Plantar wart
Classification & external resources

A plantar wart. Striae (fingerprints) go around the lesion.
ICD-10	B07
ICD-9	078.19

A plantar wart (verruca plantaris, VP; also commonly called a verruca) is a wart caused by the human papilloma virus (HPV). It is a small lesion that appears on the sole of the foot (hence the name, from Latin planta pedis, the sole of the foot) and typically resembles a cauliflower. A plantar wart may have small black specks within it that ooze blood when the surface is shaved; these are abnormal capillaries. Though the name plantar wart describes specifically 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. Because of pressure on the sole of the foot, 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, by sharing shoes, etc. Image File history File linksMetadata Veruca_right_foot_detail. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... A wart is generally a small, rough tumor, typically on hands and feet, that can resemble a cauliflower or a solid blister. ... “HPV” redirects here. ... For other uses, see Latin (disambiguation). ... Cauliflower is a cultivar group within Brassica oleracea, in the family Brassicaceae. ...

Diagnosis

Young plantar warts

Plantar warts, can often be differentiated from helomata, corns, by close observation of skin striations. Feet, like hands, are covered in skin striae, which are more commonly called fingerprints. With plantar warts, the skin striae go around the lesion; if the lesion is not a plantar wart, the cells' DNA is not altered and the striations continue across the top layer of the skin. Plantar warts tend to be painful on application of pressure from eithe side of the lesion rather than direct pressure. Helomata tend to be painful on direct pressure rather than pressure from either side. Image File history File links Size of this preview: 800 × 373 pixelsFull resolution (1175 × 548 pixel, file size: 37 KB, MIME type: image/jpeg) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Plantar wart User:RaffiKojian ... Image File history File links Size of this preview: 800 × 373 pixelsFull resolution (1175 × 548 pixel, file size: 37 KB, MIME type: image/jpeg) File links The following pages on the English Wikipedia link to this file (pages on other projects are not listed): Plantar wart User:RaffiKojian ... This article is about calluses and corns of human skin. ... Bodybuilding In bodybuilding, striations are the tiny grooves of muscle across major muscle groups characteristic of a well-developed body. ... A macro shot of a palm and the base of several fingers; as seen here, debris can gather between the ridges. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ...

The difference between plantar warts and warts elsewhere on the body is that warts are generally outgrowth lesions, but on the bottom of the foot, they are pushed inward by the pressure of walking. Since the skin on the bottom of the foot tends to be thicker than elsewhere, the treatment of plantar warts is more difficult.

Treatment

No treatment in common use is 100% effective. The most comprehensive medical review^[1] 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:^[2] For other uses, see Placebo (disambiguation). ... The American Family Physician is a medical journal of the American Academy of Family Physicians. ...

Podiatrists and dermatologists are considered specialists in the treatment of plantar warts, though most warts are treated by primary care physicians. Salicylic acid is the chemical compound with the formula C6H4(OH)CO2H, where the OH group is adjacent to the carboxyl group. ... Cryosurgery (cryotherapy) is the application of extreme cold to destroy abnormal or diseased tissue. ... The term immunotherapy incorporates an array of strategies of treatment based upon the concept of modulating the immune system to achieve a prophylactic and/or therapeutic goal. ... Bleomycin is an anti-cancer agent. ... It has been suggested that this article or section be merged with podiatry. ... Dermatology (from Greek δερμα, skin) is a branch of medicine dealing with the skin and its appendages (hair, ass, sweat glands etc). ... A primary care physician, or PCP, is a physician who provides both the first contact for a person with an undiagnosed health concern as well as continuing care of varied medical conditions, not limited by cause, organ system, or diagnosis. ...

Vaccination

Although immunization is available for the HPV and strains causing cervical cancer and venereal warts, there is currently no vaccination treatment for plantar warts. Cervical cancer is a malignant cancer of the cervix. ... Genital warts (or condyloma, or condylomata acuminata) is a highly contagious sexually transmitted infection. ...

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 trichophytin 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.

As warts are contagious, precautions should be taken to avoid spreading.

Keratolytic (ker-uh-toe-lih-tik) therapy is treatment to remove warts. ... Two viral warts on a middle finger, being treated with a mixture of acids (like salicylic acid, brand name Aporil®) to remove them. ... In organic chemistry, the chloroethanoic acids (trivial name chloroacetic acids) are three related chlorocarbon carboxylic acids: chloroethanoic acid (chloroacetic acid), CH2ClCOOH dichloroethanoic acid (dichloroacetic acid), CHCl2COOH trichloroethanoic acid (trichloroacetic acid), CCl3COOH As the number of chlorine atoms increases, the electronegativity of that end of the molecule increases, and the molecule... Salicylic acid is the chemical compound with the formula C6H4(OH)CO2H, where the OH group is adjacent to the carboxyl group. ... The term immunotherapy incorporates an array of strategies of treatment based upon the concept of modulating the immune system to achieve a prophylactic and/or therapeutic goal. ... Chemotherapy is the use of chemical substances to treat disease. ... Glutaraldehyde is a colourless liquid with a pungent odor used to sterilize medical and dental equipment. ... The Retinoids are a class of chemical compounds that are related chemically to vitamin A. Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth. ... Isotretinoin (INN) (IPA: ) is a medication used for the treatment of severe acne. ... Tretinoin is the acid form of vitamin A and so also known as all-trans retinoic acid or ATRA. It is a drug commonly used to treat acne vulgaris and keratosis pilaris. ...

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.
• Electrodesiccation 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 the most effective treatment of all, and does not leave scars, but is generally a last resort treatment as it is expensive and painful, and multiple laser treatments are required (generally 4-6 treatments repeated once a month until the wart disappears).

Cryosurgery (cryotherapy) is the application of extreme cold to destroy abnormal or diseased tissue. ... General Name, Symbol, Number nitrogen, N, 7 Chemical series nonmetals Group, Period, Block 15, 2, p Appearance colorless gas Standard atomic weight 14. ...

Other

• X-ray is an old method that is seldom recommended due to the long term adverse side effects of irradiation.

• 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.^[3]

• Watchful waiting may be appropriate since many warts will eventually resolve due 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

Duct tape occlusion therapy (DTOT): is a controversial method for treating warts by keeping them covered with duct tape for an extended period. ... A piece of transparent duct tape, left, and of silver duct tape, right. ... Watchful waiting, also referred to as observation, is an approach to a medical problem in which time is allowed to pass before further testing or therapy is pursued. ...

Relative effectiveness of treatments

A 2006 study assessed the effects of different local treatments for cutaneous, non-genital warts in healthy people.^[4] 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.

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.

Prevention

• Avoid walking barefoot in public areas such as showers, communal changing rooms. (Covering with an adhesive bandage is not a safe method as it will not last for long at all, especially while showering or swimming)
• 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.

References

1. ^  Cochrane Database Syst Rev. 2003;(3):CD001781. PMID 12917913
2. ^  Cochrane Database Syst Rev. 2006;(3):CD001781. PMID 16855978 [5]
3. ^  BMJ. 2002 Aug 31;325(7362):461. PMID 12202325
4. ^  Plantar Warts, Treatment [6] (Mayo Clinic)
5. ^  Warszauer-Szwarc L.Treatment of plantar warts with banana skin. Plast.Reconstr.Surg 1981. 68; 975-6. PMID 7301999
6. ^  Cutaneous Warts: An Evidence-Based Approach to Therapy. American Family Physician 2005;72(4):647-52. PMID 16127954

External links

1. Mayo Clinic
2. Advice from UK Society of Chiropodists and Podiatrists
3. Warts, The Merck Manual
4. Plantar Wart photo library at Dermnet