Plantar wart
From Wikipedia, the free encyclopedia
| ICD-10 | B07 |
|---|---|
| ICD-9 | 078.19 |
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.
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[edit] 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.
The difference between plantar warts and warts located elsewhere on the body is the fact that warts are generally outgrowth type lesions, but on the bottom of the foot they are pushed inward due to the pressure of walking, plus the fact that the skin on the bottom of the foot tends to be thicker than skin elsewhere, making the treatment of plantar warts more difficult.
[edit] Treatment
No treatment in common use is 100% effective. The most comprehensive medical review found that no treatment method was more than 73% effective, and using a placebo had a 27% average success rate. The American Family Physician recommends:
| First-line therapy | over the counter salicylic acid |
| Second-line therapy | Cryosurgery, intralesional immunotherapy, or pulsed dye laser therapy |
| Third-line therapy | Bleomycin, surgical excision |
Podiatrists and dermatologists are considered specialists in the treatment of plantar warts, though most primary care physicians are capable of treating simple plantar warts.
[edit] Vaccination
Although immunization is available for the HPV strains causing cervical cancer and venereal warts, there is currently no vaccination treatment for plantar warts.
[edit] Pharmacologic Rx
- Keratolytic Chemicals
- The treatment of warts by keratolysis involves the peeling away of dead surface skin cells with trichloroacetic acid or salicylic acid.
- 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
- Topical application of dilute glutaraldehyde (a virucidal chemical, used for "cold" sterilization of surgical instruments) is an older effective wart treatment. More modern chemotherapy agents, like 5-fluoro-uracil, are also effective topically or injected intralesionally. Retinoids, systemically (eg. isotretinoin) or topically (tretinoin cream) may be effective.
[edit] Non-pharmaceutic
- Duct tape occlusion therapy
- The wart is kept covered with duct tape for six days, then soaked and debrided with a pumice stone. The process is repeated for 6 to 8 weeks.
- Banana peel
- A piece of banana peel is taped over the wart and dead skin is subsequently cut away.
- Garlic
- A sliver of garlic is taped over the wart and dead skin is subsequently cut away. The active ingredient may be allicin which is known to also be an antiobiotic and anti-fungal.
- Celandine
- Rub with greater celandine.
- As warts are contagious, precautions should be taken to avoid spreading.
[edit] 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.
[edit] 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. In many cases, the body will become naturally immune to the wart and verrucæ will turn black and effectively fall off, although it can be two years before this takes place.
[edit] Relative Effectiveness of Treatments
A 2006 study assessed the effects of different local treatments for cutaneous, non-genital warts in healthy people. The study reviewed 60 randomized clinical trials dating up to March 2005. The main findings were:
- overall there is a lack of evidence (many trials were excluded because of poor methodology and reporting).
- the average cure rate using a placebo was 27% after an average period of 15 weeks.
- the best treatments are those containing salicylic acid. They are clearly better than placebo.
- there is surprisingly little evidence for the absolute efficacy of cryotherapy.
- two trials comparing salicylic acid and cryotherapy showed no significant difference in efficacy.
- one trial comparing salicylic acid and duct tape occlusion therapy showed no significant difference in efficacy.
- evidence for the efficacy of the remaining treatments was limited.
[edit] Complications
Warts may spread, develop into clusters or fuse to become a mosaic wart. Plantar warts can be painful making it difficult to walk and run. Over-aggressive treatment may lead to scarring. Others may be infected. If a wart is being treated professionally and does not seem to improve in a reasonable period of time, the growth should be excised and biopsied.
[edit] 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.
[edit] References
- ↑ Cochrane Database Syst Rev. 2003;(3):CD001781. PMID 12917913
- ↑ Cochrane Database Syst Rev. 2006;(3):CD001781. PMID 16855978 [6]
- ↑ BMJ. 2002 Aug 31;325(7362):461. PMID 12202325
- ↑ Plantar Warts, Treatment [7] (Mayo Clinic)
- ↑ Warszawer-Schvarcz L.Treatment of plantar warts with banana skin. Plast.Reconstr.Surg 1981. 68; 975-6. PMID 7301999
- ↑ Cutaneous Warts: An Evidence-Based Approach to Therapy. American Family Physician 2005;72(4):647-52. PMID 16127954
