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What to Know About Periungual Warts

Medically Reviewed by Jabeen Begum, MD on November 09, 2021

Periungual warts and subungual warts are common types of warts that occur under and around the nail in people at any age. While they do not have the appearance of a common wart or a wart that has a more noticeable shape, it is still a wart. Their treatments, and symptoms, however, are unique. 

What Are Subungual and Periungual Warts?

Subungual warts are warts that occur underneath the fingernail. Due to their location, they can be challenging to treat, and they can be pretty painful. 

Periungual warts are warts that form in the grooves of your nail folds around your nailbeds. They can either be positioned lengthwise or sideways on your finger.

These warts are either covered by the nail, or they create a raised or rounded shape around the nail. 

What Causes Subungual and Periungual Warts?

Both subungual and periungual warts are caused by an infection called the human papillomavirus (HPV). There are hundreds of types of HPV. The different strains of the infection affect you differently. 

Infection from HPV starts at the outer layers of your skin then infects the skin cells. After it penetrates a particular layer of the skin cells, it produces infectious virus cells that create warts. Most commonly, subungual and periungual warts are caused by HPV 1, 2, 3, or 4. 

HPV is given or received through skin contact or contamination. If you pick at your wart or touch it, you may create another wart on a different part of your skin. HPV can take up to a year to fully incubate and form a wart, depending on the situation. 

What Is the Treatment for Subungual and Periungual Warts?

Subungual warts are difficult to treat because of their placement underneath the nail. They are also quite painful, even to the point of feeling like an under-the-nail tumor. Usually, with subungual warts, the surface area of the skin around the nail becomes raised and ridged. 

People with subungual warts will often start to pick or bite at their nails to relieve pain and try to get at the wart. Unfortunately, this is usually how subungual warts spread and stay in your body for so long. 

Typically, subungual warts are treated very similarly to other types of warts caused by HPV. The main difference is that sometimes your doctor may have to remove parts of your nail or nail bed to get to them. Unfortunately, sometimes this can cause permanent deformation. 

Periungual warts are tough to treat as well. They present similar challenges in reaching the wart directly. Your doctor may need to make an incision or cut into your nail to fully access it.

Some of the subungual wart treatments and periungual wart treatments your doctor may offer:

  • Salicylic acid application directly on your wart. This chemical will dissolve the layers of your skin and wart. You can use this in gel, liquid, or patch form. However, you may have to apply this consistently every day for months to fully get rid of your wart.
  • Cryotherapy. This is a procedure in which your doctor will freeze your warts using liquid nitrogen. A blister forms and eventually is shed, taking the wart with it. To fully treat your warts, you may need to get several cryotherapy treatments.
  • Immunotherapy. If you find that your wart does not respond to the other treatments, your doctor might try immunotherapy. This therapy usually involves applying a chemical onto your wart. Usually, the chemicals used in the treatment cause your body to have an allergic reaction, which will make your wart go away.
  • Laser treatment. Your provider might apply a laser light that will heat up and destroy the cells in your wart. This heat cuts off your blood flow to your wart, which causes it to die.
  • Topical medicine. Another topical medicine your doctor may prescribe is cantharidin. Like other chemicals, it cuts off the blood supply to your wart and forms a blister over your wart. Your doctor will then remove the dead wart off your skin about a week after the initial application of this chemical.

Often, finding the proper treatment for your wart will be a game of trial and error. Your specific body, wart, age, and other factors will play a huge role in which treatment will work for you and your wart.

Show Sources

SOURCES:

Cleveland Clinic: “Warts.”

Journal of Cutaneous and Aesthetic Surgery: “Combination Treatment of Periungual Warts.”

Journal of Wound Management and Research: “Recurrent Subungual Viral Warts.”

DermNet NZ: “Viral wart.”

Medscape: “Nail Disorders in Children.”

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