Plantar wart

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Plantar wart
Other namesVerruca myrmecia, verruca plantaris [1]
Largeplanterwart.jpg
Close up image of a large plantar wart
Specialty Dermatology, Podiatry
Symptoms Skin colored lesion, may be painful [2]
Complications Trouble walking, [2] transmission to other parts of the body, callus formation
DurationTwo years [2]
Causes Human papillomavirus (HPV) [2]
Risk factors Communal showers and pools, barefoot walking, open footwear, prior warts, poor immune function [2] [3]
Diagnostic method Based on symptoms [3]
Differential diagnosis Callus, molluscum contagiosum, squamous cell carcinoma [2]
Treatment Salicylic acid, chemo-based Fluorouracil and bleomycin, [4] cryotherapy, surgical removal [2]
FrequencyCommon [5]

A plantar wart is a wart occurring on the bottom of the foot or toes. [5] Its color is typically similar to that of the skin. [2] Small black dots often occur on the surface. [5] One or more may occur in an area. [2] They may result in pain with pressure such that walking is difficult. [2]

Contents

They are caused by the human papillomavirus (HPV). [2] A break in the skin is required for infection to occur. [2] Risk factors include use of communal showers, having had prior warts, and poor immune function. [2] [3] Diagnosis is typically based on symptoms. [3]

Treatment is only needed if it is causing symptoms. [3] This may include salicylic acid, cryotherapy, chemo-based fluorouracil or bleomycin, and surgical removal. [2] The skin atop the lesion should generally be removed before treatment. [2] In about a third to two-thirds of cases, they go away without specific treatment, but this may take a few years. [2] Plantar warts are common. [5] Children and young adults are most often affected. [3]

Signs and symptoms

Their colors are typically similar to that of the nearby skin. [2] Small, black dots may occur on their surfaces. [5] One or more may occur in an area. [2] They may result in pain with pressure such that walking may be difficult. [2]

Cause

Plantar warts are benign epithelial tumors generally caused by infection by human papillomavirus types 1, 2, 4, 60, or 63, [6] but also by types 57, [7] 65, [8] 66, [9] and 156. [10] These types are classified as clinical (visible symptoms). The virus attacks compromised skin through direct contact, possibly entering through tiny cuts and abrasions in the stratum corneum (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot or finger, the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated. [11] [12]

Warts may spread through autoinoculation, by infecting nearby skin, or by contaminated walking surfaces. They may fuse or develop into clusters called mosaic warts. [6]

Diagnosis

A plantar wart is a small lesion that appears on the surface of the skin and typically resembles a cauliflower, with tiny black petechiae (tiny hemorrhages under the skin) in the center. Pinpoint bleeding may occur when these are scratched. Plantar warts occur on the soles of feet and toes. They may be painful when standing or walking.[ citation needed ]

Plantar warts are often similar to calluses or corns, but can be differentiated by close observation of skin striations. Feet are covered in friction ridges, which are akin to fingerprints of the feet. Friction ridges are disrupted by plantar warts; if the lesion is not a plantar wart, the striations continue across the top layer of the skin. Plantar warts tend to be painful on application of pressure from either side of the lesion rather than direct pressure, unlike corns (which tend to be painful on direct pressure, instead).[ citation needed ]

Prevention

HPV is spread by direct and indirect contact from an infected host. Avoiding direct contact with contaminated surfaces such as communal changing rooms and shower floors and benches, avoiding sharing of shoes and socks and avoiding contact with warts on other parts of the body and on the bodies of others may help reduce the spread of infection. Infection is less common among adults than children. [12]

As all warts are contagious, precautions should be taken to avoid spreading them. Recommendations include:

Plantar warts are not prevented by inoculation with HPV vaccines because the warts are caused by different strains of HPV. Gardasil protects against strains 6, 11, 16, and 18, and Cervarix protects against 16 and 18, whereas plantar warts are caused by strains 1, 2, 4, and 63.[ dubious – discuss ]

