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Black Dots in Palmoplantar Warts—Challenging a Concept: A Histopathologic Study
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This histopathologic study critically examined the long-held belief that the black dots clinically observed within palmoplantar warts represent thrombi within dermal blood vessels. The authors examined 18 formalin-fixed paraffin-embedded specimens of completely excised palmoplantar warts and used narrow step sections to evaluate the presence of dermal micro thrombi. None of the warts had any evidence of thrombi within dermal blood vessels using standard hematoxylin and eosin staining. The authors also used a monoclonal antibody to the receptors on platelets to detect occult thrombi; this method also failed to show thrombi in any of the warts. Of note, clinical information regarding the presence or absence of black dots within the palmoplantar warts was lacking. However, hematoxylin and eosin staining did reveal intracorneal hemorrhages in 61% of warts, and a specific stain for hemorrhagic exudate was positive within the stratum corner in 72% of warts.
Black dots observed clinically within palmoplantar warts are likely not the result of dermal blood vessel thrombi but rather intracorneal hemorrhages. Thus, shave removal of the black dots may not imply that the wart was removed to the level of the superficial dermis.
– Jeffrey F. Scott, MD
- Written by
It is difficult to understand how hemorrhage in the stratum corneum is not preceded by hemorrhage in the papillary dermis. In order for the blood/hemosiderin to get there, it must have exited the vessel prior to entering the epidermis. I accept that clinically observed black dots in warts reside in the stratum corneum, but some hemorrhage in the papillary dermis must have come first. The a priori notion that microthrombi needed to be seen may not be true. The authors don't comment on hemorrhage in the papillary dermis, which, to my mind, may (must) underlie the findings in the stratum corneum. Otherwise – abracadabra!
Abstract
Palmoplantar warts are diagnosed by dermatologists on a daily basis. Clinically, 43 many lesions have characteristic small black dots, which are considered to represent thrombi in dermal vessels. This concept has been taught by dermatologists over many decades and is found in the newest versions of our standard literature. However, to our knowledge, this concept has not been sufficiently substantiated by morphological studies. A few publications have described thrombi in association with an infarctive process, showing black dots with rapid progression to blackening and regression of the wart clinically, but this is observed in <5% of warts. We therefore histologically investigated formalin-fixed paraffin-embedded specimens of 18 completely excised palmoplantar warts in narrow step sections for the presence of dermal microthrombi and in a second step curettage material of 2 additional plantar warts that had black dots clinically.
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Black Dots in Palmoplantar Warts—Challenging a Concept: A Histopathologic Study
J Am Acad Dermatol 2018 Jan 12;[EPub Ahead of Print], I Fried, RS Kasper, I Hegyi, W Kempfposted by dermatica at
February 23, 2018
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