Lindsey Ebbs Podiatry - Insights

Verrucae and Warts

What are they?

Human papilloma virus (HPV) is the cause of warts and verrucae, they can appear anywhere on the skin but are mostly seen on the hands and feet. When they are located on the sole of the feet, they are called Verrucae. (Plantar warts)

Here are a few common types;

Common wartsare firm and raised with a rough surface that resembles a cauliflower (common on the knuckles, knees and fingers)

Plane warts are round, flat topped and yellow (common on the back of the hand)

Filiform warts are long and slender (common on the face)

Plantar warts (verrucae) grow on the soles of the feet, often have dark dots in the centre and may be painful.

Mosaic warts occur when plantar or palmo warts coalesce into larger plaques on the feet and hands

The striae (finger print lines) deviate from their course and go around the wart/verrucae and never go through it.

How can you get them? They are usually spread by direct skin-to-skin contact, or indirectly via contact with contaminated floors and surfaces, the virus gains entry through micro- abrasions in the skin which are not always visible to the naked eye.

Approximately two million people seek medical advice about warts each year in the UK and it is considered that most people will have them at some point in their life. They are unusual in infancy and early childhood and the incidence of having them increases during early school years and peaks in adolescence and early adulthood.

They are usually harmless, painless and will clear after about 2 years when the immune system recognises the virus, this will take longer in people who are older and immune compromised.

When would you consider treatment?

  1. When the warts/ verrucae are painful
  2. The wart/verrucae are cosmetically unsightly and concerning the person

Otherwise leave them alone, refrain from picking and let the immune system do its job of getting rid of them.

These are the available treatments and the recent evidence-based research around them?

Microwave (Swift) - is the most recent treatment protocol for verrucae and the one we use in clinic all the time due to its 76% resolution rate. This treatment works by delivering microwaves capable of passing through the verrucae and heating the tissue behind, causing inflammation, which in turn, stimulates an immune response to ultimately get rid of the verrucae. The treatment is quick, without dressings and no compromise to lifestyle, a course of 3 x monthly treatment is recommended.

Cryotherapy (freezing) - usually with liquid nitrogen. As Podiatrists, over the years we have frozen verrucae with limited success and recent evidence shows that aggressive treatment with cryotherapy is more effective than gentler applications but can have complications of pain, blistering and scarring. A 12-week treatment protocol on plantar verrucae was found to be no more successful than a placebo or no treatment at all. Cryotherapy is not recommended for the use on younger children.

Falknor’s needling method - This method is performed under local anaesthesia and with an empty hypodermic needle the verruca is punctured through to the underlying fat many times to create a beefy red wound, in the hope of an enhanced immune response. In a small study of 45 patients it had a 69% success rate

Salicylic acid (15-50%) - examples of over the counter preparations are Duofilm®, Bazuka, Occlusal® and Salactol® This a cheaper and easily available option, they have a modest effect compared to placebo but have to be applied daily over at least a 12-week period. The salicylic acid could cause irritation to the normal skin around the verrucae.

Electrodessication with curettage (surgery) - This procedure can be very successful in the treatment of verrucae; it is done under local anaesthesia. There can be post-surgery pain with complications of possible scarring dependant on the location of the verrucae.

Laser - Currently, the use of lasers for wart treatment is limited due to the lack of established treatment guidelines. Of the evidence available, the Er:YAG Laser has the highest successful resolution rate of 72-100% compared with other lasers

Podiatry used acids - Phenol 80%, Monochloroacetic acid, Trichloroacetic acid 80%, Pyrogallol acid 60% and Salicylic acid 60%. Although as podiatrists, we have used all of these acids over the last 30 years, some have been very successful but do carry a higher risk of complications and chemical burns to the skin. Consequently, there has been a move away from these treatments by the profession in recent years.

Occlusive tapes like `Duct tape` - registered on the internet there is lots of advice on how to use duct tape in the successful resolution of verrucae and warts however evidence has been shown that this is not the case an they are no better than a placebo. In addition to that, they are made with an industrial adhesive which can cause allergic dermatitis on the skin. Really not to be recommended for any skin related problems, keep it for the household fixes!

Homeopathy, hypnotherapy, silver nitrate, zinc oxide, citric acid and herbal remedies have no evidence to support any claims to successfully treating warts and verrucae.

The warts on the hands in all treatments seem to clear before the feet but there is no concrete evidence to suggest why?

Podiatrists are qualified and insured to treat hands as well as feet.

These statistics could change as soon as any new evidence is produced but they are accurate to this published date.

Can I do anything to prevent getting a verrucae or warts?

It's difficult to prevent warts and verrucae completely, but the following measures can help stop them spreading:

  1. Avoid touching other people's warts – wash your hands after touching your own warts.
  2. Avoid sharing towels, flannels, shoes and socks with other people
  3. Keep your feet and hands clean and dry
  4. Change your socks every day
  5. Don’t go barefoot in public places, wear flipflops
  6. Cover warts and verrucae with a waterproof plaster when swimming
  7. Avoid scratching or picking at warts or verrucae – this may spread the infection to other parts of your body
  8. Don’t bite nails or suck fingers that have warts on

If you are not sure if you have a verruca or not or just want to discuss a treatment plan that is right for you, then consult a Podiatrist who will take into account your medical history, medication, age, lifestyle and suitability for verrucae treatment.

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