VERUCCA VULGARIS

By
Kamilah
Fitriyani B.
Zulkifli Thamrin
Advisor:
dr. Saribumi
Supervisor:
dr. Suswanto Wahab, Sp.KK

INTRODUCTION
Wart is a benign proliferation of the skin
and mucosa caused by HPV
Verruca vulgaris is known as common
wart
Common wart rarely undergoes
malignant transformation, therefore its
not dangerous

Other types of verruca :

Plantar wart,
Genital wart,
Flat wart

ETIOLOGY
Caused by the human papilloma virus
(HPV)
There are more than 100 types of HPV
The ones which caused common wart are
type 2 and 4 (most common) followed by
type 1, 3, 27, 29 and 57

PATHOGENESIS
viral inoculation at the epidermis
HPV infection
Maseration
infection the on the skin
stem cell
Basal cell infection

epidermal

Mitosis
virus

Replicated and transported

epithelium

Differentiated

Hiperkeratosis

CLINICAL MANIFESTATIONS
Usually occurs in children of school age,
but rare in infants. It can also occurs in
adults
Locations : any parts of the body but
most commonly on hands and knees

 Efflorescent : hyperkeratotic papules with

rough irreguler surface, can be less than
1mm to more than 1 cm in size
Rarely itches, pain (-)

 Common warts with hyperkeratotic,

rough irregular surface

 Common warts on the scalp, note the long,

slender shape of the wart. Because of its
unique shape, it is also known as the filiform
wart.

 Sometimes a single common wart can

caused the growth of other warts near its
location

 Flat wart : smooth and

flat surface, brownish in
color, usually on the
neck and face
Plantar wart : wart on
the sole of the feet
Condyloma : note the
cauliflower shape

DIAGNOSIS
Diagnosis of verucca vulgaris is made
based on its clinical manifestations
If uncertain, histopathology findings can
be made using skin biopsy
Histopathology findings can differentiate
most papillomas

 Histopathologic features of common

warts include digitated epidermal
hyperplasia, acanthosis, papillomatosis,
compact orthokeratosis, hypergranulosis
etc.

Histopatologis

 Sometimes, elongated rete ridges may

point radially toward the center of the
lesion

 In the granular layer, HPV-infected cells

may have coarse keratohyaline granules
and vacuoles surrounding wrinkledappearing nuclei. Koilocytic (vacuolated)
cells are pathognomonic for warts.

Other lab studies..

Immunohistochemical detection of
HPV structural proteins
Viral DNA identification using
Southern blot hybridization (identify
specific HPV type in tissue)
Polymerase chain reaction (used to
amplify viral DNA for testing)

DIFFERENTIAL DIAGNOSIS
Tuberculosis cutis
verrucousa
A single lesion, rougher,
may elongate in a
serpiginous spreading

 Prurigo nodularis
Usually on the
extremities, itchy
Can be differentiated
from verruca vulgaris
using histopathology

 The histologic features : hyperkeratotic

epidermis with acanthosis and
parakeratosis.
Rete ridges are elongated and irregular
with a dense dermal infiltrate consisting
of neutrophils, eosinophils, histiocytes,
and monocytes.

 Also notable in the dermis are thickened

nerve fibers and fibrosis with thickened
collagen bundles.

 Squamous cell
carcinoma
Cauliflower-like
vegetation, easily bled,
smelly
Keratinocyte
windblown appearance

TREATMENTS
Some resolve on its own
Include non-surgical and surgical
methods

Non-surgical methods
Using keratolytic agentscause cornified
epithelium to swell, macerate, and
desquamate
Trichloroacetic acid 50%-80%
Salicylic acid 20%, lactate acid 10%

Surgical methods
Cryosurgery : Liquid nitrogen (-196C) is the
most effective method
Electrodesiccation and curettage: effective but
painful
Lasers : expensive
Surgical excision: Avoided risks of scarring
and recurrence.

PROGNOSIS
Approximately 65% of warts disappear
spontaneously within 2 years.
When warts resolve on their own, no
scarring is seen. However, scarring can
occur as a result of different treatment
methods.

THANK YOU