Foot Health

Subnungal and periungual warts


n the feet, warts are more common on the bottom of the feet, and are called plantar warts. However, warts can also be under the nail or on the skin around the nail. These are called subungual or periungal warts and can occur in people at any age.

Subungual warts are warts that occur underneath the toenail. Due to their location, they can be challenging to treat, and can be painful.

Periungual warts are warts that form on the skin around the nail (nail folds) on the toes. They can be positioned lengthwise or sideways on your toe and can be raised or rounded around the nail.

Like plantar warts, both subungual and periungual warts are also caused by an infection called the human papillomavirus (HPV). There are hundreds of types of HPV. The most common types of HPV that causes subungual and periungual warts are 1, 2, 3, or 4.

Infection from HPV starts at the outer layers of the skin, then infects the skin cells. After it penetrates the epidermis it produces infectious virus cells that create the warts.

You can get HPV through skin contact or contamination from a surface where the HPV is. If you pick at your wart or touch it, you can spread it to a different part of your skin. HPV can take up to a year to fully incubate and form a wart, depending on your health and what’s going on in your life.


While subungal and periungal warts do not usually have the appearance of a common plantar wart, periungal warts are often more noticeable because of the location on the toe, positioned either lengthwise or sideways on your toe. Also, the skin around the nail becomes raised and ridged, dry and scaly. The area may also be different colors like yellowish, brown or black. The subungal warts are under the nail and can often be seen through the nail plate, sometimes they are red and may even have some drainage. Once the nail is removed the wart can be seen and may be raised, pink and fleshy. It can also be very painful.


Subungual warts can be difficult to treat because they are underneath the nail. Typically, treatment for subungual warts are treated like other types of warts caused by HPV. The main difference is that sometimes your podiatrist may have to remove a part of, or the whole nail to get to the nail bed and the wart. Based on the location on the nail bed, the nail regrows normally but sometimes the wart can cause permanent damage and affect nail regrowth if it is on the matrix, where the nail grows from.

Periungual warts can also be tough to treat. They can present a similar challenge in reaching the wart directly and again we many need to cut the nail to fully access the wart.

Some of the subungual and periungual wart treatments may include:

• Salicylic acid application directly on the wart. This chemical will dissolve the layers of your skin and wart. You can use this in gel, liquid, or patch form. However, you may have to apply this consistently every day for months to fully get rid of your wart.

• Cryotherapy. In this procedure your doctor will freeze your warts using liquid nitrogen. A blister may form and eventually it sheds, taking the wart with it. To fully treat your warts, you may need to get several cryotherapy treatments.

• Immunotherapy. If you find that your wart does not respond to the other treatments, your doctor might try immunotherapy. This therapy usually involves applying a special chemical directly onto your wart.

• Laser treatment. Your provider might apply a laser light or other treatment methods that will heat up and destroy the cells in your wart. This heat cuts off your blood flow to your wart, which causes it to die.

• Topical medicine. Another topical medicine your doctor may prescribe is cantharidin. Like other chemicals, it cuts off the blood supply to your wart and forms a blister over your wart. Your doctor will then remove the dead wart off your skin about a week after the initial application of this chemical.

Finding the best treatment for your wart may vary based on the wart size and location, age, health status and other factors. If you have a wart or think you have a wart, it is time to see your podiatrist.

 • For more information, email us at or visit To see a podiatrist, telephone 325-2996 for an appointment, visit Bahamas Foot Centre on Rosetta Street, or call 394-5824 for an appointment; or visit Bahamas Surgical Associates Centre on Hilltop Medical Centre off 4th Terrace Collins Avenue. In Grand Bahama, call Lucayan Medical Centre at 373-7400 for an appointment.

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