|
KMID : 0363220170550010083
|
|
Korean Journal of Dermatology
2017 Volume.55 No. 1 p.83 ~ p.84
|
|
|
A Case of Subungual Verruca in All Fingers
|
|
Suh Hyun-Yi
Kim Hong-Lim
Kim Kyung-Ho
Park Mi-Youn
Youn Jai-Il
Ahn Ji-Young
|
|
|
Abstract
|
|
|
|
Viral warts are common, benign, and frequently irritating skin lesions caused by the human papillomavirus (HPV). Direct skin trauma is the usual cause of local viral infection 1. However, development of infection depends on various local and systemic factors such as working environment or immunocompromise2. Subungual verruca is HPV infection of the nail bed. We report a rare case with subungual verruca in all 10 fingers. A 64-year-old man visited our clinic with subungual hyperkeratotic plaques in all fingers (Fig. 1A, B). The condition initially appeared in the hyponychium of the right first finger 3 years prior, and had since spread to all fingers. There was no evidence of trauma or underlying disease. The patient`s occupation was that of a professional scrubber, who scrubs down bathrooms in a public bathhouse. Potassium hydroxide (KOH) test was performed on all fingers to assess the possibility of a fungal infection(s); however, the results were negative. Subsequent biopsy and histological analysis of the lesion indicated papillomatous hyperplasia with hypergranulosis and parakeratosis in the epidermis. Viral inclusions were found in the upper epidermis. The biopsy tissue was subjected to liquid bead microarray assay for HPV detection and genotyping. The HPV oligonucleotide microarray detected type 11 and type 58 HPV. Thus, the final diagnosis was subungual warts. The patient was provided only three sessions of cryotherapy treatment and the lesions showed improvement after each session. However, owing to the pain during treatment, the patient did not return after the third session. Warts can develop from a few weeks to greater than a year after infection with HPV1. A less common area of infection is under the nail plate. Subungual warts may appear as a linear growth that penetrates deep underneath the nail plate, producing a longitudinal band of onycholysis, or a nodular lesion that lifts the nail plate ultimately leading to onycholysis 2. Lesion characteristics are influenced by the virus type as well as environmental and host factors4. Butcher`s warts are related to HPV type 73. People in certain occupations have an increased risk of ungual warts. Up to 23% of handlers of meat and fish develop warts due to continuous skin maceration5. HPV is highly resistant to heat, desiccation, and detergents. Our patient worked in a communal washing area and his hands were subject to continuous skin maceration. In addition, one study5 suggested that public shower users are at greater risk for plantar warts than those who do not use such communal showers. Therefore, our patient`s occupation and constant exposure to environ-mental factors contributed to the development of his skin lesions. Treatment for warts should be prescribed based on factors such as lesion size, number, and immunity2. Further-more, subungual warts may be difficult to treat due to their location. The most common forms of wart treatment are topical salicyclic acid application, cryotherapy with nitrogen, and laser therapy. In conclusion, we report a rare case in which an otherwise healthy man developed subungual warts on all fingers; the most probable cause was the environmental factor related to his occupation.
|
|
|
KEYWORD
|
|
|
Subungual verruca, Human papillomavirus, Type11 HPV, Type 58 HPV
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
  
|
|