Derm Cases · Dermatology / General Practice / Infectious Diseases
OSCE — plantar and common warts: diagnosis, treatment ladder and HPV counselling
An 8-minute OSCE station on clinical diagnosis of cutaneous warts, distinction from corn/callus, stepwise therapy (salicylic acid, cryotherapy), genital wart/red-flag awareness, and HPV vaccination counselling.
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Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on clinical diagnosis of cutaneous warts, distinction from corn/callus, stepwise therapy (salicylic acid, cryotherapy), genital wart/red-flag awareness, and HPV vaccination counselling.
Brief (to candidate)
A 22-year-old runner has painful hyperkeratotic lesions on the plantar forefoot for 9 months. Paring shows black dots. Over-the-counter corn plasters failed. He asks about freezing and whether warts mean he has an STI. You have 8 minutes to diagnose, treat, and counsel.
[4]Candidate instructions
- Diagnose verruca/plantar wart and distinguish from corn/callus.
- Explain HPV transmission in plain language (not automatically an STI for plantar/common warts).
- Offer a stepwise treatment plan with realistic expectations.
- Know when to escalate (immunocompromise, facial/genital, refractory, diagnostic doubt).
- Counsel prevention and HPV vaccination where relevant.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition | Hyperkeratotic papules/plaques; interruption of skin lines; black dots (thrombosed capillaries) on paring; plantar tenderness on side-to-side squeeze vs callus[1][7] |
| Differential | Corn/callus (retained skin lines, no black dots), foreign body, verrucous SCC (rare — elderly, resistant, atypical), mosaic vs myrmecia plantar types |
| Natural history | Many cutaneous warts self-resolve over months–years especially in children; treatment is for pain, spread, cosmesis or immunosuppression context |
| First-line Rx | Salicylic acid with regular paring (weeks of adherence) is first-line evidence-based topical therapy; cryotherapy as alternative/adjunct; combination for refractory plantar disease[3][4][9] |
| Special sites | Genital warts (condyloma) need STI framework, partner issues, and different therapies; face/periungual need caution with destructive methods; never assume all warts are STIs |
| Vaccination & prevention | Discuss HPV vaccine for oncogenic/genital types per national schedule; hygiene, avoid sharing footwear when practical; immunosuppression worsens burden[2] |
| Communication | Set expectation of weeks–months of therapy; return if rapid growth, pigmentation change, or diagnostic uncertainty |
Model key actions
- Confirm plantar wart with interrupted dermatoglyphics + black dots, not corn plaster alone.[7]
- Start salicylic acid + paring (± cryotherapy) with adherence plan and realistic timeline.[3][9]
- Counsel correctly that common/plantar warts are not genital STIs, while offering HPV vaccine education as appropriate.[1][2]
Common errors
- Treating corns with wart therapy (or vice versa) without paring assessment.
- Promising overnight cure with one freeze.
- Labelling all warts as STIs, causing unnecessary stigma.
- Missing immunocompromise / refractory / atypical lesions needing specialist review.
- Ignoring pain and gait impact in plantar disease.
References6ShowHide
- [1]Wolf J, Kist LF, Pereira SB, et al. Human papillomavirus infection: Epidemiology, biology, host interactions, cancer development, prevention, and therapeutics. Reviews in medical virology, 2024.PMID 38666757
- [2]Jensen JE, Becker GL, Jackson JB, et al. Human Papillomavirus and Associated Cancers: A Review. Viruses, 2024.PMID 38793561
- [3]Kwok CS, Gibbs S, Bennett C, et al. Topical treatments for cutaneous warts. Cochrane Database of Systematic Reviews, 2012.PMID 22972052
- [4]García-Oreja S, Álvaro-Afonso FJ, García-Álvarez Y, et al. Topical treatment for plantar warts: A systematic review. Dermatologic Therapy, 2021.PMID 33263934
- [7]Witchey DJ, Witchey NB, Roth-Kauffman MM, et al. Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management. The Journal of the American Osteopathic Association, 2018.PMID 29379975
- [9]Zhu P, Qi RQ, Yang Y, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). Journal of evidence-based medicine, 2022.PMID 36117295