Dermoscopy of Wart

Warts are noncancerous skin growths caused by the human papilloma virus (HPV). HPV infecting through the skin and mucous membranes enters to its target epithelial cells where proliferates in these polarized keratinocytes inducing abnormal cell growth, differentiation and warts formation. Dermoscopy provides a more detailed scrutiny of lesions than can be achieved with the naked eye and is based on cutting-edge optical technology, to better appreciate features visible at skin surface. This technique permits the detection of minor variations, from mild dystrophy to modest abnormalities within follicular framework which facilitate the recognition of compact wart-like lesions.

The Basics of Warts

According to their location and form, warts are mainly divided into common warts, plantar warts, flat warts and genital wars. Warts are most commonly passed through skin-to-skin, self-inoculation, sexual contact and perinatal transmission.

Common warts tend to be grayish-brown or brownish, slightly drooping (like a soybean), hard papillary growths with a rough surface. These are considered plantar warts based on the appearance of these typical circumscribed, keratinized, and rough-surfaced papules that appear as slightly elevated rings of hyperkeratosis. Flat warts often present as well-demarcated apical flat papules the size of grains of rice and sesame seeds. Genital warts are papillary or cauliflower-like projections that are susceptible to infection by secondary microbial erosion and pus, accompanied by itching and pain.

Unique Advantages of Dermoscopy in the Diagnosis of Warts

A dermatoscopic instrument employs the principles of optics to visualize surface morphology and texture. The features are seen in it. Dermoscopy magnifies the skin surface structure and is a procedure that physicians can use to more closely examine morphology, of colour variations in pigmentation distribution or colour asymmetry variegation on any other lesion site details for an accurate diagnosis. This increased detail allows for better detection and diagnosis of early or small skin lesions, which can be difficult to see with the naked eye.

Dermoscopy readily reveals the delicate modification in epidermal and hair follicle substructure of warts as hyperkeratosis, thickening of spinous layer over wart area which help doctors to diagnose accurately. Simultaneously, dermoscopy magnification and image enhancement effects can capture lots of wafer-like lesion very small in number difficult to be visualized.

Warts on Different Parts of the Body under Dermoscopy

Common Warts: Many areas showing papillomatous structures in a compact pattern. The frogspawn lesion will have a central red punctate/looped vessel with several fused vessels, usually  characterised as low to intermediate grade however occasionally having some ipsilateral associated punctate bleeding and peripheral adjacent blood lines that are present creating this appearance.

Plantar Warts: Displayed against a yellow unstructured background are variable reddish to dark brown dots or linear bleeding.

Flat Warts: Multiple papules, pinhead sized to 2.5mm in diameter with a hyperpigmented-to-violaceous appearance and peripheral white halo At times, punctate or even linear vessels might be observed.

Genital Warts: A mosaic pattern with papillary structures grown out can be observed

Warts and other skin lesions

Warts

Clinical Features: Verrucous architecture with an irregular papillomatous surface often likened to a cauliflower; location frequently on the extremities (hands and feet)

Dermoscopy: Presence of small, dark thrombosed capillaries or dots in conjunction with finger-like projections and a distinctive mosaic pattern Seborrheic Keratosis

Seborrheic Keratosis

Clinical Features: Waxlike appearance appearing to be stuck onto skin; colour brownade, black and or tan.

Dermoscopy: milia-like cystic structures, comedo-like openings, cerebriform pattern.

Nevus

Clinical Features: Characterized by small, darkly pigmented papules, which are predominantly located on the facial and cervical regions, with heightened prevalence in individuals possessing darker skin pigmentation.

Dermoscopy: Reveals a uniformly pigmented lesion with an unvascularized smooth cutaneous surface.

Acne

Clinical Features: Erythematous/Inflamed papules, pustular but also comedonal distribution; facial/dorsal/thoracic involvement

Dermoscopy: Presence of orifices related to hair follicles, peripheral erythematous areas and occasionally pustular lesions.

Dermoscopy

Dermoscopy is a non-invasive, in-vivo technique designed to identify morphologic structures on the skin not typically visible at submicroscopic levels that can help distinguish features such as color and vascular details of pigmented lesions. The discovery of these well-recognized patterns plays an important role in distinguishing among different dermatoses. For example, in pigmented skin lesions (pigmented nevi and melanomas), the ability of dermoscopy to distinguish between these two is clearly established. In addition, as a kind of non-invasive dermatological examination method, dermoscopy can alleviate the harm and pain to patients (at least relatively). Through dermoscopic observation and diagnosis, doctors can more accurately determine the nature and extent of skin lesions, thus avoiding unnecessary skin biopsies.

Dermoscopy in the Treatment of Warts

Warts are managed according to the dermoscopic images. This permitted stepwise observation of change in colour intensity and morphologic characteristics, as well vasculature appearance within the wart with treatment. So it leads to early detection of response to treatment and abnormality like noneffective regression or new onset.

Besides, dermoscopic assessment is an objective endpoint to judge the efficacy. Dermoscopic change in terms of area reduction as well as an improved vascular pattern, etc., are some specific changes seen which doctors use it to assess responses before and after therapy. Because of this, the number reduced patient visits which greatly improved accuracy and effectiveness care result decreased pain but increased significantly accurate.

How to Prevent Warts？

We should not touch another person’s warts in the first place, and secondly we need to be careful of sharing private things like cleaning tools or razors shoes, since touching transmits very easily because it is caused by human Papillomavirus. If you just used hand sanitizer and water to wash your hands immediately after contact with things or surfaces which might be contaminated with warts. Seconding is that try not to have skin contactin public places especially in areas which are wet like public toilets, swimming pools and gyms in order to prevent chances of getting a wart infection.

How to Treat Warts？

Wart treatment options include use of drugs, cryotherapy and laser therapy. Medication therapy mainly involves Flurouracil Ointment, Imiquimod Ointment, Salicylic Acid Ointment, and Tazarotene Creams which act as wart remover creams. These medications help dissolve wart tissues, limit replication of viral cells or destroy viral particles thus improving symptoms associated with warts. Cryotherapy is a technique for treating common warts through rapid freezing using liquid nitrogen. The low temperature of liquid nitrogen leads to freezing damage within the wart tissue; this destroys the virus particles as well as the wart cells hence treating it. Laser treatment removes warts by directly cauterizing, vaporizing or charring the wart tissue. The photothermal effect of the laser can effectively destroy the wart tissue to achieve the purpose of treatment.