Periungual warts are innocuous growths that form in the vicinity of one’s finger- or toenails. Triggered by exposure to the human papillomavirus (HPV), periungual warts generally form and disappear without treatment. In most cases, the presence of a periungual wart poses a cosmetic issue that leaves the individual feeling uncomfortable or embarrassed. If treatment is necessary, there are several methods available for wart removal, from over-the-counter (OTC) medication to surgery.
Warts caused by the papillomavirus are easily recognizable. A physician will generally evaluate the wart to check for markers that confirm it's benign. In some cases, if the growth is abnormally shaped or discolored, it may be biopsied to discount other more serious conditions.
The papillomavirus that causes periungual warts is extremely contagious. Not only may the infection spread by direct, interpersonal contact, but inanimate objects handled by an infected individual may also carry the virus. Abrasions and breaks in the skin are primary points where the virus may enter the body. Anyone may contract HPV, but immunosuppressed individuals and children are considered at greatest risk for developing periungual warts following infection exposure.
Initially, periungual warts present as very small, flesh-toned, raised lesions with a smooth texture. As the warts mature, they adopt a ragged, rough appearance. When positioned close to the nail, the wart can spread underneath, raising the nail. It is common for some warts to cause discomfort, but if periungual warts become too invasive to the nail bed and surrounding tissues, infection can occur.
Depending on the severity of the wart and the types of issues it may be causing, there are a variety of treatment options available. Many OTC wart removal medications contain salicylic acid, which is an effective wart removal agent. It is important to understand that though its use does eliminate the wart, it does not kill the responsible HPV, and wart recurrence is likely. Problematic periungual warts that do not respond to traditional OTC treatment can necessitate removal by a physician.
The most common in-office method for wart removal is freezing, known as cryotherapy, which involves applying liquid nitrogen to the wart. Electrodessication and curettage, which necessitates local anesthetic, may be performed to excise large or clustered periungual warts. Utilizing an electrified needle, the procedure does carry some risk for scarring. Warts that do not respond to treatment may require the expertise of a dermatologist to find other treatment alternatives, including topical and oral medication therapies.