Plantar wart: Difference between revisions
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{{Infobox disease |
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{{Infobox medical condition (new) |
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|Name = Plantar wart |
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| name = Plantar wart |
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|ICD10 = B07 |
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| image = Largeplanterwart.jpg |
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|ICD9 = {{ICD9|078.12}} |
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| caption = Close up image of a large plantar wart |
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|Image = Veruca right foot detail.jpg |
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| synonyms = Verruca myrmecia, verruca plantaris<ref name="andrews">{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |pages=405 |isbn=978-0-7216-2921-6|display-authors=etal}}</ref> |
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|Caption = A plantar wart. Striae (fingerprints) go around the lesion. |
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| field = [[Dermatology]], [[Podiatry]] |
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| symptoms = Skin colored lesion, may be painful<ref name=V2016/> |
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| complications = Trouble walking,<ref name=V2016/> transmission to other parts of the body, callus formation |
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| onset = |
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| duration = Two years<ref name=V2016/> |
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| types = |
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| causes = [[Human papillomavirus]] (HPV)<ref name=V2016/> |
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| risks = Communal showers and pools, [[barefoot]] walking, [[sandals|open footwear]], prior warts, [[immunocompromised|poor immune function]]<ref name=V2016/><ref name=Fer2018/> |
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| diagnosis = Based on symptoms<ref name=Fer2018/> |
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| differential = [[Callus]], [[molluscum contagiosum]], [[squamous cell carcinoma]]<ref name=V2016/> |
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| prevention = |
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| treatment = [[Salicylic acid (medical use)|Salicylic acid]], [[chemotherapy|chemo]]-based [[Fluorouracil]] and [[bleomycin]],<ref name="fluorouracil">{{cite journal |last1=Salk |first1=Robert S. |last2=Grogan |first2=Kirk A. |last3=Chang |first3=Thomas J. |title=Topical 5% 5-Fluorouracil Cream in the Treatment of Plantar Warts: A Prospective, Randomized, and Controlled Clinical Study |journal=Journal of Drugs in Dermatology |date=May 2006 |volume=5 |issue=5 |pages=418–24 |pmid=16703777 |url=https://jddonline.com/articles/dermatology/S1545961606P0418X }}</ref> [[cryotherapy]], surgical removal<ref name=V2016/> |
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| medication = |
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| prognosis = |
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| frequency = Common<ref name=AO2017/> |
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| deaths = |
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}} |
}} |
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<!-- Definition and symptoms --> |
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A '''plantar wart''' (also known as "Verruca plantaris"{{R|andrews|page1=405}}) is a [[wart]] caused by the [[human papillomavirus]] occurring on the sole or toes of the foot. (HPV infections in other locations are not plantar; see [[human papillomavirus]].) Plantar warts are usually [[Self-limiting (biology)|self-limiting]], but treatment is generally recommended to lessen symptoms (which may include pain), decrease duration, and reduce transmission.{{R|emed_plantar}} |
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A '''plantar wart''' is a [[wart]] occurring on the [[sole (foot)|bottom]] of the [[foot]] or [[toe]]s.<ref name=AO2017>{{cite web|title=Plantar Warts|url=http://www.aofas.org/footcaremd/conditions/ailments-of-the-big-toe/Pages/Plantar-Warts.aspx|website=AOFAS|access-date=11 November 2017|language=en-us|archive-url=https://web.archive.org/web/20171111204815/http://www.aofas.org/footcaremd/conditions/ailments-of-the-big-toe/Pages/Plantar-Warts.aspx|archive-date=11 November 2017|url-status=dead}}</ref> Its color is typically similar to that of the [[Human skin|skin]].<ref name=V2016/> Small black dots often occur on the surface.<ref name=AO2017/> One or more may occur in an area.<ref name=V2016/> They may result in pain with pressure such that walking is difficult.<ref name=V2016/> |
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==Infection and development== |
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[[Image:Plantarwartscluster.jpg|thumb|Mosaic warts cluster]] |
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[[Image:Wart-IMG 1676.JPG|thumb|Young plantar warts]] |
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It is estimated that 7–10% of the US population is infected. Infection typically occurs from moist walking surfaces such as showers or swimming pools. The virus can survive many months without a host, making it highly contagious.{{R|emed_plantar|emed_hpv}} |
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<!-- Cause and diagnosis --> |
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Plantar warts are benign [[epithelial]] [[tumors]] caused by infection by human papilloma virus types 1, 2, 4, or 63{{R|emed_hpv}}. These types are classified as clinical (visible symptoms). The virus attacks the skin through direct contact, entering through possibly tiny cuts and abrasions in the [[stratum corneum]] (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot or finger, the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated.{{R|emed_plantar|hipusa}} |
