Synopsis
Differentiate HPV warts from umbilicated molluscum, identify genital, periocular, immunocompromised and malignant mimics, and balance spontaneous resolution against safe site-specific treatment.
- Common warts are rough hyperkeratotic papules with interrupted skin lines and thrombosed capillary dots; plantar warts are flattened inward beneath callus.
- Molluscum lesions are smooth, firm, pearly or skin-coloured domes with a central umbilication and often cluster around eczema.
- Both are usually self-limiting: observation is a valid first choice when lesions are painless, confidently diagnosed and not at a high-risk site.
Key red flags
Bleeding, ulceration, rapid growth, pigment asymmetry, fixation, diagnostic uncertainty, widespread giant lesions in immune compromise, periocular threat, anogenital lesions in a child or pregnancy-related genital disease requires specialist assessment.
Rapid growth, spontaneous bleeding, induration, ulceration or irregular pigment requires urgent diagnostic review and possible biopsy.
Investigation priorities
Confirm wart or molluscum morphology and select a site-safe option.
Management branches
Typical painless lesions are confidently diagnosed and cause little functional or psychosocial burden.
- Explain viral transmission and natural history, cover lesions for contact sport where practical and avoid picking, shaving over them or sharing towels.
- Treat surrounding eczema with appropriate anti-inflammatory and emollient care without applying steroid directly as a destructive viral treatment.
A non-facial, non-genital wart is painful, functionally troublesome or treatment is preferred.