Periungual warts (verruca periungualis) are rough, textured growths that appear around the fingernails or toenails. They are caused by the Human Papillomavirus (HPV), which infects the outer layer of skin. This infection triggers rapid cell growth, forming the wart. Periungual warts often start as small lesions and can develop a distinct, cauliflower-like appearance. Their location near the nail fold, cuticle, or beneath the nail plate makes them particularly stubborn and often causes discomfort.
Natural Resolution and Persistence
Common warts often resolve without intervention, especially in younger people, as the immune system clears the viral infection. Typically, about half of all common warts disappear within one year, and two-thirds clear within two years. Periungual warts are far more persistent than warts found elsewhere on the body.
This persistence is due to their location near the nail unit, where moisture and microtrauma are common. Habits like nail-biting or picking create tiny breaks in the skin, allowing HPV to establish the infection. Furthermore, the wart’s proximity to the nail bed makes it difficult for immune cells to effectively eliminate the virus.
Constant pressure and friction on the fingers and toes can stimulate the wart’s growth, making spontaneous regression less likely. While natural resolution is possible, patients should expect a longer timeline, often requiring active intervention. Prolonged presence can cause complications, including nail disfigurement and secondary bacterial infection of the surrounding skin.
Professional Treatment Options
If natural clearance fails, or the wart becomes painful, professional treatment is usually required due to the stubborn nature of these warts. Treatment selection depends on the wart’s size, position relative to the nail, and the patient’s overall health. The primary goal is to destroy the infected tissue while preserving the surrounding nail matrix to prevent permanent nail deformity.
Cryotherapy, which uses liquid nitrogen to freeze the wart tissue, is a widely used and effective method. This procedure destroys wart cells through thermal death and stimulates an immune response. It often requires multiple sessions spaced one to two weeks apart, with cure rates between 50 and 70 percent after three or four treatments.
Topical chemical treatments, such as high-concentration salicylic acid, are a first-line approach, especially for children and milder cases. The acid acts as a keratolytic agent, slowly breaking down the thickened wart tissue over several weeks or months. Other topical agents include cantharidin, which causes a blister beneath the wart, or prescription-strength retinoids.
Treatment for Resistant Warts
For very resistant or large lesions, several office-based procedures may be used:
- Laser therapy, which targets and destroys the tissue with focused light.
- Electrosurgery, or electrical cauterization, which uses a high-frequency current to burn off the wart tissue.
- Immunotherapy, which uses injected antigens like Candida or the mumps vaccine to stimulate a localized immune attack against the virus.
- Surgical removal, which is generally reserved for the most severe cases due to the potential for scarring and nail damage.
Understanding Transmission and Prevention
Periungual warts are caused by the highly contagious Human Papillomavirus (HPV). HPV spreads through direct skin-to-skin contact or contact with contaminated surfaces. The virus enters the body through small cuts, abrasions, or cracks in the skin, often created around the nails, allowing easy spread from one finger to another.
Effective prevention focuses on minimizing opportunities for the virus to enter the skin and avoiding its spread. It is important to avoid habits like nail-biting, picking at hangnails, or excessive cuticle trimming, as these compromise the skin barrier. Keeping the skin around the nails healthy and moisturized helps prevent the tiny cracks that serve as entry points for the virus.
Good hand hygiene, including regular hand washing, is an important preventative measure. Sharing personal items, such as nail clippers, files, or towels, should be avoided as they facilitate virus transfer. Individuals who frequent public areas like gyms or pools should wear protective footwear to limit exposure to HPV on surfaces.