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They are caused by the [[human papillomavirus]] (HPV).<ref name=V2016>{{cite journal|last1=Vlahovic|first1=TC|last2=Khan|first2=MT|title=The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management.|journal=Clinics in Podiatric Medicine and Surgery|date=July 2016|volume=33|issue=3|pages=337–53|doi=10.1016/j.cpm.2016.02.003|pmid=27215155}}</ref> A break in the skin is required for infection to occur.<ref name=V2016/> Risk factors include use of communal showers, having had prior warts, and [[immunocompromised|poor immune function]].<ref name=V2016/><ref name=Fer2018>{{cite book|last1=Ferri|first1=Fred F.|title=Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1|date=2017|publisher=Elsevier Health Sciences|isbn=9780323529570|page=1375|url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA1375|language=en}}</ref> Diagnosis is typically based on symptoms.<ref name=Fer2018/> |
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<!-- Treatment and epidemiology --> |
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Warts may spread through [[autoinoculation]], by infecting nearby skin or by infecting walking surfaces. They may fuse or develop into clusters called mosaic warts.{{R|emed_hpv}} |
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Treatment is only needed if it is causing symptoms.<ref name=Fer2018/> This may include [[Salicylic acid (medical use)|salicylic acid]], [[cryotherapy]], [[chemotherapy|chemo]]-based [[fluorouracil]] or [[bleomycin]], and surgical removal.<ref name=V2016/> The skin atop the lesion should generally be removed before treatment.<ref name=V2016/> In about a third to two-thirds of cases, they go away without specific treatment, but this may take a few years.<ref name=V2016/> Plantar warts are common.<ref name=AO2017/> Children and young adults are most often affected.<ref name=Fer2018/> |
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==Signs and symptoms== |
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Their colors are typically similar to that of the nearby [[Human skin|skin]].<ref name=V2016/> Small, black dots may occur on their surfaces.<ref name=AO2017/> One or more may occur in an area.<ref name=V2016/> They may result in pain with pressure such that walking may be difficult.<ref name=V2016/> |
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<gallery mode="packed"> |
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Veruca right foot detail.jpg|A plantar wart: [[striae]] ([[fingerprint]]s) go around the lesion. |
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File:Plantarwartscluster.jpg|Mosaic wart cluster |
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File:Wart-IMG 1676.JPG|Young plantar warts |
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File:30 year old plantar wart.jpg|30-year-old plantar wart |
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File:Painful plantar warts.jpg|Deep, painful plantar warts |
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File:Plantar wart at heel.jpg|Deep plantar wart on heel |
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</gallery> |
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==Cause== |
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Plantar warts are benign [[epithelial]] [[tumors]] generally caused by infection by [[human papillomavirus]] types 1, 2, 4, 60, or 63,<ref name="emed_hpv">{{EMedicine|MED|1037|Human Papillomavirus}}</ref> but also by types 57,<ref name="egawa">{{cite journal |vauthors=Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T | title = Human papillomavirus 57 identified in a plantar epidermoid cyst | journal = Br. J. Dermatol. | volume = 138 | issue = 3 | pages = 510–4 | year = 1998 | pmid = 9580810 | doi = 10.1046/j.1365-2133.1998.02135.x | s2cid = 19998825 }}</ref> 65,<ref name="compendium1994">{{cite web |url=http://pave.niaid.nih.gov/lanl-archives/compendium/94PDF/1/sm1g.pdf |title=Human Papillomaviruses Compendium |access-date=2013-02-05 |publisher=Los Alamos National Laboratory }}</ref> 66,<ref name="davis">{{cite journal |vauthors=Davis MD, Gostout BS, McGovern RM, Persing DH, Schut RL, Pittelkow MR | title = Large plantar wart caused by human papillomavirus-66 and resolution by topical cidofovir therapy | journal = J. Am. Acad. Dermatol. | volume = 43 | issue = 2 Pt 2 | pages = 340–3 | year = 2000 | pmid = 10901717 | doi = 10.1067/mjd.2000.100534 }}</ref> and 156.<ref name="chouhy2013">{{cite journal |vauthors=Chouhy D, Bolatti EM, Piccirilli G, Sánchez A, Fernandez Bussy R, Giri AA | title = Identification of human papillomavirus type 156, the prototype of a new human gammapapillomavirus species, by a generic and highly sensitive PCR strategy for long DNA fragments | journal = J. Gen. Virol. | volume = 94 | issue = Pt 3 | pages = 524–33 | year = 2013 | pmid = 23136368 | doi = 10.1099/vir.0.048157-0 | doi-access = free | hdl = 11336/4852 | hdl-access = free }}</ref> These types are classified as clinical (visible symptoms). The virus attacks compromised skin through direct contact, possibly entering through tiny cuts and abrasions in the [[stratum corneum]] (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot or [[finger]], the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated.<ref name="emed_plantar">{{EMedicine|EMERG|641|Warts, Plantar}}</ref><ref name="hipusa"/> |
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Warts may spread through [[autoinoculation]], by infecting nearby skin, or by contaminated walking surfaces. They may fuse or develop into clusters called mosaic warts.<ref name="emed_hpv"/> |
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==Diagnosis== |
==Diagnosis== |
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A plantar wart is a small lesion that appears on the |
A plantar wart is a small lesion that appears on the surface of the skin and typically resembles a [[cauliflower]], with tiny black [[petechia]]e (tiny [[hemorrhage]]s under the skin) in the center. Pinpoint bleeding may occur when these are scratched. Plantar warts occur on the soles of feet and toes. They may be painful when standing or walking.{{cn|date=May 2021}} |
