Warts - Verruca Plantaris
The Plantar Wart, caused by the Human Papilloma Virus is a benign skin infection involving the bottom of the foot. This skin infection is unique to the bottom of the foot and does not spread to any other area of the skin.
Children between 12-15 years of age appear to have the greatest likelihood of developing this infection. Genetics and immune factors may predispose someone to the infection but direct contact with the virus must occur. The virus is community acquired and can be seen in high foot traffic areas like locker rooms.
The infection is generally self limited and can spontaneously resolve within one to two years. The infection however, can spread over time creating a larger surface area of infection on the bottom of the foot. The wart is a raised lesion on the bottom of the foot that when observed closely has an irregular surface pattern, usually round, and can have dark pinpointed regions in the body of the wart that are capillary blood vessels. Calluses or corns on the bottom of the feet are commonly mistaken as warts. calluses generally occur on the high pressures areas of the heel and the ball of the foot and when closely observed don’t have irregular surfaces and capillary blood vessels as do warts.
Warts are often recognized by patients because pain occurs due to the thickness of the wart increasing pressure during walking activity. The increased pressure placed on the underlying sensory nerves causes this pain response. Alleviating pressure from the wart tissue by padding around the wart can relieve this discomfort.
There are many forms of treatment for warts. All treatments are designed at creating an injury to the skin level to help eliminate the wart. Surgical excision, liquid nitrogen (cold therapy), chemical ablation, as well as topically applied salicylic acid wart agents are just a few of the approaches to wart treatment.
Creating an effective strategy for treating warts is very important. A single plantar wart may be most effectively treated by surgically removing the wart during an office visit while a wart that has spread may be better treated over time with topical medications.
Surgical removal of warts is done in the office under a local anesthetic. After the procedure, warm water soaks and wound care are performed for a short period of time until skin healing has occurred. Complications including infection and scarring are rare. Recurrence rates for warts after surgical excision range between 20-30 percent. The recurrence rate is not related to re-infection but incomplete excision.
Cantharone® topical chemical application is a highly effective treatment for the plantars wart. Cantharone is an extract of beetle juice that when applied to the skin can create a blister at the site of the wart. Cantharone is applied painlessly in the office and allowed to dry. A band-aid is applied to cover the area of application and padding is dispensed to take the pressure off of the area. The application can cause a delayed pain reaction after the first several days. Patients are generally seen back in the office after two weeks to remove the blistered skin and reapply the medication if needed. Generally, two to three applications are needed prior to complete wart resolution.
After Cantharone® application, please adhere to the following:
- Keep your foot dry for 48 hours.
- Resume normal bathing and showering with protective use of a band-aid and antibacterial ointment for the next week. You can expect a blister responses after the Cantharone
- (If signs of infection including pain, swelling, redness, or streaking from the site of Cantharone application, call the office for advice at 543-7788 / 434-2009)
- After the first week, remove the calloused area with manual techniques as reviewed with your physician.
- Begin the use of topical wart removal medications including any commercially available salicylic acid preparation or Plantarstat® Wart Remover.
- The topical medication generally should be applied once daily to the wart and covered with an occlusive barrier including band-aids or duct tape.
- The occlusive barrier should be removed after 24 hours and the tissue should be again debrided.
- (If the wart region becomes excessively tender, reduce the daily application of topical medication and self treatment to every other day).
- Adhesive felt pads can reduce pain at the wart by relieving pressure at the wart site.
After successful removal it is important to periodically check to make sure that the wart has not returned.
Information about warts, how Cantharone and Cantharone Plus work, and the progression of treatment.