatrics, Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada.


Abstract: Cutaneous warts or verruca are benign growths of the skin that affect 30 to 70% of school-age children and has a lifetime prevalence of 10 to 22% in children. It is caused by human papillomavirus (HPV) which spreads from skin-to-skin contact or fomites and infects squamous cell in areas like the hands and feet. There are different HPV subtypes that cause different types of warts including common warts (verruca vulgaris), plantar warts (verruca plantaris), flat warts (verruca plana), mosaic warts, filiform/digitate warts, epidermodysplasia verruciformis, and condyloma acuminata (genital or venereal warts). Most warts will spontaneously clear within 2 years. Diagnosis is based on history and physical examination features which may include dermoscopy and rarely, histological confirmation. Management includes treatment with topical salicylic acid and cryotherapy, the two most common and effective modalities.
Key Words: warts (verruca), human papillomavirus (HPV), common warts (verruca vulgaris), plantar warts (verruca plantaris), flat warts (verruca plana), mosaic warts, filiform/digitate warts, epidermodysplasia verruciformis (EV), condyloma acuminata (genital or venereal warts).
Cutaneous warts are a benign growth caused by human papillomavirus (HPV) infection that can cause discomfort. These are most common in school-aged children and in adolescents.
HPV infection is acquired through skin-to-skin contact, contact with fomites, or through maternal transmission during birth. The virus infects squamous cells on the skin and inserts its viral genome into the cells causing survival and proliferation of the virus.
History and physical examination help diagnose warts in children. Dermoscopy and histology may also aid in diagnosis, especially in more challenging presentations. A history of genital warts in children mandates ruling out sexual abuse.
There is a wide range of treatment modalities that can be used for warts. The most well-studied are destructive therapies such as salicylic acid and cryotherapy. There are side effects from treatments such as pain, blistering, scarring and dyspigmentation from cryotherapy. HPV vaccination in children is useful in preventing certain subtypes of genital warts and those that may cause cancer.
Warts often spontaneously resolve with 33% clearing within the first 6 months, 66% within the first 2 years, and 90% within the first 5 years.
Treatment can hasten resolution of warts and often involve destructive therapies such as salicylic acid and cryotherapy.
HPV subtypes causing cancer are rare. Vaccination can significantly decrease the chance of acquiring HPV subtypes that cause genital warts and cervical, anal, oropharyngeal, penile, vulvar, and vaginal cancer.
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