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Plantar warts are often similar to [[callus]]es or corns, but can be differentiated by close observation of skin striations. Feet are covered in |
Plantar warts are often similar to [[callus]]es or [[Corn (pathology)|corns]], but can be differentiated by close observation of skin striations. Feet are covered in friction ridges, which are akin to [[fingerprint]]s of the feet. Friction ridges are disrupted by plantar warts; if the lesion is not a plantar wart, the striations continue across the top layer of the skin. Plantar warts tend to be painful on application of pressure from either side of the lesion rather than direct pressure, unlike corns (which tend to be painful on direct pressure, instead).{{cn|date=May 2021}} |
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==Prevention |
==Prevention== |
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HPV is spread by direct and indirect contact from an infected host. Avoiding direct contact with contaminated surfaces such as communal changing rooms and shower floors and benches, avoiding sharing of shoes and socks and avoiding contact with warts on other parts of the body and on the bodies of others may help reduce the spread of infection. Infection is less common among adults than children.<ref name="hipusa">{{cite web |url=http://www.hipusa.com/webmd/encyclopedia/plantar_warts/index.html |title=Understanding Plantar Warts |access-date=2007-12-07 |publisher=Health Plan of New York }}</ref> |
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As all warts are contagious, precautions should be taken to avoid spreading them. Recommendations include: |
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Once a person is infected, there is no evidence that any treatment eliminates HPV infection or decreases infectivity, and warts may recur after treatment because of activation of latent virus present in healthy skin adjacent to the lesion. There is currently no vaccine for these types of the virus{{Dubious|date=March 2010}}{{Citation needed|date=March 2010}}. However, treatments are sometimes effective at addressing symptoms and causing [[remission (medicine)|remission]] (inactivity) of the virus.{{R|emed_hpv}} |
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* Cover them with an [[adhesive bandage]] while swimming |
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* Wear latex swimming socks |
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* Wear [[flip-flops]] when using communal showers |
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* Do not share towels.<ref name="nhs">{{cite web |title=Clinical Knowledge Summaries: Previous version – Warts (including verrucas) |url=http://www.cks.nhs.uk/clinical_knowledge/clinical_topics/previous_version/warts_and_verrucae.pdf |publisher=National Health Service |access-date=2010-12-05 |page=2 |date=January 2007 |url-status=dead |archive-url=https://web.archive.org/web/20110601150216/http://www.cks.nhs.uk/clinical_knowledge/clinical_topics/previous_version/warts_and_verrucae.pdf |archive-date=2011-06-01 }}</ref> |
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Plantar warts are not prevented by inoculation with [[HPV vaccine]]s because the warts are caused by different strains of HPV. [[Gardasil]] protects against strains 6, 11, 16, and 18, and [[Cervarix]] protects against 16 and 18, whereas plantar warts are caused by strains 1, 2, 4, and 63.{{dubious|date=September 2020}}<!-- contradicts https://www.mayoclinic.org/diseases-conditions/plantar-warts/diagnosis-treatment/drc-20352697 --> |
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The treatment that will be effective in a particular case is highly variable. The most comprehensive medical review found that no treatment method was more than 73% effective and using a [[placebo]] had a 27% average success rate.{{R|cochrane2006}} |
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==Treatment== |
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Some treatments that have been found to be effective include:{{R|bacelieri}} |
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{{further|Wart#Treatment}} |
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{| class="wikitable" |
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center" |
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| First-line therapy || Over |
| First-line therapy || [[Over-the-counter drug|Over-the-counter]] [[Salicylic acid (medical use)|salicylic acid]] |
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|- |
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| Second-line therapy |
| Second-line therapy || [[Prescription drug|Prescribed]] 60% salicylic acid, intralesional [[immunotherapy]] |
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|- |
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| Third-line therapy || [[ |
| Third-line therapy || [[Fluorouracil|Fluorouracil cream]], [[cryotherapy]], [[laser]] therapy |
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|- |
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| Fourth-line therapy || [[Bleomycin]], surgical excision |
| Fourth-line therapy || [[Bleomycin|Bleomycin injection]], surgical excision |
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|} |
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[[Image:Wart cryotherapy.jpg|thumb|Cryotherapy being applied to a plantar wart with a [[cotton swab]]]] |
