Skin nonmelanocytic tumor
Benign (nonmelanotic) epidermal tumors or tumor-like lesions
Verruca vulgaris

Topic Completed: 1 December 2015

Minor changes: 24 September 2020

Copyright: 2003-2020,, Inc.

PubMed Search: Verruca vulgaris [title]

Hillary Rose Elwood, M.D.
Page views in 2019: 33,081
Page views in 2020 to date: 24,292
Cite this page: Elwood H. Verruca vulgaris. website. Accessed October 24th, 2020.
Definition / general
  • Also known as Common Wart (see also Warts)
  • Common human papillomavirus (HPV) infection of skin
Essential features
Clinical features
  • All ages can be affected, common in children and adolescents
  • Immunocompromised particularly susceptible
  • Many HPV types implicated, HPV type 2 most common
  • Rough hyperkeratotic to papillomatous skin colored or erythematous papule / plaque
  • Often multiple
  • Commonly on hands and feets
  • May have black dots within the lesion (correlating with thrombosed capillaries in dermal papillae)
  • Often slow to respond to therapy
  • Some may regress spontaneously
  • Various therapies have been used
  • Common management options include observation, electrocautery, excision, cryotherapy, topical therapy (such as salicyclic acid, antharidin, podophyllin, tretinoin)
Clinical images

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Verruca vulgaris

Verruca vulgaris

Microscopic (histologic) description
  • Well circumscribed exophytic growth with marked hyperkeratosis and papillomatosis
  • Rete ridges slope inward at borders of lesion
  • Prominent granular layer with vacuolated superficial keratinocytes with pyknotic nuclei (koilocytes)
  • Dilated blood vessels within papillary dermis
  • Tiers of parakeratosis overly papillary epidermal tips
  • Red blood cells often seen within parakeratotic tiers
  • May have lichenoid lymphocytic infiltrate, particularly in regressing verrucae
  • Areas resembling trichilemmoma may be at the base of some long standing warts
Microscopic (histologic) images

Contributed by Hillary Rose Elwood, M.D.
Verruca vulgaris Verruca vulgaris Verruca vulgaris Verruca vulgaris Verruca vulgaris

Verruca vulgaris

Images hosted on other servers:
Low power

Low power

Differential diagnosis
  • Seborrheic keratosis:
    • No hypergranulosis, koilocytes, tiers of parakeratosis
    • Some benign lesions have intermediate overlapping features of verruca vulgaris and seborrheic keratosis, and may be termed "verrucous keratosis"
  • Squamous cell carcinoma:
    • May have a papillomatous architecture, but has the cytologic atypia, mitoses and infiltrative growth pattern of a carcinoma
  • Verrucous carcinoma:
    • This is mainly an issue in distinguishing from verrucae when the lesion is transected above the base
    • Deeper biopsies / excisions will show the classic deep bulbous downgrowths
    • Clinical history is important and verrucous carcinoma is worth considering in long standing lesions, particularly in genital or plantar locations, that are superficially transected at biopsy
  • Verruciform xanthoma:
    • At low power may have a verruca-like architecture with hyperkeratosis and papillomatous acanthosis
    • However, papillary dermis is filled with numerous xanthomatous cells
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