Periungual Warts

Periungual warts appear under or around toenails and fingernails.   In the beginning they are about the size of a pinhead, smooth and virtually impossible to spot.  But as the weeks progress they grow to pea size and turn into rough, irregular bumps that can affect nail growth and cause them to detach as the sheer size of a wart cluster elevates the nail.   In the most severe cases nails can be permanently deformed.  Further complications may arise if the wart enters the nail plate, as this can lead to a fungal infection.

Causes

The culprit is the human papilloma virus (HPV), a highly contagious infectious agent which can enter the body through cuts and abrasions.  Periungual warts are often found on people who bite, pick, and tear at their nails.  The broken skin surfaces make it easier for the virus to take hold.

Symptoms

It’s very easy to spot the presence of periungual warts as ugly growths around or under toenails and finger nails.   These nail warts look like rough bumps with uneven borders.  A periungual wart can sometimes have a cauliflower like appearance around the nail.  If left untreated they can be particularly painful, especially for young children, as the large lesions may cause the nail plate to left.  There is a danger of spreading the virus to other parts of the body if nails are bitten and hands are not washed.

Treatment

Just like all other warts that plague humans, it is possible to treat those that have made a home on the skin around finger and toe nails with salicylic acid, laser therapy, the freezing process cryotherapy, and various other topical treatments.

No matter how difficult, treatment should start as soon as possible to prevent the nail from lifting. However, warts lying under the nail present a more difficult challenge to physicians and traditional treatments are ineffective.  That’s because the viral induced growths are much harder to get to.  Liquid nitrogen and salicylic acid treatments can’t reach them, and in fact may actually damage the nail in the process.  Laser therapy has proved to be very effective so far (Gonzales J. The Treatment of Warts with Intense Pulsed Light Technology.   University of Puerto Rico, Department of Dermatology http://www.palomarmedical.com/FileUploads/Gonzalez-WartsIPL-1553-0003.pdf), and it could soon be joined by photodynamic therapy.  A small study of 20 patients in The Netherlands achieved a 100 per cent clearance rate after an average of 4.5 treatments.  Periungual warts were treated with a photosensitizer, and then irradiated with Versa Light (Schroeter CA et al. Successful treatment of periungual warts using photodynamic therapy: a pilot study. J Eur Acad Dermatol Venereol. 2007: Oct; 21 (9): 1170-4).   Larger studies will be needed to replicate these results.  But as with all warts, removal may only be temporary; warts have a nasty habit of returning to a previously infected person.

 


Alternate names:  periungal warts, fingernail warts, nail warts

Periungual Wart Prevention Tip

Keep children's fingernails and toenails clipped so they won't be tempted to start biting their nails.  Also, encourage hand washing.  It can help prevent periungual warts and other numerous types of sickness.

More About Warts