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A number of treatments have been found to be effective.<ref name="bacelieri">{{cite journal |vauthors=Bacelieri R, Johnson SM |title = Cutaneous warts: an evidence-based approach to therapy |journal = Am Fam Physician |volume = 72 |issue = 4 |pages = 647–52 |year = 2005 |pmid = 16127954 |url = http://www.aafp.org/afp/20050815/647.html}}</ref> A 2012 review of different treatments for skin warts in otherwise healthy people concluded modest benefit from salicylic acid, and cryotherapy appears similar to salicylic acid.<ref>{{cite journal |last1=Kwok |first1=Chun Shing |last2=Gibbs |first2=Sam |last3=Bennett |first3=Cathy |last4=Holland |first4=Richard |last5=Abbott |first5=Rachel |title=Topical treatments for cutaneous warts |journal=Cochrane Database of Systematic Reviews |date=12 September 2012 |volume=2020 |issue=9 |pages=CD001781 |doi=10.1002/14651858.CD001781.pub3 |pmid=22972052 |pmc=8101088 }}</ref> |
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===Medications=== |
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[[Podiatrist]]s and [[dermatology|dermatologists]] are considered specialists in the treatment of plantar warts, though most warts are treated by [[primary care physician]]s. |
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Salicylic acid, the [[treatment of warts by keratolysis]], involves the peeling away of dead surface skin cells with [[keratolytic]] chemicals such as salicylic acid or [[trichloroacetic acid]]. These are available in over-the-counter products, but in higher concentrations may need to be prescribed by a physician. A 12-week daily treatment with salicylic acid has been shown to lead to a complete clearance of warts in 10–15% of the cases.<ref>{{cite journal |last1=Cockayne |first1=S |last2=Curran |first2=M |last3=Denby |first3=G |last4=Hashmi |first4=F |last5=Hewitt |first5=C |last6=Hicks |first6=K |last7=Jayakody |first7=S |last8=Kang’ombe |first8=A |last9=McIntosh |first9=C |last10=McLarnon |first10=N |last11=Stamuli |first11=E |last12=Thomas |first12=K |last13=Turner |first13=G |last14=Torgerson |first14=D |last15=Watt |first15=I |author16=EVerT team |title=EVerT: cryotherapy versus salicylic acid for the treatment of verrucae – a randomised controlled trial |journal=Health Technology Assessment |date=September 2011 |volume=15 |issue=32 |pages=1–170 |doi=10.3310/hta15320 |pmid=21899812 |doi-access=free }}</ref> |
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[[Formic acid]], topical, is a common treatment for plantar warts, which works by being applied over a period of time, causing the body to reject the wart.<ref>{{cite journal |last1=Bhat |first1=RM |last2=Vidya |first2=K |last3=Kamath |first3=G |title=Topical formic acid puncture technique for the treatment of common warts |journal=International Journal of Dermatology |date=June 2001 |volume=40 |issue=6 |pages=415–9 |pmid=11589750 |doi=10.1046/j.1365-4362.2001.01242.x |s2cid=42351889 }}</ref> |
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As warts are contagious, precautions should be taken to avoid spreading. |
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[[Fluorouracil]] cream, a [[chemotherapy]] agent sometimes used to treat [[skin cancer]], can be used on particularly resistant warts, by blocking [[virus|viral]] [[DNA]] and [[RNA]] production and repair.<ref name="fluorouracil" /> |
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===Pharmaceutical treatments=== |
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; [[Keratolytic|Keratolytic chemicals]]: The [[treatment of warts by keratolysis]] involves the peeling away of dead surface skin cells with [[trichloroacetic acid]] or [[salicylic acid]], which can be prescribed by a dermatologist in a higher concentration than that found in over-the-counter products. |
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; [[Immunotherapy]]: Intralesional injection of antigens ([[mumps]], ''[[Candida (genus)|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. |
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; [[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. [[Retinoid]]s, systemically (e.g. [[isotretinoin]]) or topically ([[tretinoin]] cream) may be effective. |
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[[Bleomycin]], a more potent chemotherapy drug, can be injected into deep warts, destroying the viral DNA or RNA. Bleomycin is notably not US [[FDA]] approved for this purpose. Possible side effects include [[necrosis]] of the digits, nail loss, and [[Raynaud syndrome]]. The usual treatment is one or two injections.<ref>{{cite journal |last1=Soni |first1=Prasoon |last2=Khandelwal |first2=Kanika |last3=Aara |first3=Naushin |last4=Ghiya |first4=Bhikam C |last5=Mehta |first5=Rajesh D |last6=Bumb |first6=Ram A |title=Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts |journal=Journal of Cutaneous and Aesthetic Surgery |date=2011 |volume=4 |issue=3 |pages=188–191 |doi=10.4103/0974-2077.91250 |pmid=22279384 |pmc=3263129 |doi-access=free }}</ref><ref>Champion, R. H., et al. (1998). ''Rook's Textbook of Dermatology''. Blackwell Science, p. 1044, {{ISBN|0-632-06429-3}}</ref> |
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===Surgical=== |
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[[Image:Plantar wart papilloma.jpg|thumb|right|A ~7mm plantar wart surgically removed from patient's footsole after other treatments failed.]] |
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[[Immunotherapy]], as intralesional injection of [[antigen]]s ([[mumps]], ''[[Candida (genus)|candida]]'' or [[trichophytin]] antigens USP), is a wart treatment that may trigger a host immune response to the wart virus, resulting in wart resolution. It is now recommended as a second-line therapy.<ref>{{cite journal |vauthors=Bacelieri R, Johnson SM |title = Cutaneous warts: An evidence-based approach to therapy |journal = American Family Physician |volume = 72 |issue = 4 |pages = 647–652 |year = 2005 |pmid = 16127954 |url = http://www.aafp.org/afp/2005/0815/p647.html }}</ref> |
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* Liquid nitrogen: [[Cryosurgery]] with [[liquid nitrogen]]. A common treatment that works by producing a blister under the wart. |
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* Electrodesiccation and surgical excision produce scarring. If the wart recurs, the patient has a permanent scar along with the wart. |
