Verrucae planae juveniles

Besnier and Doyon 1881.

Plane juvenile warts, flat warts.

Self-limiting warts, which are particularly common in children and adolescents.

Almost exclusively children and adolescents. In adults, immunosuppression should be sought.

Infection caused by human papillomavirus types 3, 10, 28, 29 or 40, often triggered by scratching. Since UV-exposed areas of the body are mainly affected, especially the face, it can be assumed that sunlight is also of aetiological significance.

• Flat, 1-2 mm in size, sometimes hyperpigmented, usually multiple and striate papules on the face, dorsum of the hands, distal forearms and legs

• Dermatoscopy
• No pigmentation, featureless yellowish background with punctate vessels

• Clinic sufficient
• If necessary, biopsy with HPV typing

Decent marked changes. In addition to ballooned cells in the upper stratum granulosum and stratum corneum, acanthosis, papillomatosis, basket-weave hyperkeratosis and parakeratosis are to be expected.

Despite sometimes years of existence, spontaneous healing is possible within a few days.

• Educate patients about autoinoculation (scratching, shaving)
• Therapy often difficult, lengthy and frustrating

• Topical therapy
  • Immune modulators
  • Imiquimod cream 5%
    • 3x weekly for 12 weeks
    • off-label use:
      • Application: 5x/week for several weeks, maximum 16 weeks
      • Necessary before ablation of the wart surface
      • Side effects: redness, itching, burning, erosion of the skin. Patients must be informed about this before the start of therapy
• Topical retinoids
  • Tretinoin
    • Cream 0.05% 1-2x daily
    • Lotio 0.05% 1-2x daily
      • off-label-use:
      • Apply 1-2x daily, or 1x daily if necessary, or every 2nd day for sensitive skin. Application should be carried out for at least 6-14 weeks
      • contraindication: acute dermatitis, rosacea, pregnancy, lactation
  • Isotretinoin gel 0.05%
    • contraindication: Pregnancy, lactation
    • application: apply thinly 1x daily in the evening approx. 15 minutes after cleansing the skin and leave to act. For a successful therapy, the application must often be done for several months
• Curettage under local anaesthesia
• Cryotherapy: especially on the face, this must be done very carefully, otherwise hypopigmentation or scarring may occur

Not used by us, but mentioned in literature:

• Salicylic acid 1-5%
• Application of PDT described. On the part of the authors, restraint is recommended here
• Erbium:YAG laser and Co² laser should not be considered as first choice therapy due to possible scarring tendencies

1. Babini G. [Sodium arsenate in therapy of verruca plana juvenilis]. Minerva Med 1952;43:1327.
2. Gauvain EA. Verruca plana juvenilis. Arch Derm Syphilol 1946;53:298.
3. Altmeyer, Peter. Enzyklopädie Dermatologie, Allergologie, Umweltmedizin. Heidelberg: Springer Medizin, 2011. Print.
4. Dirschka Th. (Hsg.) et. al. Klinikleitfaden Dermatologie. München (3. Auflage), 2011, 229-237
5. Braun-Falco's Dermatologie, Venerologie und Allergologie. Berlin: Springer, 2012. Print.