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Plantar warts (verrucæ pedis; VP - also commonly referred to as a verruca) are warts caused by the human papilloma virus (HPV). They are small lesions that appear on the sole of the foot (hence the name, from Latin planta pedis, the sole of the foot) and are typically "cauliflower-esque" in appearance. They may have small black specks within them that ooze blood when the surface is shaved; these are abnormal capillaries. Though "plantar wart" refers specifically to HPV infection on the sole of the foot, infection by the virus is possible anywhere on the body and common especially on the palm of the hand, where the appearance of the wart is often exactly as described above for plantar warts. Due to pressure on the soles of the feet, a layer of hard skin forms over the wart. A plantar wart may or may not be painful. It can be spread in communal showers, around swimming pools, sharing shoes, etc.
Diagnosis
Verrucæ pedis, "plantar warts", can often be differentiated from helomata, "corns", by close observation of skin striations. Feet, like hands, are covered in skin striæ which are more commonly called fingerprints. Where verrucæ pedis are present, the skin striæ can be observed as going around the lesion; where the lesion is not verrucæ pedis, the cell DNA are not altered and the striations continue across the top layer of the skin. Furthermore, VPs tend to be painful on application of pressure from either side of the lesion rather than direct pressure. Helomata tend to be the opposite and are painful on direct pressure rather than pressure from either side.
Treatment
Many different treatments have been tried, and several are in common use - but none is 100% effective. The most comprehensive medical review found that no treatment method was more than 75% effective, and using a placebo had a 30% success rate.
For simple cases the most common treatments advised are:
- Watchful waiting - recognising that the problem may self-resolve
- Salicylic acid - applied manually (see below)
- Cryosurgery - freezing with liquid nitrogen
- Duct tape occlusion therapy - (see below)
Dermatologists are the physicians who are experts in the treatment of plantar warts.
Vaccination
Although immunization is available for the HPV strains causing cervical cancer and venereal warts, there is currently no vaccination treatment for plantar warts.Pharmacologic Rx
- Keratolytic Chemicals: The peeling away of dead surface skin cells with trichloroacetic acid or salicylic acid may eventually result in wart disappearance.
- Immunotherapy: Intralesional injection of antigens (mumps, candida or tichophytin antigens USP) is a new wart treatment which may trigger a host immune response to the wart virus, resulting in wart resolution. Distant, non-injected warts may also disappear.
- Chemotherapy:
Non-pharmaceutic
- Duct tape occlusion therapy: The wart is kept covered with duct tape for six days, soaked and debrided with a pumice stone, then the proceess repeated.
- Banana peel : A piece of banana peel is taped over the wart and subsequently dead skin is cut away.
- Garlic : A sliver of garlic is taped over the wart and subsequently dead skin is cut away. The active ingredient may be Allicin which is known to also be an antiobiotic and anti-fungal.
- Celandine : Rub with greater celandine.
Note: as plantar warts are contagious precautions should be taken to avoid spreading. Infection may lead to warts forming under the fingernail (subungual) and around the fingernail or on the cuticle (periungual). These may be more difficult to cure than warts in other locations.
Surgical
- Liquid nitrogen : Cryosurgery with liquid nitrogen. A common treatment that works by producing a blister under the wart. It is painful but usually nonscarring.
- Electrodessication and surgical excision produce scarring. If the wart recurs, the patient has a permanent scar along with the wart.
- Lasers may be effective, especially the 585nm pulsed dye laser which is a nonscarring method.
Other
- X-ray is an old method that is seldom recommended due to the long term adverse side effects of irradiation.
- Watchful waiting may be appropriate since many warts will eventually resolve thanks to the patient's own immune system.
Relative Effectiveness of Treatments
A 2002 study assessed the effects of different local treatments for cutaneous, non-genital warts in healthy people. The study reviewed 52 randomized clinical trials. The main findings were:
- overall there is a lack of evidence (many trials had poor methodology and reporting).
- the average cure rate using a placebo was 30% after an average period of 10 weeks.
- the best treatments are those containing salicylic acid. They are clearly better than placebo.
- there is less evidence for the efficacy of cryotherapy.
Complications
Warts may spread, develop into clusters or fuse to become mosaic warts. Plantar warts can be painful making it difficult to walk and run. Over-aggressive treatment may lead to scarring. Others may be infected.
Prevention
- Avoid walking barefoot in public areas such as showers, communal changing rooms.
- Change shoes and socks daily.
- Avoid sharing shoes and socks.
- Avoid direct contact with warts on other parts of body.
- Avoid direct contact with warts on other persons.
References
- Cochrane Database Syst Rev. 2003;(3):CD001781. PMID 12917913
- Cochrane Database Syst Rev. 2006;(2):CD00????. PMID ??? *
- BMJ. 2002 Aug 31;325(7362):461. PMID 12202325
- Plantar Warts, Treatment * (Mayo Clinic)
- Warszawer-Schvarcz L.Treatment of plantar warts with banana skin. Plast.Reconstr.Surg 1981. 68; 975-6. PMID 7301999
External Links
- http://www.mayoclinic.com/health/plantar-warts/DS00509 Mayo Clinic
"Plantar wart"