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* Lasers may be effective, especially the 585 nm pulsed dye laser which is 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). |
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* Cauterization may be effective as a prolonged treatment. As a short-term treatment, cauterization of the base with anaesthetic can be effective but risks scars or [[keloid]]s. Subsequent surgical removal is unnecessary, and risks keloids and recurrence in the operative scar.{{R|kunnamo}} |
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=== |
===Surgery=== |
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[[File:Plantar wart papilloma.jpg|thumb|right|A 7 mm plantar wart surgically removed from the sole of a person's foot after other treatments failed]] |
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* Suffocation of the surrounding skin with plastic is anecdotally effective, akin to the "duct tape" method. A layer of plastic wrap is cut slightly larger than the surface area of the wart(s), and then affixed firmly with a bandage. Care must be taken to ensure the skin does not breathe for long periods between fresh dressings, and effective results should be noticeable within 2 weeks, or else be discontinued. Despite the excess moisture of sweat, the lack of oxygen speeds the degeneration of the wart and surrounding skin; especially in combination with other treatments that gradually expose the root, such as [[salicylic acid]]. |
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[[Liquid nitrogen]] and similar [[cryosurgery]] methods are common surgical treatments, which act by freezing the external cell structure of the warts, destroying the live tissue.{{cn|date=May 2021}} |
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* [[Watchful waiting]] is discouraged due to significantly increased likelihood of passing on the virus and the possibility that in some individuals the virus may spread more extensively over the skin surface, further increasing discomfort and making treatment more difficult and requiring it to be more extensive. However some warts eventually resolve due to the patient's own immune system. In many cases, the body will attack and kill the wart and verrucæ will turn black and effectively fall off, although it can be two years or longer before this takes place. |
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[[Electrodesiccation]] and surgical excision may produce scarring.{{cn|date=May 2021}} |
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===Relative effectiveness of treatments=== |
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A 2006 study assessed the effects of different local treatments for cutaneous, non-genital warts in healthy people.{{R|cochrane2006}} The study reviewed 60 randomized clinical trials dating up to March 2005. The main findings were: |
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* overall there is a lack of evidence (many trials were excluded because of poor methodology and reporting). |
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* the average cure rate using a placebo was 27% after an average period of 15 weeks. |
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* the best treatments are those containing salicylic acid. They are clearly better than placebo. |
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* there is little clinical trial data for the absolute efficacy of cryotherapy |
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* two trials comparing salicylic acid and cryotherapy showed no significant difference in efficacy. |
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* one trial comparing cryotherapy and [[duct tape occlusion therapy]] showed no significant difference in efficacy. |
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* evidence for the efficacy of the remaining treatments was limited. |
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[[Laser surgery]] is generally a last resort treatment, as it is expensive and painful, but may be necessary for large, hard-to-cure warts.<ref>[http://www.webmd.com/skin-problems-and-treatments/laser-surgery-for-warts "Laser Surgery for Warts"], webmd.com</ref> |
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== See also == |
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* [[List of cutaneous conditions]] |
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[[Cauterization]] may be effective as a prolonged treatment. As a short-term treatment, cauterization of the base with anesthetic can be effective, but this method risks scarring or [[keloid]]s. Subsequent surgical removal, if necessary, also risks keloids and/or recurrence in the operative scar.<ref name="kunnamo">{{cite book |title=Evidence-based Medicine Guidelines |last=Kunnamo |first=Ilkka |year=2005 |publisher=John Wiley and Sons |isbn=978-0-470-01184-3 |pages=422 |url=https://books.google.com/books?id=frYEiHYtOv0C&pg=PA422 }}</ref> |
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{{-}} |
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==References== |
==References== |
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{{Reflist}} |
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{{Reflist|refs=<ref name="andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref> |
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== External links == |
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<ref name="bacelieri">{{cite journal |author=Bacelieri R, Johnson SM |title=Cutaneous warts: an evidence-based approach to therapy |journal=Am Fam Physician |volume=72 |issue=4 |pages=647–52 |year=2005 |month=August |pmid=16127954 |doi= |url=http://www.aafp.org/afp/20050815/647.html }}</ref> |
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{{Medical resources |
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| ICD10 = B07 |
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<ref name="cochrane2006">{{cite journal |author=Gibbs S, Harvey I, Sterling JC, Stark R |title=Local treatments for cutaneous warts |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD001781 |year=2001 |pmid=11406008 |doi=10.1002/14651858.CD001781 |url=http://www.cochrane.org/reviews/en/ab001781.html}}</ref> |
