Periungual Warts Treatment Options

Periungual warts are a distinct type of warts that appear on the digits of your hands as well as feet. They are a thick growth of skin, visibly resembling a cauliflower and rigid to touch. Though benign in nature, they might cause pain if they appear in weight bearing positions like the base of the feet. Because of their painless nature, most patients ignore these warts. However, not only are they repulsive in looks, but they can also cause some serious damage to your nails, permanently altering their structure. There are various treatment options available through which patients can get relief from this HPV infection.


Periungual warts belong to the big family of warts which are caused by the human papillomavirus (HPV) infection. The HPV virus is highly contagious and enters the body through cuts, abrasions, scrapes or any other kind opening in the skin. On multiple occasions, the HPV virus enters our body through the openings caused by the nail biting habit of certain individuals, causing pariungual warts. The open wounds of nail biters make it easy for the HPV virus to settle in the nail beds and develop warts. Periungual warts belong to the common warts family and hence do not have a specific cause. Since Periungual warts are contagious, a common cause of this infection is touching an infected person. Individuals already infected with warts are at a high risk of spreading it to other parts of their body. Touching objects earlier used by persons infected with Periungual warts might also be a cause of the disease. Public places which are frequented by various people like beauty salons or swimming pools might be instrumental in spreading the HPV infection. People who are involved in activities which include great water usage like dishwashing, etc are more prone to HPV infections than others. Since Periungual warts are caused by a virus, reoccurrence of these warts even after removal is common if the virus lives on.


The Periungual warts are seen in the nail beds of the hands and feet as raised, rigid, cauliflower like structures. The most common symptoms of periungual warts are the unnatural growth surrounding the lateral nail folds causing benign fissures. Periungual warts also cause loss of cuticle (base skin of the nail) and may cause paronychia (a type of nail disease).


Diagnosis for Periungual warts is mostly done through clinical evaluation and rarely through biopsy. Differential diagnosis might be conducted to rule out possibility of other diseases.
The clinical evaluation is generally based on the appearance and occurrence of the wart. The Periungual warts like all other common warts are rigid and cauliflower like in shape with pinpoint black dots appearing on the surface caused by thrombosed capillaries. A common sight on Periungual warts is the absence of skin lines covering the infected area and bleeding if the wart skin gets shaved off.
Differential diagnosis includes:
– Onychomycosis: The nail infection in this disease resembles that seen in Periungual warts. A biopsy of the nail plate is conducted to reaffirm infection.

– Corns: The appearance of fissures developed in corns is similar to that of the Periungual warts but they lack the thrombosed capillaries when shaved.

– Lichen Planus: They mimic flat warts but also display other symptoms uncommon in warts like lacy oral lesions and Wickham striae (randomly located, visually unappealing white lines).

Periungual Warts Treatment options

Treatment options for Periungual warts differ from non invasive home remedies to surgery in extreme cases.
Home treatment
One of the most used home treatment options is suffocating the wart growth by covering it with an electrical duct tape or some other tape which is not made of a breathable material. Once the infection is covered with the tape, it is not to be disturbed unless you have to change the tape. Change the tape everyday and continue suffocating it for six out of seven days a week to get results.

Over the counter drugs, which contain salicylic acid have been proven effective in fighting warts. Though salicylic acid and compounds are effective in treating Periungual warts on the surface, they cause damage to the nails if used to treat warts going deep into the nail beds. Bleomycin is a drug which is primarily used in cancer treatment but has also been proven effective against warts. These medicines progressively disperse the wart and, over time, cure it. Bleomycin is directly administered into Periungual warts with diluted doses. Though effective, it might have negative effects.

Liquid nitrogen is used in this process to be sprayed over the infected area through a cryogun, a special instrument for precise application of the cooling agent. In the Greek language ‘Cryo’ means cool and hence the name cryosurgery as it involves freezing the infected area. Cryosurgery is general considered as a second-line of treatment with drugs and medication being the first.

Surgery is saved as a last resort if the wart growth is recurring or the growth is abnormally large and unresponsive to any other modes of treatment. The sutures, part of traditional surgery, might leave scars on the patient.

Combination therapy
According to a recent study published by Dr Sukhdeo Patidar in the Journal of Cutaneous and Aesthetic Surgery, the recurrence of warts can be stopped by combining two available treatment options into a single treatment program. Dr Patidar conducted a combination of two common treatment methods, i.e. electrodessication and chemical cautery with trichloroacetic acid (TCA) on a 24 year old male volunteer and successfully averted recurrence.

Prevention tips

Prevention against Periungual warts is difficult as there is no exact cause known which can be avoided. It’s a highly contagious disease and hence it is important we follow the basic prevention guidelines.

  1. Do not bite around your nails. Many individuals have a distasteful habit of biting the skin around the nail, because of stress or other reasons. This habit should be discouraged completely as open wounds on the hands attract HPV virus.
  2. If you have already contracted Periungual warts on either of your hands or feet, make sure you maintain highest level of hygiene when touching other body parts. There are strong chances you might spread it to your other body parts.
  3. When in the vicinity of a person suffering from Periungual warts, avoid direct touch to the infected area. Excuse yourself from pleasantries like handshakes.