Treatment

First-line therapy Over-the-counter salicylic acid
Second-line therapy Prescribed 60% salicylic acid, intralesional immunotherapy
Third-line therapy Fluorouracil cream, cryotherapy, laser therapy
Fourth-line therapy Bleomycin injection, surgical excision
Cryotherapy being applied to a plantar wart with a cotton swab Wart cryotherapy.jpg
Cryotherapy being applied to a plantar wart with a cotton swab

A number of treatments have been found to be effective. [14] A 2012 review of different treatments for skin warts in otherwise healthy people concluded modest benefit from salicylic acid, and cryotherapy appears similar to salicylic acid. [15]

Medications

Salicylic acid, the treatment of warts by keratolysis, involves the peeling away of dead surface skin cells with keratolytic chemicals such as salicylic acid or trichloroacetic acid. These are available in over-the-counter products, but in higher concentrations may need to be prescribed by a physician. A 12-week daily treatment with salicylic acid has been shown to lead to a complete clearance of warts in 10–15% of the cases. [16]

Formic acid, topical, is a common treatment for plantar warts, which works by being applied over a period of time, causing the body to reject the wart. [17]

Fluorouracil cream, a chemotherapy agent sometimes used to treat skin cancer, can be used on particularly resistant warts, by blocking viral DNA and RNA production and repair. [4]

Bleomycin, a more potent chemotherapy drug, can be injected into deep warts, destroying the viral DNA or RNA. Bleomycin is notably not US FDA approved for this purpose. Possible side effects include necrosis of the digits, nail loss, and Raynaud syndrome. The usual treatment is one or two injections. [18] [19]

Immunotherapy, as intralesional injection of antigens (mumps, candida or trichophytin antigens USP), is a wart treatment that may trigger a host immune response to the wart virus, resulting in wart resolution. It is now recommended as a second-line therapy. [20]

Surgery

A 7 mm plantar wart surgically removed from the sole of a person's foot after other treatments failed Plantar wart papilloma.jpg
A 7 mm plantar wart surgically removed from the sole of a person's foot after other treatments failed

Liquid nitrogen and similar cryosurgery methods are common surgical treatments, which act by freezing the external cell structure of the warts, destroying the live tissue.[ citation needed ]

Electrodesiccation and surgical excision may produce scarring.[ citation needed ]

Laser surgery is generally a last resort treatment, as it is expensive and painful, but may be necessary for large, hard-to-cure warts. [21]

Cauterization may be effective as a prolonged treatment. As a short-term treatment, cauterization of the base with anesthetic can be effective, but this method risks scarring or keloids. Subsequent surgical removal, if necessary, also risks keloids and/or recurrence in the operative scar. [22]

Related Research Articles

<span class="mw-page-title-main">Wart</span> Small, rough growth resembling a cauliflower or a solid blister

Warts are non-cancerous viral growths usually occurring on the hands and feet but which can also affect other locations, such as the genitals or face. One or many warts may appear. They are distinguished from cancerous tumors as they are caused by a viral infection, such as a human papillomavirus, rather than a cancer growth.

<span class="mw-page-title-main">Human papillomavirus infection</span> Human disease

Human papillomavirus infection is caused by a DNA virus from the Papillomaviridae family. Many HPV infections cause no symptoms and 90% resolve spontaneously within two years. In some cases, an HPV infection persists and results in either warts or precancerous lesions. These lesions, depending on the site affected, increase the risk of cancer of the cervix, vulva, vagina, penis, anus, mouth, tonsils, or throat. Nearly all cervical cancer is due to HPV, and two strains – HPV16 and HPV18 – account for 70% of all cases. HPV16 is responsible for almost 90% of HPV-positive oropharyngeal cancers. Between 60% and 90% of the other cancers listed above are also linked to HPV. HPV6 and HPV11 are common causes of genital warts and laryngeal papillomatosis.