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| ICD9 = {{ICD9|078.12}} |
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<ref name="emed_hpv">{{EMedicine|MED|1037|Human Papillomavirus}}</ref> |
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<ref name="emed_plantar">{{EMedicine|EMERG|641|Warts, Plantar}}</ref> |
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<ref name="hipusa">{{cite web |url=http://www.hipusa.com/webmd/encyclopedia/plantar_warts/index.html |title=Understanding Plantar Warts |accessdate=2007-12-07 |publisher=Health Plan of New York }}</ref> |
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<ref name="kunnamo">{{cite book |title=Evidence-based Medicine Guidelines |last=Kunnamo |first=Ilkka |year=2005 |publisher=John Wiley and Sons |isbn=9780470011843 |pages=422 |url=http://books.google.com/?id=frYEiHYtOv0C&pg=PA422&lpg=PA422 }}</ref> |
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}} |
}} |
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* [http://www.mayoclinic.com/health/plantar-warts/DS00509 Plantar warts] at the [[Mayo Clinic]] website |
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* [https://www.merckmanuals.com/home/skin-disorders/viral-skin-infections/warts?query=Warts Warts] at ''[[Merck Manual]]'' |
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==External links== |
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*[http://www.mayoclinic.com/health/plantar-warts/DS00509 Mayo Clinic] |
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*[http://www.merck.com/pubs/mmanual/section10/chapter115/115b.htm Warts, The Merck Manual] |
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* [http://www.dermnet.com/thumbnailIndex.cfm?moduleID=21&moduleGroupID=634&groupIndex=0&numcols=0 Plantar Wart photo library at Dermnet] |
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{{Viral cutaneous conditions}} |
{{Viral cutaneous conditions}} |
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{{DEFAULTSORT:Plantar Wart}} |
{{DEFAULTSORT:Plantar Wart}} |
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[[Category:Virus-related cutaneous conditions]] |
[[Category:Virus-related cutaneous conditions]] |
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[[Category:Papillomavirus]] |
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[[Category:Foot diseases]] |
[[Category:Foot diseases]] |
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[[Category: |
[[Category:Papillomavirus-associated diseases]] |
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[[Category:Wikipedia medicine articles ready to translate]] |
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[[ast:Úzara]] |
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[[bg:Мазол]] |
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[[ceb:Verrue]] |
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[[cs:Bradavice]] |
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[[da:Vorte]] |
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[[de:Warze]] |
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[[es:Verruga]] |
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[[fr:Verrue]] |
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[[ko:사마귀 (피부병)]] |
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[[it:Verruca]] |
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[[he:יבלת עור]] |
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[[hu:Szemölcs]] |
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[[nl:Wrat]] |
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[[ja:鶏眼]] |
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[[no:Verruca vulgaris]] |
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[[pl:Brodawka]] |
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[[pt:Verruga]] |
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[[qu:Tikti]] |
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[[ru:Бородавка]] |
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[[simple:Wart]] |
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[[fi:Syylä]] |
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[[sv:Vårta]] |
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[[uk:Бородавка]] |
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[[vi:Hột cơm]] |
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[[wa:Porea (maladeye)]] |
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[[yi:אויסוואוקס]] |
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[[zh:疣]] |
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Latest revision as of 15:04, 7 October 2024
| Plantar wart | |
|---|---|
| Other names | Verruca myrmecia, verruca plantaris[1] |
 | |
| Close up image of a large plantar wart | |
| Specialty | Dermatology, Podiatry |
| Symptoms | Skin colored lesion, may be painful[2] |
| Complications | Trouble walking,[2] transmission to other parts of the body, callus formation |
| Duration | Two years[2] |
| Causes | Human papillomavirus (HPV)[2] |
| Risk factors | Communal showers and pools, barefoot walking, open footwear, prior warts, poor immune function[2][3] |
| Diagnostic method | Based on symptoms[3] |
| Differential diagnosis | Callus, molluscum contagiosum, squamous cell carcinoma[2] |
| Treatment | Salicylic acid, chemo-based Fluorouracil and bleomycin,[4] cryotherapy, surgical removal[2] |
| Frequency | Common[5] |
A plantar wart is a wart occurring on the bottom of the foot or toes.[5] Its color is typically similar to that of the skin.[2] Small black dots often occur on the surface.[5] One or more may occur in an area.[2] They may result in pain with pressure such that walking is difficult.[2]
They are caused by the human papillomavirus (HPV).[2] A break in the skin is required for infection to occur.[2] Risk factors include use of communal showers, having had prior warts, and poor immune function.[2][3] Diagnosis is typically based on symptoms.[3]
