Verrucae planae juveniles

Last Updated: 2019-08-26

Author(s): -

Besnier und Doyon 1881.

Plane juvenile Warzen, Flachwarzen.

Self-limiting warts, which occur especially in children and adolescents.

Almost exclusively children and young people. Immunosuppression is to be sought in adults.

Infection by human papilloma viruses type 3, 10, 28, 29 or 40, often caused by scratching. Since UV-exposed areas of the body are particularly affected, especially the face, it can be assumed that sunlight is also aetiologically significant.

  • Flat, 1-2 mm large, partly hyperpigmented, mostly multiple and bar-shaped papules on the face, back of the hand, distal forearms and legs.
  • Dermatoscopy.
  • No pigmentation, unstructured yellowish background with dots.

  • Clinic.
  • If necessary, biopsy with HPV typing.

Discreetly pronounced changes. Besides ballooned cells in the upper stratum granulosum and stratum corneum, acanthosis, papillomatosis, basket-like hyperkeratosis and parakeratosis are to be expected.

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

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

 

  • Topical Therapy
    • Immunomodulators 
    • Imiquimod
  • Aldara® 3x a week for 12 weeks. 
    • off-label-use:
      • Individ. 5x/ week over several weeks, maximum 16 weeks.

      • The wart surface must be removed beforehand.

      • Side effects: redness, itching, burning, erosion of the skin. Inform Pat. About this before starting therapy!

  • Topical retinoids 
    • Tretinoin
      • Airol® cream 0.05% 1-2x daily 

      • Airol® Lotio 0.05% 1-2x daily 
        • off-label-use:
        • Application 1-2x daily, if necessary 1x daily or every 2nd day for sensitive skin. Application should be carried out at least 6-14 weeks.

        • Contra indication: acute dermatitis, rosacea, pregnancy, lactation.

    • Isotretinoin 
      • Roaccutan® Gel 0.05 
        • Application: Apply a thin layer once a day in the evening approx. 15 minutes after cleansing the skin and leave to work. In order for the therapy to be successful, it often has to be applied for several months. Contra indication: Pregnancy, lactation.

      • Curettage under local anesthesia.

      • Cryotherapy: This must be done very carefully, especially on the face, otherwise hypopigmentation or scarring may occur.

 

  • Not in use with us, but mentioned in literature:

  • Salicylic acid 1-5%.

  • Application of PDT. The authors recommend restraint here.

  • Erbium:YAG lasers and Co² lasers should not be regarded as the treatment of choice 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.