<span class="mw-page-title-main">Genital wart</span> Sexually transmitted infection caused by certain types of human papillomaviruses

Genital warts are a sexually transmitted infection caused by certain types of human papillomavirus (HPV). They may be flat or project out from the surface of the skin, and their color may vary; brownish, white, pale yellow, pinkish-red, or gray. There may be a few individual warts or several, either in a cluster or merged together to look cauliflower-shaped. They can be itchy and feel burning. Usually they cause few symptoms, but can occasionally be painful. Typically they appear one to eight months following exposure. Warts are the most easily recognized symptom of genital HPV infection.

<span class="mw-page-title-main">Molluscum contagiosum</span> Viral infection of the skin

Molluscum contagiosum (MC), sometimes called water warts, is a viral infection of the skin that results in small raised pink lesions with a dimple in the center. They may become itchy or sore, and occur singularly or in groups. Any area of the skin may be affected, with abdomen, legs, arms, neck, genital area, and face being the most common. Onset of the lesions is around seven weeks after infection. They usually go away within a year without scarring.

<span class="mw-page-title-main">Adapalene</span> Third-generation topical retinoid

Adapalene is a third-generation topical retinoid primarily used in the treatment of mild-moderate acne, and is also used off-label to treat keratosis pilaris as well as other skin conditions. Studies have found adapalene is as effective as other retinoids, while causing less irritation. It also has several advantages over other retinoids. The adapalene molecule is more stable compared to tretinoin and tazarotene, which leads to less concern for photodegradation. It is also chemically more stable compared to the other two retinoids, allowing it to be used in combination with benzoyl peroxide. Due to its effects on keratinocyte proliferation and differentiation, adapalene is superior to tretinoin for the treatment of comedonal acne and is often used as a first-line agent. The Swiss company Galderma sells adapalene under the brand name Differin.

<span class="mw-page-title-main">Hyperpigmentation</span> Darkening of an area of skin or nails due to increased melanin

Hyperpigmentation is the darkening of an area of skin or nails caused by increased melanin.

<span class="mw-page-title-main">Actinic keratosis</span> Rough skin induced by UV exposure

Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure.

<span class="mw-page-title-main">Cutaneous larva migrans</span> Medical condition

Cutaneous larva migrans is a skin disease in humans, caused by the larvae of various nematode parasites of the hookworm family (Ancylostomatidae). The parasites live in the intestines of dogs, cats, and wild animals; they should not be confused with other members of the hookworm family for which humans are definitive hosts, namely Ancylostoma duodenale and Necator americanus.

<span class="mw-page-title-main">Papilloma</span> Medical condition

A papilloma is a benign epithelial tumor growing exophytically in nipple-like and often finger-like fronds. In this context, papilla refers to the projection created by the tumor, not a tumor on an already existing papilla.

A skin infection is an infection of the skin in humans and other animals, that can also affect the associated soft tissues such as loose connective tissue and mucous membranes. They comprise a category of infections termed skin and skin structure infections (SSSIs), or skin and soft tissue infections (SSTIs), and acute bacterial SSSIs (ABSSSIs). They are distinguished from dermatitis, although skin infections can result in skin inflammation.

<span class="mw-page-title-main">Bovine papillomavirus</span> Group of viruses

Bovine papillomaviruses (BPV) are a paraphyletic group of DNA viruses of the subfamily Firstpapillomavirinae of Papillomaviridae that are common in cattle. All BPVs have a circular double-stranded DNA genome. Infection causes warts of the skin and alimentary tract, and more rarely cancers of the alimentary tract and urinary bladder. They are also thought to cause the skin tumour equine sarcoid in horses and donkeys.

<span class="mw-page-title-main">Vulvar cancer</span> Cancer involving the vulva

Vulvar cancer is a cancer of the vulva, the outer portion of the female genitals. It most commonly affects the labia majora. Less often, the labia minora, clitoris, or Bartholin's glands are affected. Symptoms include a lump, itchiness, changes in the skin, or bleeding from the vulva.

