Dermoscopy of plantar wart

A 30-year-old female office worker with no significant medical history and no immunosuppression presented with a painful lesion on her left sole for 3 months. The lesion was more painful on walking. Clinical examination revealed a tender hyperkeratotic papule [Figure 1]. The pain was more on lateral pressure compared to vertical pressure. Dermoscopy revealed multiple dotted and linear vessels surrounded by yellow-gray structureless areas giving a “frogspawn appearance” with interrupted and distorted dermatoglyphics over the lesion [Figure 2]. Based on the clinical and dermoscopic findings, a diagnosis of plantar wart was confirmed and the patient was advised to apply a combination of salicylic acid (16.7%) and lactic acid (16.7%) paint once daily.

Close

Figure 1:

Solitary hyperkeratotic papule of the forefoot.

Export to PPT

Close

Figure 2:

Polarized dermoscopy (Heine DELTAone) showing multiple dotted and linear vessels surrounded by yellow-gray structureless areas giving a “frogspawn appearance” with interrupted and distorted dermatoglyphics over the lesion (×20).

Export to PPT

Plantar warts, or verrucae plantaris, are hyperkeratotic papules caused by HPV, predominantly types 1, 2, 4, and 63. These warts often cause significant pain and can impede walking. Dermoscopy significantly enhances the diagnostic accuracy of plantar warts by revealing specific morphological features not visible to the naked eye. The presence of black dots and globules, dotted and linear vessels, frogspawn or falooda seed appearance, and interrupted dermatoglyphics are highly indicative of warts.^[1] These features help differentiate warts from other benign (corns, calluses), and malignant lesions (squamous cell carcinoma). Corns and calluses typically show a central core with intact dermatoglyphics and lack thrombosed capillaries. Squamous cell carcinoma may present with a similar hyperkeratotic appearance but lacks the characteristic black dots and vascular structures of warts.^[1] Dermoscopy can be utilized to evaluate the therapeutic response of trichloroacetic acid in treating warts. Successful treatment is indicated by a uniform white frost and the absence of blood vessels on dermoscopic examination, thus improving treatment assessment and efficacy.^[2]