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.
- For non-facial cutaneous warts, daily salicylic acid under product directions for up to 12 weeks is a practical first treatment; protect surrounding skin and pare only safely.
- Cryotherapy can be repeated every two to three weeks but causes pain, blistering and pigment change and is not automatically superior to patient-applied therapy.
- Do not use ordinary wart acids on face, genitals or broken skin; anogenital lesions need sexual-health assessment and safeguarding appropriate to age and context.
- Routine destructive treatment of molluscum in children is usually unnecessary; control surrounding eczema and discourage scratching, squeezing and shared towels.
- Numerous giant or facial molluscum, extensive refractory warts or unusual adult onset can signal immune suppression and warrants targeted assessment.
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.
- Review if lesions change, become painful or affect eyes or genitals, and avoid promising an exact clearance date.
A non-facial, non-genital wart is painful, functionally troublesome or treatment is preferred.
- Soak and gently reduce loose callus, protect normal skin and apply a licensed salicylic-acid wart product daily for up to 12 weeks.
- Pause for painful erosion and stop if infection or severe dermatitis develops; do not use on neuropathic or poorly perfused feet without specialist advice.
- Consider cryotherapy every two to three weeks after consent for pain, blistering, scar and dyspigmentation if self-treatment fails or is unsuitable.