<span class="mw-page-title-main">Pitted keratolysis</span> Medical condition

Pitted keratolysis is a bacterial skin infection of the foot. The infection is characterized by craterlike pits on the sole of the feet and toes, particularly weight-bearing areas.

<span class="mw-page-title-main">Epidermodysplasia verruciformis</span> Medical condition

Epidermodysplasia verruciformis (EV) is a skin condition characterised by warty skin lesions. It results from an abnormal susceptibility to HPV infection (HPV) and is associated with a high lifetime risk of squamous cell carcinomas in skin. It generally presents with scaly spots and small bumps particularly on the hands, feet, face and neck; typically beginning in childhood or in a young adult. The bumps tend to be flat, grow in number and then merge to form plaques. On the trunk, it typically appears like pityriasis versicolor; lesions there being slightly scaly and tan, brown, red or looking pale. On the elbows, it may appear like psoriasis. On the forehead, neck and trunk, the lesions may appear like seborrheic keratosis.

<span class="mw-page-title-main">Squamous cell papilloma</span> Medical condition

A squamous cell papilloma is a generally benign papilloma that arises from the stratified squamous epithelium of the skin, lip, oral cavity, tongue, pharynx, larynx, esophagus, cervix, vagina or anal canal. Squamous cell papillomas are typically associated with human papillomavirus (HPV) while sometimes the cause is unknown.

<span class="mw-page-title-main">Periungual wart</span> Medical condition

Periungual warts are warts that cluster around the fingernail or toenail. They appear as thickened, fissured cauliflower-like skin around the nail plate. Periungual warts often cause loss of the cuticle and paronychia. Nail biting increases susceptibility to these warts.

Knuckle pads, also known as heloderma, meaning similar to the skin of the Gila monster lizard for which it is named, are circumscribed, keratotic, fibrous growths over the dorsa of the interphalangeal joints. They are described as well-defined, round, plaque-like, fibrous thickening that may develop at any age, and grow to be 10 to 15mm in diameter in the course of a few weeks or months, then go away over time.

<span class="mw-page-title-main">Bowenoid papulosis</span> Medical condition

Bowenoid papulosis is a cutaneous condition characterized by the presence of pigmented verrucous papules on the body of the penis. They are associated with human papillomavirus, the causative agent of genital warts.

Pseudoepitheliomatous keratotic and micaceous balanitis, (PKMB) is a cutaneous condition characterized by skin lesions on the glans penis that are wart-like with scaling. It can present as a cutaneous horn. PKMB is usually asymptomatic, with occasional irritation, burning sensation, fissuring, or maceration.

<span class="mw-page-title-main">Epidermolytic acanthoma</span> Medical condition

Epidermolytic acanthomas are a cutaneous condition characterized by discrete keratotic papules in adults.

