What are periungual warts?

Periungual warts form around your fingernails or toenails. They start small, about the size of a pinhead, and slowly grow to rough, dirty-looking bumps that can resemble cauliflower. Eventually, they spread into clusters.

Periungual warts commonly affect children and young adults, especially if they are nail biters. These warts are difficult to treat, but it helps to start treatment as soon as you identify the warts. Like all warts, periungual warts are caused by the human papilloma virus (HPV).

What are the symptoms?

Periungual warts are not painful when small. But they can become painful when they grow. They can also interrupt your regular nail growth and split the skin around your nail. Your nails and cuticle can become disfigured by periungual warts.

What causes periungual warts?

Periungual warts are caused by HPV, specifically by strains:

  • 1
  • 2
  • 4
  • 5
  • 7
  • 27
  • 57

Learn more: Common types of human papillomavirus »

HPV can enter your body through a cut or scrape. That’s why you have an increased risk for periungual warts if you bite your nails or pick at your cuticles. You’re also at an increased risk if you frequently have your hands in water. For example, if you wash dishes at a restaurant, you may have an increased risk for developing this type of wart.

People with a compromised immune system are also at an increased risk for developing warts, and if you do develop warts, they may take longer to go away. People with atopic dermatitis also have a higher risk of getting periungual warts.

The HPV virus is highly contagious. You or your child can catch it by touching someone with a wart or by sharing:

  • towels
  • toys
  • other personal items used by someone who has a periungual wart

The virus can remain on a surface and spread to someone who touches it. The virus can also spread to other parts of your body, so good hygiene and frequent hand-washing are essential if you have periungual warts.

How is a periungual wart treated?

If you suspect that you or your child has a periungual wart, it’s best to see a doctor as soon as possible. If the wart spreads under your nail to the nail bed, it can cause permanent damage and lead to a fungal infection.

There’s no cure for warts. Treatments focus on eliminating symptoms and clearing the appearance of the warts. Many treatment possibilities and combinations exist. There are no clear treatment guidelines because there are few double-blind studies of wart treatment.

Periungual warts are generally considered difficult to treat. They can recur and spread further, even after treatment.

Possible treatments for periungual warts include the following:

Salicylic acid

Salicylic acid has been studied as a treatment of warts more than most other wart treatments. A 2011 review of the medical literature found salicylic acid to be the treatment option with the best evidence of effectiveness.

Salicylic acid works slowly, and requires frequent treatments for up to 12 weeks. It works by destroying the infected skin. As a result, it may cause skin irritation. Salicylic acid is available over-the-counter, but it’s best to check with your doctor on whether and how to use it, and what strength to use.

Cryotherapy

Cryotherapy refers to a treatment where your doctor uses liquid nitrogen to freeze off your warts. It may require fewer treatments than salicylic acid, often only needing three to four treatments. Success rates for salicylic acid and cryotherapy are about the same, with reported success rates in 50 to 70 percent of cases. Cryotherapy can also be used in combination with salicylic acid. It may cause blistering or skin discoloration.

Antigen injections

Injections of antigens to mumps or Candida into the wart is reported to be effective. The antigens mediate an immune system attack on the warts. Before using this treatment, your doctor will test to make sure that you will develop an immune reaction to the skin antigen. Side effects may include itching and burning.

Additional treatments

Other treatments include carbon dioxide laser, or pulsed dye laser therapy and combination therapies with topical drugs. All of these are reported to have success with some people. More random controlled studies of treatment effectiveness with periungual warts are needed.

A 2006 review of all treatments for warts concluded that more research is needed to find the best treatment. The researchers suggested that the most promising research is in the development of type-specific antiviral therapies for HPV.

What are the possible complications?

Periungual warts can cause permanent damage and disfigurement to your nails and nail beds. The warts may also lead to a soft tissue infection called paronychia.

What’s the outlook?

Periungual warts are not easy to treat because of their location. They also have a high rate of recurrence, no matter which treatment is used. In general, you can expect to see results from treatment within three to four months. Even without treatment, more than half the cases of all types of skin warts are reported to disappear on their own within a year, and two thirds of cases resolve within about two years.

How can you prevent spreading periungual warts?

The first line of defense against spreading warts is careful hygiene.

Warts are very contagious and the virus remains transmissible even while the warts are being treated. If your child has periungual warts, or your child is around children who have them, take care that your child understands how warts spread.

To prevent the spread of warts:

  • Wash your hands often.
  • Don’t bite your fingernails or pick your cuticles.
  • Wear protective gloves if your hands have to be in water for long periods.
  • Disinfect nail-cutting equipment each time you use it.
  • Don’t share personal items, like towels or nail clippers.
  • Don’t touch other people’s warts, equipment, or toys they may have used.

Here are some more things to keep in mind to help prevent catching warts from a nail salon:

  • Don’t shave your legs right before you go to the salon. Shaving can break the skin and create an entry point for viruses.
  • If a salon worker uses pumice stone, be sure it’s a new one or bring your own.
  • Employees should wash their hands and change their gloves between clients.
  • Don’t be afraid to ask how their instruments are sterilized. Instruments should soak in a disinfectant for 10 minutes between clients.
  • Disposable tools, such as nail files, buffers, and orange sticks, should be disposed of between treatments.
  • When getting a pedicure, ask for a pipeless drainage system, and that all water is drained from tub and is disinfected before being filled again.

Good hygiene can help reduce your risk for warts, so be sure to speak up if you think you’re being put at unnecessary risk.