Verrucas (aka Plantar Warts)

Verrucas is an embarrassing problem that by this name many people do not know. Another common name for verrucas, and the one most people are familiar with is plantar warts. The scientific name is verruca plantaris which is commonly shortened to either verruca or plantar warts. These particular warts are caused by the human papillomavirus (HPV). Unlike like many other wart types, plantar warts, or verrucas only occur on the sole or toes of the foot. It is called something else is HPV infections in other locations. While caused by a virus, it is important to understand that plantar warts are harmless. They can be painful, and but should be treated to lessen symptoms, decrease duration, and to reduce the likelihood of you spreading them to someone else, but if you do not treat them, besides some pain, the biggest problem they pose is that they are ugly and embarrassing.

What do they look like?

 Well, there are many different variations of the verrucas or plantar warts, and it is going to look different depending on who you are, however, in general the warts will have a hard `warty' or `verrucous' surface. The plantar wart variety includes one or in some cases several tender inwardly growing `myrmecia' on the sole of the foot. Many times there is a small black dot in the middle. This dot is due to a thrombosed capillary, and is typical of these warts. Of course, all viral warts are different. The following is a quick look at some of the various viral warts, and how they manifest, but these are not verrucas, only have many similarities to it.

• Common warts: These most often are found on the backs of fingers or toes, and on the knees. They are raised scaly surfaces. 
• Mosaic warts: These often qualify as verrucas as they are found on the sole of the foot and are usually in clusters over an area sometimes several centimetres in diameter.  
• Plane, or flat, warts: These can be very numerous and may be spread by shaving.  
• Periungual warts: These viral warts are some of the worst as they prefer to grow at the sides or under the nails and can distort nail growth and look really gross. 
• Filiform warts: These are warts that are on a long stalk.  
• Oral warts: These are very uncomfortable, and can affect the lips and even inside the cheeks. They include squamous cell papillomas.  
• Genital warts: These are warts found in the genital area and are often transmitted sexually and predispose to cervical, penile and vulval cancer.  

In general warts that are viral will clear up within a few months for children, even if they are not treated. In adults it can take much longer, but they should eventually clear up, although, using treatment is always wise when you are dealing with viral warts because by nature they spread, whether on your own body or to other people. Treatment means you eliminate them and their discomfort faster, and you lessen the chance of someone else getting them because of you.

If you suffer from immunosuppression, or have found that certain medications you are on make you more prone to illness, it is really a good idea to treat warts, especially sicne if you have a depressed immune system your warts may never clear up.

Before we look at how to treat warts, let's look at how you get these plantar warts. Avoidance is always better than treatment, and the best way to avoid getting verrucas is to understand how you get infected in the first place.

The fact is that these viral warts spread fairly easily, and thus it is estimated that 7-10% of the US population is infected. This means that there is a good chance that someone you know carried the virus, and makes you more prone to getting it. Infection usually occurs in moist areas as they are friendlier to supporting the virus. However, this particular virus does not need a host, and can survive several months without on, which makes it even more contagious. It is typically spread on moist walking surfaces such as showers, swimming pools, or shoes. The virus can only infect you through direct contact to the skin, usually entering through tiny cuts and abrasions on the outermost layer of the skin. After you get infected, it could take several months before you show any symptoms. The reason for this is that the pressure on the sole of the foot can push the wart inward. The wart is then covered by a hard outer layer of skin. Because of how it is formed, these warts can be extremely painful, especially if you spend a lot of time on your feet.

While generally you need direct contact, warts may spread through autoinoculation, by infecting nearby skin or by infecting walking surfaces. With verrucas, the biggest risk is that they can spread to other parts of your body, or form large, painful, clusters, these are called mosaic warts, but still classify as plantar warts.

Ok, so now that you know how you get them, and some of the risks and side affects, let's look at how to avoid them.

First, try to avoid walking barefoot in communal areas that might have wet floors, such as gyms, locker rooms, swimming pools, etc. The communal showers and locker rooms of public pools, for example, are prime places for the spread of HPV in the form of verrucas.

The next thing you should do is try not to share shoes or socks with anyone, as this will increase the chances of you getting the virus.

Lastly, you should avoid direct contact of the skin with anyone who you know carries the virus.

How do you treat verrucas?

There are many treatment options for verrucas, but it is important to understand that once you are infected, there really is no treatment that eliminates the virus, or decrease the level of your infectivity, and you may even still have symptoms after treatment because of latent viruses. However, treatment can address the symptoms, and it can make the virus dormant, or inactive so that it is not as easily spread.

The most affective treatment options are going to vary based on your specific circumstances. The following are some of the most popular treatment options with the highest success rates.

Pharmaceutical treatments: 

• Keratolytic chemicals: This is where you use trichloroacetic acid or salicylic acid to peel away dead surface skin, and effectively peel the warts off. 
• Immunotherapy: This is a treatment where you inject warts with antigens that may make the body reject them. Usually when this treatment is used, it is done with intra-lesional injection of antigens like mumps, candida or trichophytin antigens US. Sometimes this treatment not only helps you get rid of the warts that are injected, but any other warts you have on your body as well. 
• Chemotherapy: If you use this treatment option it is usually done with a topical application of dilute glutaraldehyde. This is a virucidal chemical, used for cold sterilization of surgical instruments. You could also use other chemicals like 5-fluoro-uracil, which can be used topically or injected intra-lesionally. Retinoids are another chemotherapy treatment option that when used topically can be effective as well. Again, this depends on your specific case.

Surgical treatments: 

• Liquid nitrogen: This is a popular treatment options where liquid nitrogen is applied to the wart, which causes a blister to form under the wart. This is painful, but non-scarring, and very effective for removing specific warts.   
• Electrodesiccation and surgical excision: These are two surgical processes where warts are removed, however, both process are known to produce scarring. Also, in many cases, the wart reappears, especially if not all of it was successfully removed. If this happens you then have a scar and a wart. 
• Laser removal: Lasers have shown to be an effective method for removing warts, not leaving scars, and low reoccurrence. This is effective, but often requires multiple treatments, is very expensive, and can be quite painful. The most effective laser treatment is with the 585nm pulsed dye laser.  
• Cauterization: This is an effective treatment, but only if it is prolonger. If you do not prolong the treatment, but choose a short-term cauterization of the base with anaesthetic, you will find it may be effective however it has risks such as scars or keloids.

Other treatment options: 

• Duct tape occlusion therapy: This is a popular method because it is inexpensive, and can be effective, though it takes a long time. Most often it is far easier to try this then to see a doctor. With this treatment, the wart is kept covered with duct tape for six days, then soaked and scrubbed off with a pumice stone. The process is repeated for 6 to 8 weeks, but a new pumice stone must be used each time, otherwise you risk reinfection and spreading of the virus. 
• Doing nothing: This is not popular as plantar warts are quite ugly, however, often times just doing nothing will help you get rid of them as the body's immune system will fight off the warts, they should eventually turn black and fall off, although it can be two years or longer before this takes place. The biggest downside to this option is you will probably pass it on, especially to those you share a bathroom or home with. 
• Hyperthermia: This treatment option is done by immersing the wart or warts in hot water (113ºF or 45ºC) for 30 minutes to 3 hours, 2-3 times per week. This can take several weeks to work.