History and exam

Key diagnostic factors

common

presence of risk factors

Risk factors include: water immersion, occupations involving handling of meat or fish, nail biting behaviour, young age (<35 years), and an immunocompromised state.

lesion growth over weeks to months

Lesions may range in size from pinpoint to 1 cm, averaging 5 mm.

round, raised papule

Characteristic appearance of common wart.

tiny black dots on surface of lesion

May be seen after gentle paring of the lesion with a scalpel.

Represent thrombosed capillaries.

Other diagnostic factors

common

satellite lesions

Sometimes multiple similar smaller lesions develop following the appearance of the initial lesion.[1][2]​​

fingers or nail fold lesions

Common warts frequently affect the hands, fingers, and periungual areas.

facial lesions

Filiform warts commonly affect facial skin.

fissuring

Common warts may fissure, bleed, and cause pain.

hyperkeratosis

Presenting as a rough, scaly appearance.

greyish-white or light brown colour

Characteristic colour of a common wart.

filiform papule with sharp spikes

Appears to emerge from the skin from a stalk.

Risk factors

strong

water immersion

Swimming and regular dishwashing, for example, are risk factors.

occupations involving handling of meat or fish

Common warts show a prevalence of 50% in people who have direct contact with meat.

nail biting

People who bite their nails have an increased risk of developing periungual warts.[1]​​[2]​​​​

age under 35 years

Only 15% of common warts occur in patients older than 35 years.

immunocompromised

Immunocompromised patients are more susceptible and tend to have more lesions, and occasionally increased lesion size and different morphology, compared with immunocompetent individuals.

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