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Review
. 2025 Apr;92(4):861-871.
doi: 10.1016/j.jaad.2024.10.081. Epub 2024 Nov 15.

Diagnosis and management of subungual and periungual verruca: A clinical review

Kaya L Curtis  1 , Jeremy C Davis  2 , Nilton Di Chiacchio  3 , Nilton Gioia Di Chiacchio  4 , Chander Grover  5 , Matilde Iorizzo  6 , Bianca Maria Piraccini  7 , Michela Starace  7 , Antonella Tosti  8 , Shari R Lipner  9
Affiliations
Review

Diagnosis and management of subungual and periungual verruca: A clinical review

Kaya L Curtis et al. J Am Acad Dermatol. 2025 Apr.

Abstract

Nail unit verruca is the most common nail tumor encountered in clinical practice and may be highly distressing to patients due to reduced functionality, cosmesis, and stigmatization. Subungual and periungual verrucae present a challenge for treatment compared to cutaneous warts of other sites and recurrence rates are high. The risk of spread to other skin and mucosal areas inherent to all warts may be increased given location on the fingertips. There are a multitude of therapeutic options, and treatment is individualized based on patient characteristics, anatomic location, number of verrucae, and size of verrucae. Destructive techniques, if used too aggressively, can permanently damage the nail matrix. In this clinical review, nail unit verruca epidemiology, pathogenesis, clinical features, treatments, and therapeutic approaches to various patient populations, including pediatric and immunosuppressed patients, are described.

Keywords: bleomycin; nail unit verruca; periungual verruca; periungual wart; subungual verruca; subungual wart; verruca vulgaris; wart.

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Conflict of interest statement

Conflicts of interest Dr Piraccini has served as a consultant for Pierre fabre-Ducray, Difa Cooper, Dercos-L’Oreal, ISDIN, Legacy Healthcare, Pfeizer, and Eli- Lilly. Dr Tosti has served as a consultant for DS Laboratories, Almirall, Tirthy Madison, Eli Lilly, P&G, Pfizer, Myovant, Bristol Myers, Squibb, Ortho Dermatologics, and Concert. Dr Lipner has served as a consult for Ortho-Dermatologics, Eli Lilly, BelleTorus Corporation, and Moberg Pharmaceuticals. Author Curtis and Drs Davis, N. Di Chiacchio, N.G. Di Chiacchio, Grover, Iorizzo, and Starace have no conflicts of interest to declare.