What is a Periungual Wart?

A Periungual wart appears under or around toenails and fingernails. In the beginning, they are about the size of a pinhead, smooth and virtually impossible to spot. But as the weeks progress they grow to pea size and turn into rough, irregular bumps that can affect nail growth and cause them to detach as the sheer size of a wart cluster elevates the nail. In the most severe cases, nails can be permanently deformed. Further complications may arise if the wart enters the nail plate, as this can lead to a fungal infection.

Warts on your Fingers & Nails

 Alternate names for periungual warts: periungual warts, fingernail warts, nail warts

 Periungual warts are also known as nail warts or fingernail warts because these warts grow around the fingernails and toenails. Like any other warts, a periungual wart is caused by human papillomavirus or HPV. During its early stages, they are approximately 1.5 millimeters in size or comparable to a pinhead.

Its appearance is translucent, smooth and hardly visible to the naked eye. After a few weeks in the development, the size grows comparable to a pea and its appearance becomes a bit rougher and Cauliflower-like irregular bumps are found around the wart which affects the growth of the nails, causing it to elevate and separate itself from the nail bed. This would eventually expand in different clusters. In its worst cases, the growth of the nail could even remain irregular and permanently contorted and it gets even more complicated as it can cause fungal infection when the growth of Periungual wart spreads underneath the nail plate.

 Causes of Periungual Warts

 The culprit is the human papillomavirus(HPV), a highly contagious infectious agent which can enter the body through cuts and abrasions. Periungual warts are often found on people who bite, pick, and tear at their nails. The broken skin surfaces make it easier for the virus to take hold.

Specifically, HPV strains 1, 2, 4, 5, 7, 27 and 57 can cause a periungual wart. Like any other warts, you can get infected if you have cuts or abrasions. There is a higher risk of getting infected whenever children, young adults or people with weak immune systems bite, tear or pick on their nails or cuticles. The broken areas around your nails make it uncomplicated for the virus to get in. You may also be at risk when your hands are frequently wet. For example, if you work as a dishwasher, you are prone to be infected.

 Symptoms for Nail and Finger Warts

 It’s very easy to spot the presence of periungual warts as ugly growths around or under toenails and fingernails. These nail warts look like rough bumps with uneven borders. A periungual wart can sometimes have a cauliflower-like an appearance around the nail. If left untreated they can be particularly painful, especially for young children, as the large lesions may cause the nail plate to left. There is a danger of spreading the virus to other parts of the body if nails are bitten and hands are not washed.

During the initial growth of periungual warts, you will not feel any pain. As it fully develops, it may become painful. Even without the pain, they can be spotted because of irregularities that you see around your fingernails or toenails. Try not to ignore when spotted, especially with children, because this can become really painful as the bumps can spread and grow under the nail plate and partially detach it from the nail bed. Biting the fingernails and not washing thoroughly can lead to spreading to other parts of the body. If completely ignored for a long time, nails can become permanently disfigured and would even cause more pain.

 Treatments for Periungual Warts

Just like all other warts that plague humans, it is possible to treat those that have made a home on the skin around the finger and toenails with salicylic acid, laser therapy, the freezing process cryotherapy, and various other topical treatments.

No matter how difficult, treatment should start as soon as possible to prevent the nail from lifting. However, warts lying under the nail present a more difficult challenge to physicians and traditional treatments are ineffective. That’s because the viral-induced growths are much harder to get to. Liquid nitrogen and salicylic acid treatments can’t reach them, and in fact, may actually damage the nail in the process.

Periungual warts are one of the hardest to treat because there is a huge possibility that it may spread and grow again even after treating it. There are various treatments available to treat or remove periungual warts. Some of these treatments are also used to treat other forms of warts. However, children who have these warts should visit the doctor immediately.

Salicylic Acid on Periungual Warts

 One of the ways to treat periungual warts is the use of Salicylic acid. The use of Salicylic acid for warts treatment is being studied more than other forms of treating warts. Using salicylic acid for treating warts could take a long time to see visible results. The application must be continuous and consistent for up to 12 weeks. 

Before applying salicylic on the wart, you may soak the wart in warm water for about 5 minutes and then trim the wart by using a nail file or a pumice stone. Trim it down until the dead skin is removed. This can all be purchased over the counter at your nearest pharmacy. Once applied on the wart, it will slowly penetrate the wart and destroy it. This may cause your skin to be irritated.

 Cryotherapy Can Treat Periungual Warts

 Nowadays, there are different ways to perform cryotherapy for wart treatments. The most common way to perform cryotherapy is through the use of liquid nitrogen which should be administered by a specialist. This is a good option when home remedies have failed to remove the wart but is not recommended to patients who are pain sensitive like children and elderly people. It is as effective as using the salicylic acid but provides a result within 4 weeks of treatment. 

Cryotherapy can also be performed at home with over-the-counter cryotherapy kits. These may not be as strong as using liquid nitrogen but can also provide good results with constant application. Over-the-counter cryotherapy kits are mainly composed of dimethyl ether and propane. Examples of cryotherapy kits are Compound W Freeze Off and Freeze Away Easy Wart Remover.

 Injecting Antigens

Studies show that injecting the proper dosage of Candida Albicans antigen can be beneficial to wart removal. It is known that the immune system can defeat HPV and would destroy warts for good. In the case of injecting this antigen, it is being detected by the immune system and would initiate an attack on the area where the antigen was injected. This will then attack warts and HPV, destroying both slowly. https://warts.org/wart-removal/immunotherapy

Just before it’s injected at the site of warts, the doctor will do a skin test just to make sure that your immune system will have a reaction to it. This may have some side effects of burning and itching.

Laser Removal

 This form of treatment is the most expensive and maybe your option if all other treatments failed to work. There are various forms of laser removal treatment, depending on what chemical is used. The main function of the laser is to burn off the wart. This method is only done by a doctor.

Surgery

 This may be one of the recommended options when the periungual warts are causing severe discomfort to the patient. The wart is cut off with a surgical knife and the wound is sealed with the use of heat. There is a high chance of scarring after the operation and warts may recur with this form of treatment.

 No matter how difficult this may be, the treatment of periungual warts should start as soon as possible to prevent the nail from lifting. However, periungual warts lying under the nail presents a more difficult challenge to physicians because the viral-induced growths are much harder to get to. Liquid nitrogen and salicylic acid treatments can’t reach them, and in fact, may actually damage the nail in the process. So, it is best to treat periungual warts just before it even reaches the nail bed to avoid having this problem in the future.

Periungual Wart Prevention Tip

Keep children’s fingernails and toenails clipped so they won’t be tempted to start biting their nails. Also, encourage hand washing. It can help prevent periungual warts and other numerous types of sickness

Having periungual warts is more serious than other warts like common warts or plantar warts because it can result in more pain and can be a social barrier due to the infected look of a fingernail. The option of preventing this from happening should always be considered. The most basic way to prevent this is by properly washing your hands with the right technique regularly.

You also have to make sure that the nail cutter and other tools used to cut nails are disinfected before using them. When hands and feet are wet or soaked in water for a long time, make sure to wear protective gear like gloves and footwear. Also, avoid sharing personal items like towels, pumice stone, nail care tools and toys for children.