Verruca are warts that can be found anywhere on the foot but commonly occur on the soles of the feet (plantar warts). They are caused by the Human Papillomavirus (HPV) and are passed from person to person by direct contact. The virus is thought to thrive in moist, damp environments such as swimming pools, changing room floors and communal shower areas. If an infected foot deposits skin cells onto the floor then it is possible to walk across the same floor and pick up the virus especially if your skin is cut or scratched.
Is it serious? A verruca infection is not typically 'serious', but it is worth consideration because
a) they are very infectious and can spread to other parts of your foot and body (e.g. if you pick at one on your foot, you may get another on your hand) and you can easily infect other people
b) they can be painful to walk on
c) they can be unsightly and embarrassing
d) if you have had one for months/years and it hasn't improved, is getting worse or it's appearance is changing, it is sensible to request the verruca is examined by a suitably qualified professional (i.e. a podiatrist, your GP or a dermatologist) to rule out any sinister pathology. RISK FACTORS - if you swim - if you are immunocompromised (i.e. cancers, taking steroids, older age) - if you live with someone who has a verruca WHAT DOES ONE LOOK LIKE?
It may just look like a bit of hard callus, but there will be black pinpricks in the skin - these are capillary heads and will bleed readily on reduction of the area with a scalpel (by your podiatrist, please don't scalpel yourself!) This is very diagnostic. Other clues lie in a bumpy 'cauliflower' surface, and the area will be sore if you pinch it (rather than on direct pressure as in a corn).
CONSIDER - Do you regularly get stubborn warts? Are you often ill? You may need a general MOT with your GP to check you are not immunocompromised.
TREATMENT
Firstly, let’s manage expectations - there is no definitive topical treatment for verruca. This is not to say that you cannot get rid of them, but it may take a few attempts using different topical agents/treatments - and lots of patience. Treatment is aimed at kicking your own immune system into action (by using an irritant such as salicyclic acid) so that it identifies the virus and destroys it. THE EVIDENCE... .,, is limited. The extensive multi-centre randomised controlled trials just do not exist. My advice is offered mostly through clinical experience. YOUR APPOINTMENT Initial Appointment Differential diagnoses will be discussed, and ruled out as indicated. Previous treatments trialled, and their relative success, will be noted. The verruca will be measured and photographed, so that progress can be properly monitored. The verruca will be pared down; please note that if the verruca bleeds this is completely normal and actually of positive benefit as it will alert your body's defences to the 'injury' thereby presenting the verruca to your immune system for destruction. Treatment modalities will be discussed and a first line treatment will be commenced for 6-8 weeks. Follow-Up If there is no or minimal improvement, a second line treatment will be offered for 6 - 8 weeks. If there is no improvement after this time, onward referral will be discussed and arranged. WHAT ARE 'TOPICAL TREATMENTS'? The Bazuka you bought from the chemist is a topical treatment; the term encompasses anything that can be applied directly to the skin. I tend to offer Salicylic Acid as my second line of defence in the treatment of verruca. Salicylic Acid provided by your podiatrist will be a stronger acid than those sold over the counter.
ZINC... … is a mineral 'immunity booster' which may be helpful to take orally alongside application of any topical treatments. It works in synergy with Vitamin C. SWIFT The latest therapy for treatment of plantar warts, with a reported 80% success rate, is Swift Microwave Therapy. I do not offer this as part of my practice, however it is available in Oxford here and in Thame here. CHILDREN Personally, unless the verruca has been present for some time or is particularly painful, my advice is to not actively treat a verruca in a child. A child's immune system is very up and down and the verruca will go away by itself without any intervention. The risk of applying acids or using any other treatments which could potentially damage the skin long-term is not a worthwhile trade -off, in my opinion. Patience is key! OXFORDSHIRE CHIROPODY'S PROTOCOL I don't like cryotherapy, or anything that is going to cause you pain. There are plenty of other options and as there is no decent evidence that cryotherapy is any better than any other treatment, I do not feel the pain and damage it can cause weighs out any potential benefit.
Questions? Please get in touch!
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