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Pathology of Virally Induced Epidermal Lesions

Dr Sampurna Roy MD   

Dermatopathology Quiz Case 203

Diagnosis: Verruca Vulgaris

Path Quiz Case 29: Case History and images

Diagnosis: Verruca Vulgaris




Human Papilloma Virus - Associated Lesions: 

Keratinocytes react to human papillomavirus (HPV) infection by proliferation resulting in different clinical manifestations ranging from flat warts to common warts and cauliflower-like or filiform warts.

The clinical presentation may vary according to the HPV type and anatomical site.

Classifiation of Verruae:

1. Verruca Vulgaris or common wart

2. Verruca palmaris or plantaris (myrmecia or palmoplantar wart)

3. Verruca plana

4. Epidermodysplasia verruciformis

5. Condyloma Acuminatum

Pathology of Verruca Vulgaris:

Verruca vulgaris (common wart) is caused by various strains of human papilloma virus (HPV 1, 2, 4, 7, 26-29).

Gross features:  Verruca vulgaris may present as a hard, rough surfaced papule 0.2 - 2cm.

Lesion may be solitary or multiple.

Microscopic features: 

1 2 3

 Image 1. Showing papillomatous lesion with inward bending of reteridges

 Image 2. Prominent keratohyaline granules.

 Image 3. Low power view showing  the characteristic features of Verruca Vulgaris.

- Exophytic;

- Symmetric;

- Papillomatous lesion with large keratohyaline granules and characteristic inturning of the rete ridges ; 

- Parakeratotic columnar tiers of stratum corneum overlie the papillomatous surface ;

- Small amounts of haemorrhage may be present within the columns of parakeratosis ; 

Other characteristic features -

- Koilocytosis ; 

- Hypergranulosis and presence of multinucleated cells;

- Koilocytes are not seen in older lesions ;

- In the filiform type of verruca vulgaris there is marked papillomatosis.


Further reading:

Morphological characterization of the virus of the human common wart (verruca vulgaris)

The nature of the inclusion body of verruca vulgaris: A histochemical study of nucleotids

Cutaneous warts: an evidence-based approach to therapy.

Verruca Vulgaris (Common Warts)

Identification of human papillomavirus types in oral verruca vulgaris

Possible clonal origin of common warts (Verruca vulgaris)

PCNA expression in cutaneous keratinous neoplasms and verruca vulgaris.

Pathology of Verruca Palmaris or Plantaris (Myrmecia or Palmoplantar Wart) 

These are painful endophytic lesions found on palms and soles of adolescents.

Microscopic features:


-Symmetric and endophytic lesions.

-Characterised by epidermal hyperplasia and presence of large intracytoplasmic, keratohyaline granules in the superficial keratinocytes.

Further reading:

Intralesional recombinant alpha-2 interferon for the treatment of patients with condyloma acuminatum or verruca plantaris

Heterogeneity of the human papillomavirus group.

Detection of human papillomavirus type 60 in plantar cysts and verruca plantaris by the in situ hybridization method using digoxigenin labeled probes.

New approach to the treatment of intractable verruca plantaris (plantar wart)

Acral lentiginous melanoma misdiagnosed as verruca plantaris: a case report


Pathology of Verruca Plana (Plane Wart) 

These are usually multiple flat to slightly papular lesions, located on the face, neck or extremities.

Microscopic features:   

Symmetric lesions with slightly hyperplastic epidermis ;

Verrucous changes and parakeratosis are minimal ;

There is vacuolation of cells in the upper epidermis and basket weave pattern is noted in the overlying stratum corneum.

Read related posts: Epidermodysplasia verruciformis ; Condyloma Acuminatum.


Further reading:

Verruca plana of the face treated by posthypnotic suggestion.

Seborrheic keratosis or verruca plana? A pilot study with confocal laser scanning microscopy

The effect of cimetidine on verruca plana juvenilis: clinical trials in six patients.

Verruca plana and epithelial nevus: Including a study of epidermodysplasia verruciformis

Tattoo-acquired verruca plana.

Pox Virus Associated Lesions:
Molluscum contagiosum




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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