Periungual warts develop around the finger and toenails. As they expand, they can cause discomfort or pain and may disrupt nail growth.
Children and adolescents are most likely to develop periungual warts, especially if they bite their nails.
Treatment can stop or slow down the growth of these warts, but they may still spread or recur.
Periungual warts form around the nails. At first, they may be pinhead-sized and smooth, shiny, and translucent.
Over several weeks or months, they may grow to the size of a pea and have a cauliflower-like appearance.
The warts can also turn brown, grey, or black. Eventually, they may form in clusters.
Larger periungual warts sometimes cause pain and discomfort.
This virus is contagious, and a person may contract it from contact with infected skin or items such as towels and toys.
HPV usually enters the skin through a cut or scrape, which is why nail-biters are more likely than others to develop periungual warts.
Individuals with compromised immune systems or atopic dermatitis are also at increased risk.
Periungual warts can occasionally cause damage to the nail or nail bed.
A wart growing under a nail can raise it from the skin. Also, periungual warts may cause the loss of a cuticle.
A person with these warts may have an increased risk of developing a soft tissue infection called paronychia. It is caused by bacteria, yeast, or a combination of both. If left untreated, the infection may be painful and cause permanent deformity of the nail.
Periungual warts can be more challenging to treat than other types of wart. It may be difficult to use a topical medication, for example, if a wart is growing under the nail.
A doctor may consider the following factors when recommending treatment:
- the size of the warts
- the number of warts
- the location of the warts
- any accompanying infection
- any pain or discomfort
- the age and gender of the patient
- any previous treatments
Potential treatments include:
Salicylic acid is among the most popular treatments for wart removal.
According to research published by the American Academy of Family Physicians (AAFP), the best available evidence supports its effectiveness.
This acid can destroy the infected skin and the HPV virus. However, it may take up to 3 months of regular applications before the wart is eliminated.
Products containing salicylic acid are available over-the-counter (OTC), but it is a good idea to speak with a doctor before using them.
In this procedure, a doctor will freeze off warts using liquid nitrogen. Though cryotherapy is often a quicker treatment than salicylic acid, three or four applications spaced 2–3 weeks apart may be necessary.
This treatment has a success rate of 50 to 70 percent.
Laser therapy may be recommended if other treatments do not work. The goal is to burn off the wart, but different chemicals involved may result in varying rates of success.
Results of a study from 2011 suggest that aminolevulinic acid may be more effective than other chemicals, including the organic dye used in pulsed dye laser therapy.
However, more research is needed to determine the best laser treatment for periungual warts.
A doctor may recommend injecting an antigen to treat stubborn warts. An antigen is a toxin or foreign substance that induces an immune response.
This provoked response should kill the virus and eliminate the growth.
In severe cases or when the wart is causing complications, a doctor may recommend surgery. However, this may not be an option for all periungual warts.
The surgery is broken into stages called curettage and cautery. First, the wart is scraped or cut away. Then heat is used to seal the wound.
Although success rates are approximately 65 to 85 percent, 30 percent of people may experience scarring or warts that reappear.
A person can take steps at home to reduce the appearance of periungual warts.
The AAFP suggest that “watchful waiting” is a remedy, especially for new warts. Most periungual warts eventually disappear without treatment.
Nail-biters should quit the habit as quickly as possible. It increases the risk of periungual warts and other skin infections.
Stress diminishes the response of the immune system. This can make a person more vulnerable to infection or slow healing time.
To manage stress:
- eat a balanced diet
- exercise regularly
- get enough sleep
- try techniques such as deep breathing, meditation, or progressive muscle relaxation
Apply apple cider vinegar
Apple cider vinegar is a popular natural remedy for warts, but the evidence that supports it is purely anecdotal. No research has concluded that this is a more effective treatment than watchful waiting.
To treat warts located around the nails, proponents suggest mixing two parts vinegar with 1 part water, then soaking a cotton ball in the mixture and affixing it to the area with medical tape or a bandage and leaving it overnight.
If a person experiences pain or a burning sensation they should remove the cotton ball and run cool water over the area.
To prevent periungual warts, a person would have to ensure that they do not contract HPV. This may be difficult because the virus is extremely common. To avoid contracting HPV:
- Wash the hands regularly.
- Avoid biting or picking at the fingernails or cuticles.
- Wear protective gloves when washing the dishes.
- Do not share towels, nail polish, or other personal items.
- If a colleague, friend, or loved one has warts, avoid touching the area or items that have come into contact with it.
- Disinfect nail clippers and similar equipment after each use.
If a person is planning to visit a nail salon, the following tips may help to reduce the risk of contracting periungual warts:
- Ensure that salon workers change their gloves between clients.
- Request that a new pumice stone is used.
- Check that nail files and cuticle sticks are thrown out after each client, and that other tools are adequately disinfected.
- Do not shave the legs before a salon visit. There is always a risk of breaking the skin, which can allow HPV to enter the wound.
Even while treatment is underway, warts are contagious.
Periungual warts are difficult to treat by any method. The recurrence rate is high. With prompt treatment, warts are more likely to heal quickly, but no single method is guaranteed to work.
Every treatment is usually effective within 12 weeks. More research is needed to determine the most effective method.
Even if left untreated, these warts often resolve on their own. About half disappear within 1 year, and two-thirds within 2 years.
As the virus is transmissible, even while the warts are being treated, it is essential to take steps to prevent their spread.