Viral Wart Differential Diagnosis Table

Viral Warts Differential Diagnosis Table:

There are over 200 types of human papillomaviruses which can cause different types of warts. Cutaneous warts have different presentations like common warts, plantar warts, or the flat ones.
They can also occur singly or in groups forming plaques. Some types of viruses have predilections towards specific parts of our body. Warts typically present as painless hyperkeratotic papules with a rough, irregular surface.

How to Distinguish Viral Warts from Other Diseases

Distinguish Corns and Callosities from Viral Warts – Diagnosis

Corns and callosities are typically painful, whereas viral warts are painless. Since hyperkeratotic growth is typical of corns and callosities, skin visual examinations and thickness measurements can help us identify corns and callosities from different types of viral warts. You need to look for the following four typical scenarios if you are thinking of corns and callosities instead of viral warts:

• Skin lesion that is rough and thick
• A hardened and raised bump
• There is tenderness under the skin upon palpation
• The skin is either dry, waxy, or flaky.

Distinguish Molluscum Contagiosum from Viral Warts – Diagnosis

Typically, molluscum contagiosum has a central dimple, which is not present in viral warts. Additionally, viral warts have a rough skin texture, which is not a common finding in molluscum contagiosum.

“You must always observe smooth, dome-shaped plaques with umbilication lesions before confirming the diagnosis of molluscum contagiosum.”

Distinguish Seborrheic Keratosis from Viral Warts – Diagnosis

Yellowish skin surface is typical for seborrheic keratosis, not a common finding in viral warts. Additionally, seborrheic keratosis is characterized by a greasy, wax-like, and stuck-on appearance.

Distinguish Actinic Keratosis from Viral Warts – Diagnosis

Actinic keratosis is a UV-induced precancerous skin lesion that typically occurs in sun-exposed areas. Unlike viral warts, actinic keratosis has no skin growth, and yellowish skin finding is common.

“Given prolonged UV exposure is the major risk, you will not commonly find it in people less than 50 years of age.”

Distinguish Callus from Viral Warts – Diagnosis

When the skin is exposed to repetitive pressure and friction, the skin texture becomes thick, and a callus forms. Unlike viral warts, a callus is identified by hardened skin with bare skin growth.

Distinguish Herpes Simplex from Viral Warts – Diagnosis

It is a painful skin condition caused by infection with the herpes virus. A definite diagnosis can be achieved by using PCR to identify HSV DNA components. There is no usual finding of skin growth or a rough skin texture.
Reactivation of herpes infection is a common finding, but symptoms are less severe than the primary infections.

Distinguish Psoriasis Plaques from Viral Warts – Diagnosis

Among different varieties of psoriasis, psoriasis plaques are the most common ones, and it appears as symmetrically distributed, thick, erythematous lesions.
There were recurrent findings of plaque psoriasis in close family members, giving evidence that this variety has a strong familial component.

Distinguish Acrochordon from Viral Warts – Diagnosis

Also referred to by the name skin tags, acrochordons are skin-colored pedunculated papules. Filiform types of skin warts can be confused with acrochordons as they can be pedunculated too, but typically they have finger-like keratotic projections.

Points Not To Forget about Viral Warts

The diagnosis of viral warts is mainly through clinical examination based on their appearances. Among adults, certain occupations can be major risk factors for ending up with a wart, including handlers of meat, poultry, and fish. Otherwise, viral warts are much more common in children and young adults.
Trauma and breach in the protective skin surface followed by inoculation of the human papillomavirus through direct skin contact is a must for the warts to develop subsequently.