Verruca

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Contents

Introduction

Plantar warts

Aetiology

Human papilloma virus (HPV) - certain genotypes only.

Clinical

Warts on the sole of the foot, which may cause discomfort, especially if it is in a weight-bearing area of the foot.

Immune suppression

Patients with some types of immune suppression may have a very florid infection with warts or verrucas.

Investigations

None usually required.

Treatment

Several treatments may be used, but for most, none is necessary.

Treatment may be palliative - the lump of skin that protrudes and causes discomfort is dead skin, and not innervated, so it can be painlessly cut off with a scalpel blade. This does not cure the wart, of course, but it does prevent it from causing pain.

Warts can be "burnt off" with chemicals, or with liquid nitrogen. This can be painful and leave a scar, and interferes with the process of developing an immune response to warts.

Cytotoxic drugs have been used - 5FU[1] and bleomycin among them - this seems rough, but may be effective. It is not geenrally recommended.

In time nearly all patients will become immune to the virus causing the warts, and they will disappear spontaneously. This generally happens more quickly in children - who usually become immune within months - than in adults, in whom warts may persist for several years.

LogoKeyPointsBox.pngDuct tape occlusion
  • One small and so far unrepeatable study published in Archives of Pediatric and Adolescent Medicine October 2002 found this more effective than cryotherapy
  • Cut a small piece of duct tape to cover the wart for 6 days in a row replacing it with a new piece if it falls off.
  • After 6 days the child soaks the wart in water and then rubs it with an emery board or pumice stone.
  • The next morning fresh duct tape is applied for another 6 days.
  • Continue for 2 months unless the wart disappears sooner.

Prevention

Guidance often recommends that people with verrucas should wear verruca socks when swimming. This is illogical.

Research clearly shows that people who use "locker rooms" are more likely to get verrucas than others, and the wet floors in swimming pool changing rooms are likely to be a good place to pick up a verruca.

Furthermore, many people using swimming pool changing rooms have verrucas. So it makes sense to tell them to use a verruca sock, obviously.

Except that the research also shows that a majority of people with verrucas don't know they have them; and there's no evidence that people who are told to wear verruca socks will do them (after all, they cost money and may be stigmatising).

Exercise, including swimming, should be encouraged; and the evidence does NOT support the view that people without verrucas are effectively protected by telling people with them to wear verruca socks, and that the guidance is illogical and inappropriate.

Some people people with the types of immune suppression that put them at risk of very severe warts should wear verruca socks if they go swimming. There's no evidence for this, but it seems sensible, and would only affect a very few people. For most people plantar warts are a transitory nuisance. If anything it's probably better to get them early in life, since warts acquired in childhood generally disappear spontaneously, leaving long-term immunity, after a few months; whereas those acquired by adults may persist for several years.

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