Case Report: Treatment of Persistent Verruca Vulgaris and Actinic Keratosis in a 76-Year-Old Male
by: Caroline Vaughn
At Village Dermatology in Katy and Houston, Texas, we frequently treat patients with both common skin conditions and precancerous lesions. This case highlights the importance of follow-up care and the role of cryotherapy in dermatologic treatment.
Patient Presentation
A 76-year-old male presented for follow-up of a verruca vulgaris (common wart) on the left proximal dorsal forearm. The patient had previously undergone liquid nitrogen (cryotherapy) on July 24, 2025. While some improvement was noted, the lesion persisted, prompting today’s visit for repeat cryotherapy.
Additionally, two other concerns were evaluated:
Subungual hematoma on a fingernail, which was healing appropriately.
Actinic keratosis on the left nasal root, requiring cryotherapy.
Examination Findings
Verruca Vulgaris: Inflamed, persistent lesion on the left proximal dorsal forearm.
Subungual Hematoma: Minimal residual discoloration; nail growing out normally.
Actinic Keratosis: Single rough, scaly lesion on the left nasal root, consistent with chronic sun damage.
Treatment & Management
Verruca Vulgaris
A second round of cryotherapy with liquid nitrogen was performed on the forearm wart.
Patient was counseled on alternative therapies including topical retinoids, imiquimod (Aldara), and salicylic acid.
Education included the viral nature of warts, potential for spread, and the expectation of gradual resolution with treatment.
Subungual Hematoma
Determined to be healing well with no intervention required.
Patient was advised that discoloration would continue to grow out with the nail over several months.
Actinic Keratosis
One lesion on the nasal root was treated with liquid nitrogen cryotherapy.
The patient was counseled that actinic keratoses are precancerous skin lesions that may progress to squamous cell carcinoma if untreated.
Sun protection measures were emphasized, including broad-spectrum SPF 30+ sunscreen and protective clothing.
Patient Counseling
Warts: Viral, contagious, and may require multiple treatments.
Subungual Hematomas: Typically resolve as the nail grows out; treatment only if painful or persistent.
Actinic Keratoses: Regular skin checks are important for early detection and prevention of skin cancer.
Conclusion
This case underscores the importance of ongoing dermatologic care for both benign and precancerous skin conditions. At Village Dermatology in Katy and Houston, Texas, we use evidence-based treatments such as liquid nitrogen cryotherapy to help patients achieve the best possible outcomes.
If you or a loved one has a persistent wart, actinic keratosis, or other concerning skin lesion, schedule an appointment with our dermatology team today. Early treatment not only improves results but also helps prevent complications such as skin cancer.
