5. Warts, Psoriasis and Lichen Planus

  • Caused by Human Papilloma Virus

  • Verruca vulgaris - Common Wart

  • Periungual wart - near the nails [[Pasted image 20210622101950.png]]

    • This is due to the stress at finger such as biting nails
    • Cauliflowered shape growth - exophytic growth
  • Black dots - thrombosed capillaries [Plantar wart]

    • Pain when pressure applied - in plantar wart: horizontal pressure needs to be applied
  • Filiform wart/digitate wart: long/ thin projections of skin, giving them a distinctive appearance

  • Deep palmoplantar wart/myrmecia:

    • endophytic growth
  • [[Pasted image 20210622103443.png]]

  • Plane warts/flat warts

    • [[Pasted image 20210622103532.png]]
  • Most wart lesions resolve themselves

    • If immunosuppressed - they become more extensive
  • HPV Serotype 6, 11, 16, 18, 31, 33 - They cause genital warts (condylomata accuminata), the latter ones cause higher-risk stress leading to malignancies such as cervical cancer etc

  • True Koebner’s are seen in Lichen planus and Psoriasis

  • Bowenoid Papulosis is a rare, sexually transmitted disorder thought to be caused by human papillomavirus type 16. This disorder is characterized by lesions that are found on the genitals of males and females. The lesions are reddish brown or violet in color, small, solid, raised and sometimes velvety.

  • [[Pasted image 20210622104707.png]] Bowenoid Papulosis in the perianal are

  • In situ squamous cell carcinoma - requires biopsy

  • Epidermodysplasia veruciformis - autosomal inherited susceptibility to HPV

Treatment of warts

  • Salicyclic and Lactic acid application
  • Cryotherapy
  • Podophyllin paint- genital warts
  • Imiquimod 5% cream- genital warts
  • Electrocautery


  • Gardasil against type 6 and 11
  • Cervarix against type 16


  • Micaceous scaling

  • Koebner’s phenomenon - first discovered in Psoriasis

  • Classically seen on such as scalp and extensors, , back, elbow, knees, dorsum of the hand

  • Guttate psoriasis - normally seen after strep throat

  • Pustular psoriasis - may be localized or generalized

  • oligopharyngeal psoriatic arthritis - a few joints are involved

  • Auspitz sign: now generally not performed and considered a test of historical significance

  • [[Pasted image 20210622114352.png]]

  • There are three steps to this test:  Step A: Gently scrape lesion with a glass slide. This accentuates the silvery scales (Grattage test positive). Scrape off all the scales.  Step B: As you continue to scrape the lesion, a glistening white adherent membrane (Burkley’s membrane) appears (Fig. 4.3, step B).  Step C: On removing the membrane, punctate bleeding points become visible (Fig. 4.3, step C); this is positive Auspitz sign


  • Immunosupressants (Methotrexate) esp. when joint involvement and extensive body
  • eperemelast (PDE5 inhibitor)
  • Cyclosporine
  • Acetritin esp. in pustular
  • MABs -> Cekikinomab

Lichen Planus

7Ps - Lichen Planus Prurutic Purplish Polygonal Planetopped Papules and Plaques

  • On flexoral aspects
  • Immune-mediated disease just like Psoriasis - polygenic cause
  • Lacy pattern/striae like pattern - wickham striae
  • Dark skinned - Violecious may not be seen in dark colored as it becomes more hyperpigmented
  • Oral mucosa should be examined for ORAL Lichen Planus
  • Nail Lichen planus