Warts are common, benign skin growths caused by infection with the Human Papillomavirus (HPV). This virus stimulates rapid cell growth, resulting in the characteristic rough texture of a wart. Periungual warts develop in the skin surrounding or underneath the fingernails or toenails. Because these lesions are contagious, people often worry about the potential for them to spread from the hands to other visible parts of the body, such as the face.
What Are Periungual Warts
Periungual warts appear on the skin directly adjacent to the nail plate or sometimes grow beneath the nail itself. These growths often present with a thickened, rough, fissured texture. When they grow under the nail, they can be painful and may cause the nail plate to lift or become distorted.
These warts are caused by specific, low-risk types of HPV. The virus enters the epidermis through a minor cut or abrasion near the nail. Individuals who bite their nails or pick at their cuticles are at a higher risk because they frequently create these small entry points for the virus.
The Mechanics of Wart Transmission
Wart transmission relies on the transfer of HPV particles through direct contact between an infected surface and a susceptible area of skin. The virus requires a small break or micro-abrasion in the epidermis to gain entry and establish an infection. Areas prone to trauma, like the skin around the nails, are frequent sites of initial infection.
The primary mechanism for spread is known as autoinoculation. This occurs when an individual touches an existing wart and then transfers the virus to another uninfected skin site. Moisture and skin maceration, often found around the nails, facilitate the shedding and transmission of viral particles.
Risk of Spreading Warts to the Face
The biological possibility of periungual warts spreading to the face exists because autoinoculation is not site-specific. If an individual touches their wart and then immediately touches a vulnerable area of facial skin, especially one with a cut or abrasion, viral transfer can occur. However, transmission of a periungual wart to the face is generally considered relatively uncommon compared to spread on the hands or feet.
A factor limiting facial spread is that the HPV strains causing common warts on the hands and periungual area are often different from those that cause flat warts, which are the type typically seen on the face. Periungual HPV types are better adapted to the thicker, tougher skin of the extremities than the thin skin of the face.
The greatest localized risk of spread is to immediately adjacent structures, such as the lips or the mucosal tissues inside the mouth. This risk is primarily associated with individuals who bite their nails or pick at the surrounding skin. The likelihood of developing a periungual-type wart on distant areas like the forehead or cheeks through casual touching is lower than the risk of spreading it to another finger.
Prevention Methods to Stop the Spread
Preventing the spread of periungual warts centers on minimizing the opportunity for autoinoculation and protecting susceptible skin. A fundamental step is to strictly avoid picking, scratching, or biting the wart and the surrounding skin, as this action releases viral particles and creates new entry points. Avoiding trauma to the skin surrounding the nails is helpful, as HPV easily enters through damaged or wet skin.
Covering the existing wart with a small, clean bandage or waterproof plaster, especially during activities where contact is likely, serves as a physical barrier against viral shedding. Maintaining rigorous hand hygiene is also an important practice. Frequent washing with soap and water helps reduce the viral load on the hands, minimizing the chance of transfer. Additionally, individuals should refrain from sharing personal items that come into direct contact with the wart, such as nail clippers or towels, to minimize indirect transmission risk.
Treating Periungual Warts
Treating periungual warts is recommended since eliminating the source of the virus is the most effective way to halt its spread. Over-the-counter treatments typically rely on high concentrations of salicylic acid, a keratolytic agent that gradually dissolves the wart tissue. This method requires diligent, consistent application over several weeks or months.
Professional dermatological treatments are often necessary due to the thick, fibrous nature of these warts and their difficult location. Cryotherapy involves freezing the wart tissue using liquid nitrogen, a procedure that may be repeated every few weeks until the lesion resolves.
Other options include electrocautery, which uses heat to destroy the tissue, and laser therapy, which targets the blood vessels supplying the growth. For resistant cases, doctors may use topical prescription medications or immunotherapy. Treatment near the nail bed is particularly challenging because care must be taken to avoid permanent damage to the underlying nail matrix, which could lead to nail deformities.