References

  1. ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 405. ISBN   978-0-7216-2921-6.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Vlahovic, TC; Khan, MT (July 2016). "The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management". Clinics in Podiatric Medicine and Surgery. 33 (3): 337–53. doi:10.1016/j.cpm.2016.02.003. PMID   27215155.
  3. 1 2 3 4 5 6 Ferri, Fred F. (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 1375. ISBN   9780323529570.
  4. 1 2 Salk, Robert S.; Grogan, Kirk A.; Chang, Thomas J. (May 2006). "Topical 5% 5-Fluorouracil Cream in the Treatment of Plantar Warts: A Prospective, Randomized, and Controlled Clinical Study". Journal of Drugs in Dermatology. 5 (5): 418–24. PMID   16703777.
  5. 1 2 3 4 5 "Plantar Warts". AOFAS. Archived from the original on 11 November 2017. Retrieved 11 November 2017.
  6. 1 2 Human Papillomavirus at eMedicine
  7. ↑ Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T (1998). "Human papillomavirus 57 identified in a plantar epidermoid cyst". Br. J. Dermatol. 138 (3): 510–4. doi:10.1046/j.1365-2133.1998.02135.x. PMID   9580810. S2CID   19998825.
  8. ↑ "Human Papillomaviruses Compendium" (PDF). Los Alamos National Laboratory. Retrieved 2013-02-05.
  9. ↑ Davis MD, Gostout BS, McGovern RM, Persing DH, Schut RL, Pittelkow MR (2000). "Large plantar wart caused by human papillomavirus-66 and resolution by topical cidofovir therapy". J. Am. Acad. Dermatol. 43 (2 Pt 2): 340–3. doi:10.1067/mjd.2000.100534. PMID   10901717.
  10. ↑ Chouhy D, Bolatti EM, Piccirilli G, Sánchez A, Fernandez Bussy R, Giri AA (2013). "Identification of human papillomavirus type 156, the prototype of a new human gammapapillomavirus species, by a generic and highly sensitive PCR strategy for long DNA fragments". J. Gen. Virol. 94 (Pt 3): 524–33. doi: 10.1099/vir.0.048157-0 . hdl: 11336/4852 . PMID   23136368.
  11. ↑ Warts, Plantar at eMedicine
  12. 1 2 "Understanding Plantar Warts". Health Plan of New York. Retrieved 2007-12-07.
  13. ↑ "Clinical Knowledge Summaries: Previous version – Warts (including verrucas)" (PDF). National Health Service. January 2007. p. 2. Archived from the original (PDF) on 2011-06-01. Retrieved 2010-12-05.
  14. ↑ Bacelieri R, Johnson SM (2005). "Cutaneous warts: an evidence-based approach to therapy". Am Fam Physician. 72 (4): 647–52. PMID   16127954.
  15. ↑ Kwok, Chun Shing; Gibbs, Sam; Bennett, Cathy; Holland, Richard; Abbott, Rachel (12 September 2012). "Topical treatments for cutaneous warts". Cochrane Database of Systematic Reviews. 2020 (9): CD001781. doi:10.1002/14651858.CD001781.pub3. PMC   8101088 . PMID   22972052.
  16. ↑ Cockayne, S; Curran, M; Denby, G; Hashmi, F; Hewitt, C; Hicks, K; Jayakody, S; Kang’ombe, A; McIntosh, C; McLarnon, N; Stamuli, E; Thomas, K; Turner, G; Torgerson, D; Watt, I; EVerT team (September 2011). "EVerT: cryotherapy versus salicylic acid for the treatment of verrucae – a randomised controlled trial". Health Technology Assessment. 15 (32): 1–170. doi: 10.3310/hta15320 . PMID   21899812.
  17. ↑ Bhat, RM; Vidya, K; Kamath, G (June 2001). "Topical formic acid puncture technique for the treatment of common warts". International Journal of Dermatology. 40 (6): 415–9. doi:10.1046/j.1365-4362.2001.01242.x. PMID   11589750. S2CID   42351889.
  18. ↑ Soni, Prasoon; Khandelwal, Kanika; Aara, Naushin; Ghiya, Bhikam C; Mehta, Rajesh D; Bumb, Ram A (2011). "Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts". Journal of Cutaneous and Aesthetic Surgery. 4 (3): 188–191. doi: 10.4103/0974-2077.91250 . PMC   3263129 . PMID   22279384.
  19. ↑ Champion, R. H., et al. (1998). Rook's Textbook of Dermatology. Blackwell Science, p. 1044, ISBN   0-632-06429-3
  20. ↑ Bacelieri R, Johnson SM (2005). "Cutaneous warts: An evidence-based approach to therapy". American Family Physician. 72 (4): 647–652. PMID   16127954.
  21. ↑ "Laser Surgery for Warts", webmd.com
  22. ↑ Kunnamo, Ilkka (2005). Evidence-based Medicine Guidelines. John Wiley and Sons. p. 422. ISBN   978-0-470-01184-3.
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