Disseminated verruca vulgaris in an immunocompetent individual: an exception to the rule

Aishwarya Moparthy; Debasmita Behera; Mrinalini Dey; Chinmoy Raj; Farheen Begum; Shini Choubey

doi:10.18203/issn.2455-4529.IntJResDermatol20260375

Authors

Aishwarya Moparthy Department of Dermatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Debasmita Behera Department of Dermatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Mrinalini Dey Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Chinmoy Raj Department of Dermatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Farheen Begum Department of Dermatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Shini Choubey Department of Dermatology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20260375

Keywords:

Verruca, Human papillomavirus, Verruca plana

Abstract

Verruca or viral warts affect nearly 10% of the global population and are caused by human papillomavirus (HPV) infection, with more than 200 subtypes recognized to date. These lesions commonly involve the skin and mucous membranes and are transmitted through direct or indirect contact. Verruca plana, also known as flat warts, are typically smooth, flat-topped, reddish-brown or skin-coloured papules that often appear on the face, neck, and dorsal aspects of the hands. They are more frequent in children and young adults. While in most cases, verruca plana are self-limiting, disseminated or extensive presentations are uncommon and may indicate an underlying immune defect. Such widespread involvement warrants evaluation for immunosuppression due to conditions such as HIV infection, prolonged corticosteroid therapy, or other immunodeficiency disorders. Here, we present a case of disseminated verruca plana and outline the systematic clinical and laboratory approach undertaken to rule out any underlying immunocompromised state.

Metrics

Metrics Loading ...

References

Chen Z, Schiffman M, Herrero R, DeSalle R, Anastos K, Segondy M, et al. Classification and Evolution of Human Papillomavirus Genome Variants: Alpha-5 (HPV26, 51, 69, 82), Alpha-6 (HPV30, 53, 56, 66), Alpha-11 (HPV34, 73), Alpha-13 (HPV54) and Alpha-3 (HPV61). Virology. 2018;516:86-101. DOI: https://doi.org/10.1016/j.virol.2018.01.002

Handisurya A, Schellenbacher C, Kirnbauer R. Diseases caused by human papillomaviruses (HPV). J Dtsch Dermatol Ges. 2009;7(5):453-66. DOI: https://doi.org/10.1111/j.1610-0387.2009.06988.x

Cubie HA. Diseases associated with human papillomavirus infection. Virology. 2013;445(2):21-34. DOI: https://doi.org/10.1016/j.virol.2013.06.007

Masatkar V, Gupta LK, Khare AK, Mehta S, Mittal A. Clinicoepidemiologic study of verruca plana at a tertiary care center. Indian J Dermatol Venereol Leprol. 2018;84(2):247. DOI: https://doi.org/10.4103/ijdvl.IJDVL_1028_15

Yanagi T, Shibaki A, Tsuji-Abe Y, Yokota K, Shimizu H. Epidermodysplasia verruciformis and generalized verrucosis: the same disease?. Clin Exp Dermatol. 2006;31(3):390-3. DOI: https://doi.org/10.1111/j.1365-2230.2006.02100.x

Shimano M, Miyauchi T, Yanagi T, Nomura T, Ujiie H. Development of Verruca Plana from Human Papillomavirus 78 Dependent on Host Immune State. Acta Derm Venereol. 2021;101(11):567. DOI: https://doi.org/10.2340/actadv.v101.567

Cheng CY, Lin CY, Lai CH, Chen CB, Chung WH. Acquired epidermodysplasia verruciformis or generalized verrucosis? A clinical and virological comparative study. J Dermatol. 2021;48(9):1414-8. DOI: https://doi.org/10.1111/1346-8138.15866

Pavithra S, Mallya H, Pai GS. Extensive presentation of verruca plana in a healthy individual. Indian J Dermatol. 2011;56(3):324-5. DOI: https://doi.org/10.4103/0019-5154.82495

Sri JC, Dubina MI, Kao GF, Rady PL, Tyring SK, Gaspari AA. Generalized verrucosis: A review of the associated diseases, evaluation, and treatments. J Am Acad Dermatol. 2012;66(2):292-311. DOI: https://doi.org/10.1016/j.jaad.2010.12.011

Kim HS, Park HJ, Lee JY, Cho BK. Three Cases of Verruca Plana Treated Successfully with 5% Imiquimod Cream. Annals of Dermatology. 2005 ;17(1):38-40. DOI: https://doi.org/10.5021/ad.2005.17.1.38

Elmas ÖF, Atasoy M, Akdeniz N, Özyurt K. A recalcitrant case of facial verruca plana successfully treated with topical calcipotriol alone. Dermatol Ther. 2020;33(4):e13664. DOI: https://doi.org/10.1111/dth.13664

Berumen-Glinz C, de la Barreda-Becerril F. Treatment of Verruca Plana With Topical Combination of Calcipotriol and Fluorouracil. JAMA Dermatol. 2022;158(5):586-7. DOI: https://doi.org/10.1001/jamadermatol.2022.0154

Lv S, Fu X, Yue Z, Zhang H, Zhou G, Liu H, et al. Photodynamic therapy and CO2 fractional laser combination therapy for verruca vulgaris caused by Koebner phenomenon - Two case reports. Photodiagnosis Photodyn Ther. 2024;45:103946. DOI: https://doi.org/10.1016/j.pdpdt.2023.103946

Al‐Sabak H, Jaafar AA. Treatment of plane warts with long pulse ND – YAG laser 532 nm. Skin Res Technol. 2023;29(9):e13462. DOI: https://doi.org/10.1111/srt.13462

Balevi A, Üstüner P, Özdemir M. Use of Er:YAG for the treatment of recalcitrant facial verruca plana. J Dermatolog Treat. 2017;28(4):368-71. DOI: https://doi.org/10.1080/09546634.2016.1244601

Cengiz FP, Emiroglu N. An open, comparative clinical study on the efficacy and safety of 10% trichloroacetic acid, 25% trichloroacetic acid and cryotherapy for verruca plana. Cutan Ocul Toxicol. 2015;34(2):144-8. DOI: https://doi.org/10.3109/15569527.2014.924961