Figure 1066

Verruca vulgaris (common warts) are caused by human papillo-maviruses 1, 2, 3, 4, 5, 8, 11, 16, and 18, as well as others, with the highest percentage by type 4. Warts are found most often on the fingers, arms, elbows, and knees and are much more numerous in the immunosuppressed patient. Treatment modalities have been the same as for condyloma acuminata, with the addition of topical cidofovir and hyperthermia. Therapy should be planned based on the location, extent, and size of the lesions. Not all lesions need treatment. Early dermatologic referral is needed for those lesions that appear to be advancing rapidly as certain papilloma viruses (16, 18, 31, 51, 52, 56) have been associated with squamous cell carcinomas of the skin and cervix. A and B, Verruca vulgaris of the finger and knee. Note the large size and multiple warts. C, Verruca planae, flat warts at multiple locations of the hand, also often seen on the face.

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