Treatment is only needed if it is causing symptoms.[3] This may include salicylic acid, cryotherapy, chemo-based fluorouracil or bleomycin, and surgical removal.[2] The skin atop the lesion should generally be removed before treatment.[2] In about a third to two-thirds of cases, they go away without specific treatment, but this may take a few years.[2] Plantar warts are common.[5] Children and young adults are most often affected.[3]
Signs and symptoms
[edit]Their colors are typically similar to that of the nearby skin.[2] Small, black dots may occur on their surfaces.[5] One or more may occur in an area.[2] They may result in pain with pressure such that walking may be difficult.[2]
-
A plantar wart: striae (fingerprints) go around the lesion. -
Mosaic wart cluster -
Young plantar warts -
30-year-old plantar wart -
Deep, painful plantar warts -
Deep plantar wart on heel
Cause
[edit]Plantar warts are benign epithelial tumors generally caused by infection by human papillomavirus types 1, 2, 4, 60, or 63,[6] but also by types 57,[7] 65,[8] 66,[9] and 156.[10] These types are classified as clinical (visible symptoms). The virus attacks compromised skin through direct contact, possibly entering through tiny cuts and abrasions in the stratum corneum (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot or finger, the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated.[11][12]
Warts may spread through autoinoculation, by infecting nearby skin, or by contaminated walking surfaces. They may fuse or develop into clusters called mosaic warts.[6]
Diagnosis
[edit]A plantar wart is a small lesion that appears on the surface of the skin and typically resembles a cauliflower, with tiny black petechiae (tiny hemorrhages under the skin) in the center. Pinpoint bleeding may occur when these are scratched. Plantar warts occur on the soles of feet and toes. They may be painful when standing or walking.[citation needed]
Plantar warts are often similar to calluses or corns, but can be differentiated by close observation of skin striations. Feet are covered in friction ridges, which are akin to fingerprints of the feet. Friction ridges are disrupted by plantar warts; if the lesion is not a plantar wart, the striations continue across the top layer of the skin. Plantar warts tend to be painful on application of pressure from either side of the lesion rather than direct pressure, unlike corns (which tend to be painful on direct pressure, instead).[citation needed]
Prevention
[edit]HPV is spread by direct and indirect contact from an infected host. Avoiding direct contact with contaminated surfaces such as communal changing rooms and shower floors and benches, avoiding sharing of shoes and socks and avoiding contact with warts on other parts of the body and on the bodies of others may help reduce the spread of infection. Infection is less common among adults than children.[12]
As all warts are contagious, precautions should be taken to avoid spreading them. Recommendations include:
- Cover them with an adhesive bandage while swimming
- Wear latex swimming socks
- Wear flip-flops when using communal showers
- Do not share towels.[13]
Plantar warts are not prevented by inoculation with HPV vaccines because the warts are caused by different strains of HPV. Gardasil protects against strains 6, 11, 16, and 18, and Cervarix protects against 16 and 18, whereas plantar warts are caused by strains 1, 2, 4, and 63.[dubious – discuss]
Treatment
[edit]| First-line therapy | Over-the-counter salicylic acid |
| Second-line therapy | Prescribed 60% salicylic acid, intralesional immunotherapy |
| Third-line therapy | Fluorouracil cream, cryotherapy, laser therapy |
| Fourth-line therapy | Bleomycin injection, surgical excision |
A number of treatments have been found to be effective.[14] A 2012 review of different treatments for skin warts in otherwise healthy people concluded modest benefit from salicylic acid, and cryotherapy appears similar to salicylic acid.[15]
Medications
[edit]Salicylic acid, the treatment of warts by keratolysis, involves the peeling away of dead surface skin cells with keratolytic chemicals such as salicylic acid or trichloroacetic acid. These are available in over-the-counter products, but in higher concentrations may need to be prescribed by a physician. A 12-week daily treatment with salicylic acid has been shown to lead to a complete clearance of warts in 10–15% of the cases.[16]
Formic acid, topical, is a common treatment for plantar warts, which works by being applied over a period of time, causing the body to reject the wart.[17]
Fluorouracil cream, a chemotherapy agent sometimes used to treat skin cancer, can be used on particularly resistant warts, by blocking viral DNA and RNA production and repair.[4]
Bleomycin, a more potent chemotherapy drug, can be injected into deep warts, destroying the viral DNA or RNA. Bleomycin is notably not US FDA approved for this purpose. Possible side effects include necrosis of the digits, nail loss, and Raynaud syndrome. The usual treatment is one or two injections.[18][19]
Immunotherapy, as intralesional injection of antigens (mumps, candida or trichophytin antigens USP), is a wart treatment that may trigger a host immune response to the wart virus, resulting in wart resolution. It is now recommended as a second-line therapy.[20]
Surgery
[edit]
Liquid nitrogen and similar cryosurgery methods are common surgical treatments, which act by freezing the external cell structure of the warts, destroying the live tissue.[citation needed]
Electrodesiccation and surgical excision may produce scarring.[citation needed]
Laser surgery is generally a last resort treatment, as it is expensive and painful, but may be necessary for large, hard-to-cure warts.[21]
Cauterization may be effective as a prolonged treatment. As a short-term treatment, cauterization of the base with anesthetic can be effective, but this method risks scarring or keloids. Subsequent surgical removal, if necessary, also risks keloids and/or recurrence in the operative scar.[22]
References
[edit]- ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. p. 405. ISBN 978-0-7216-2921-6.
