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Skin-nontumor

Infectious disorders

Warts

Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC (see Reviewers page)
Revised: 5 September 2011, last major update July 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Also called verrucae
● Cutaneous and mucosal lesions are caused by various types of human papillomaviruses (HPV), a type of papova virus
● Usually resolves in 6-24 months

Micro description
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● Focal epidermal hyperplasia with hyperkeratosis, parakeratosis and papillomatosis (not verruca plana); may have trichilemmal keratinization
● Koilocytes (keratinocytes in upper squamous layer with vacuoles, large cytoplasmic eosinophilic aggregates and pyknotic nuclei)
● Tangential sections may show squamous cells surrounded by inflamed stroma
● Older lesions may lack cytoplasmic changes
● Viral nuclear inclusions are basophilic

Micro images
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Various images

Positive stains
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● HPV by in situ hybridization

Electron microscopy
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● Eosinophilic aggregates are tonofilaments

Verruca plana

Definition
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● Usually due to HPV10
● Flat, occurs in crops/clusters on face and hands

Case reports
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● 42 year old woman with lesions following eyebrow threading (Indian J Dermatol Venereol Leprol 2009;75:196)

Clinical images
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Verruca plana following eyebrow threading

Micro description
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● Involuting lesions may have chronic inflammatory infiltrates in dermis and epidermis with degenerative epithelial changes

Micro images
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Various images

Verruca plantaris

Definition
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● On soles of feet; painful
● Covered by calluses

Clinical images
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Various images

Micro description
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● Invaginated with numerous coarse, basophilic, intracytoplasmic keratohyalin granules resembling molluscum bodies

Micro images
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Verruca Plantaris

Verruca vulgaris

Definition
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● Usually due to HPV2
● Occur on hands as elevated, hard, rough, flesh-colored lesion
● If surface is peeled, undersurface is pink and granular

Clinical description
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● Exophytic papules, either single lesions or linear; appear serrated

Clinical images
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Various images

Micro description
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● Striking papillomatosis (upward displacement of dermal papillae), stratum corneum exhibits parakeratosis with pointed mounds resembling church spires, extravasated erythrocytes or hemosiderin
● Granular layer is thickened with prominent keratohyalin granules and keratinocytes displaying perinuclear clearing (koilocytosis, lost in older lesions)
● Lymphocytic infiltrate in upper dermis

Micro images
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Various images

Virtual slides
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Verruca vulgaris

End of Skin-nontumor > Infectious disorders > Warts

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