Image and content excerpted from the VisualDx clinical decision support system.
VisualDx images show variation in age, skin color, and disease stage. VisualDx has 13 images of Wart, Periungual.
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ICD-9 Codes078.10 – Viral warts unspecified
SynopsisWarts are infections of the epidermis with human papillomavirus (HPV). Warts that involve the periungual skin are usually of HPV subtypes 1, 2, or 4. Warts are the most common nail tumor and affect fingernails more frequently than toenails. Warts are spread by human contact or indirectly via fomites on surfaces. Infection is more likely to occur when the skin is macerated or traumatized; periungual warts are seen in nail biters and in certain professions (butchers). Warts of all kinds reach their peak prevalence in childhood and adolescence. In adults, warts are especially common among transplant patients and in those immunosuppressed by HIV, malignancy, or medications.
They appear as hyperkeratotic papules with a rough surface that tend to be located on the proximal nail fold or in the lateral sulcus. They may extend to the nail bed but not to the matrix. Periungual warts may occasionally occur on the undersurface of the proximal nail fold. Although they do not involve the nail matrix, warts may sometimes induce longitudinal grooving secondary to compression of the nail matrix.
Pain may occur in association with deep fissuring. Periungual warts often disappear spontaneously over a period of months to up to 5 years, especially in children. Spontaneous resolution is less frequent in long-standing warts in adults and immunocompromised patients.
Complications include bone erosion, spreading to the lips in nail biters, and, rarely, progression to squamous cell carcinoma. In immunocompetent individuals, warts almost never undergo malignant degeneration, though warts of long-standing duration or those refractory to multiple treatment modalities may arise suspicion, as should periungual warts in combination with genital HPV disease.
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