- ^ a b c d e f g h i j k l m n o p q r s Vlahovic, TC; Khan, MT (July 2016). "The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management". Clinics in Podiatric Medicine and Surgery. 33 (3): 337–53. doi:10.1016/j.cpm.2016.02.003. PMID 27215155.
- ^ a b c d e f Ferri, Fred F. (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 1375. ISBN 9780323529570.
- ^ a b Salk, Robert S.; Grogan, Kirk A.; Chang, Thomas J. (May 2006). "Topical 5% 5-Fluorouracil Cream in the Treatment of Plantar Warts: A Prospective, Randomized, and Controlled Clinical Study". Journal of Drugs in Dermatology. 5 (5): 418–24. PMID 16703777.
- ^ a b c d e "Plantar Warts". AOFAS. Archived from the original on 11 November 2017. Retrieved 11 November 2017.
- ^ a b Human Papillomavirus at eMedicine
- ^ Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T (1998). "Human papillomavirus 57 identified in a plantar epidermoid cyst". Br. J. Dermatol. 138 (3): 510–4. doi:10.1046/j.1365-2133.1998.02135.x. PMID 9580810. S2CID 19998825.
- ^ "Human Papillomaviruses Compendium" (PDF). Los Alamos National Laboratory. Retrieved 2013-02-05.
- ^ Davis MD, Gostout BS, McGovern RM, Persing DH, Schut RL, Pittelkow MR (2000). "Large plantar wart caused by human papillomavirus-66 and resolution by topical cidofovir therapy". J. Am. Acad. Dermatol. 43 (2 Pt 2): 340–3. doi:10.1067/mjd.2000.100534. PMID 10901717.
- ^ Chouhy D, Bolatti EM, Piccirilli G, Sánchez A, Fernandez Bussy R, Giri AA (2013). "Identification of human papillomavirus type 156, the prototype of a new human gammapapillomavirus species, by a generic and highly sensitive PCR strategy for long DNA fragments". J. Gen. Virol. 94 (Pt 3): 524–33. doi:10.1099/vir.0.048157-0. hdl:11336/4852. PMID 23136368.
- ^ Warts, Plantar at eMedicine
- ^ a b "Understanding Plantar Warts". Health Plan of New York. Retrieved 2007-12-07.
- ^ "Clinical Knowledge Summaries: Previous version – Warts (including verrucas)" (PDF). National Health Service. January 2007. p. 2. Archived from the original (PDF) on 2011-06-01. Retrieved 2010-12-05.
- ^ Bacelieri R, Johnson SM (2005). "Cutaneous warts: an evidence-based approach to therapy". Am Fam Physician. 72 (4): 647–52. PMID 16127954.
- ^ Kwok, Chun Shing; Gibbs, Sam; Bennett, Cathy; Holland, Richard; Abbott, Rachel (12 September 2012). "Topical treatments for cutaneous warts". Cochrane Database of Systematic Reviews. 2020 (9): CD001781. doi:10.1002/14651858.CD001781.pub3. PMC 8101088. PMID 22972052.
- ^ Cockayne, S; Curran, M; Denby, G; Hashmi, F; Hewitt, C; Hicks, K; Jayakody, S; Kang’ombe, A; McIntosh, C; McLarnon, N; Stamuli, E; Thomas, K; Turner, G; Torgerson, D; Watt, I; EVerT team (September 2011). "EVerT: cryotherapy versus salicylic acid for the treatment of verrucae – a randomised controlled trial". Health Technology Assessment. 15 (32): 1–170. doi:10.3310/hta15320. PMID 21899812.
- ^ Bhat, RM; Vidya, K; Kamath, G (June 2001). "Topical formic acid puncture technique for the treatment of common warts". International Journal of Dermatology. 40 (6): 415–9. doi:10.1046/j.1365-4362.2001.01242.x. PMID 11589750. S2CID 42351889.
- ^ Soni, Prasoon; Khandelwal, Kanika; Aara, Naushin; Ghiya, Bhikam C; Mehta, Rajesh D; Bumb, Ram A (2011). "Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts". Journal of Cutaneous and Aesthetic Surgery. 4 (3): 188–191. doi:10.4103/0974-2077.91250. PMC 3263129. PMID 22279384.
- ^ Champion, R. H., et al. (1998). Rook's Textbook of Dermatology. Blackwell Science, p. 1044, ISBN 0-632-06429-3
- ^ Bacelieri R, Johnson SM (2005). "Cutaneous warts: An evidence-based approach to therapy". American Family Physician. 72 (4): 647–652. PMID 16127954.
- ^ "Laser Surgery for Warts", webmd.com
- ^ Kunnamo, Ilkka (2005). Evidence-based Medicine Guidelines. John Wiley and Sons. p. 422. ISBN 978-0-470-01184-3.
External links
[edit]- Plantar warts at the Mayo Clinic website
- Warts at Merck Manual