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

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.