Pop Quiz #172

The correct answer is E. Human papillomavirus.

These are plantar warts, which are thick, hyperkeratotic, skin-colored papules and plaques with punctate black dots (thrombosed capillaries) and disruption of the skin lines on the plantar surface of the foot. They are caused by human papillomavirus (HPV) types 1,2, and 4. The virus is transmitted from person to person through exposure on locker room floors, public showers, and pool areas. These lesions may remit spontaneously. Therapeutic options include 40% salicylic acid, tri/monochloroacetic acid, canthaderin, cryotherapy, immiquimod, 5 Fluorouracil and intralesional bleomycin.

The other viruses listed do not cause lesions with this appearance. Dermatologic manifestations of herpes virus, cytomegalovirus and acute human immunodeficiency virus infection lesions are primarily mucocutaneous ulcers. CMV infection may also present with a generalized petecial exanthem, scarlatiniform, follicular or urticarial eruption. Epstein-Barr virus primarily presents with extra-cutaneous with fever, lymphadenopathy and pharyngitis.


Vlahovic TC, Khan MT. The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management. Clin Podiatr Med Surg. 2016;33(3):337-353. doi:10.1016/j.cpm.2016.02.003 García-Oreja S, Álvaro-Afonso FJ, García-Álvarez Y, García-Morales E, Sanz-Corbalán I, Lázaro Martínez JL. Topical treatment for plantar warts: A systematic review [published correction appears in Dermatol Ther. 2021 Mar;34(2):e14941]. Dermatol Ther. 2021;34(1):e14621. doi:10.1111/dth.14621