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

Topic Completed: 1 December 2015

Minor changes: 29 March 2019

Copyright: 2003-2018,, Inc.

PubMed Search: Verruca vulgaris [title]

Hillary Rose Elwood, M.D.
Page views in 2019: 33,081
Page views in 2020 to date: 17,247
Cite this page: Elwood H. Verruca vulgaris. website. Accessed August 7th, 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

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

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

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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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