A 22-year-old woman requests treatment for growths around
her eye. She first noted the lesions, which are asymptomatic,
several months earlier. The patient had used an over-the-counter
cream containing hydrocortisone to resolve the lesions but
had abandoned this therapy after three weeks, when she discovered
new lesions. Examination reveals multiple flesh-colored papules,
1 to 2 mm in diameter. No similar lesions are noted elsewhere.
Verrucae are caused by infection with the human
papilloma virus, of which many antigenic subtypes have been
identified, some carcinogenic. The common wart, or verruca vulgaris,
manifests as a hyperkeratotic papule or plaque. This patient
has flat warts, or verrucae plana--tiny, flesh-colored papules
often less than 2 mm thick. They frequently appear on the face,
where their eradication may prove difficult. Light cryosurgery
and electrodesiccation are the methods of choice. Topical application
of retinoic acid or imiquimod may also be effective.
Dr. Schleicher is director of the DermDx Centers for Dermatology
of Northeastern Pennsylvania and a clinical instructor of dermatology
at Graduate Hospital's City Line Campus in Philadelphia, Kings
College in Wilkes-Barre, and Beaver College in Glenside, Pennsylvania.
He is also a member of the EMERGENCY MEDICINE editorial board.
