Plantar wart ( lat. Verruca plantaris ) - warts caused by the human papillomavirus (HPV), which appear on the sole or toes (HPV infections in other places are not plantar). A common problem often seen by dermatologists.
Plantar warts | |
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Plantar wart. Papillary patterns bypass the affected area, visible petechiae | |
ICD-10 | B 07. |
ICD-10-KM | |
ICD-9 | 078.12 |
ICD-9-KM |
Diagnosis of the disease is usually simple, but treatment is difficult and time consuming. Plantar warts can go away on their own (the average recovery rate is 27% for 15 weeks), but treatment is recommended to alleviate the symptoms, reduce the duration and reduce the risk of infection to others.
Content
Etiology
Plantar warts are benign epithelial tumors caused by the human papillomavirus, which, in turn, is found in more than 118 types. Each subtype may have a preference for specific areas of the body. For example, plantar warts are more commonly caused by papillomavirus subtypes 1, 2, 4, 27 and 57, while anogenital warts are more often caused by viruses subtypes 6 and 11. Papillomavirus is transmitted through direct skin contact, including from person to person, and also to be acquired by walking barefoot on contaminated surfaces, such as public bathrooms, changing rooms, or dirty ground. The virus can live for several months without a carrier, which makes it extremely infectious. The virus attacks the skin during direct contact, penetrating through possible tiny cuts and abrasions in the stratum corneum (outer skin layer). After infection, the warts can appear only after a few weeks or months. Because of the pressure on the foot and toes, the wart can be pressed inward, and the stratum corneum can build up above it. Plantar warts can hurt if they are not cured. Warts can spread through autoinoculation , infecting the surrounding skin. In this way, they can unite and form mosaic clusters.
With age, people develop immunity, so infection is more common in children than in adults.
Diagnostics
A symptom of the disease is a lesion of the plantar surface of the foot, characterized by hard and coarse papules, destroying papillary patterns (which usually resemble cauliflower). Multiple damage merges into mosaic plaques. A lesion may have a distinct yellow color and cause pain when walking. At the opening of the lesion (unlike other skin lesions), small black dots can be found, which are thrombosed capillaries (petechiae) that can bleed. Plantar warts can occur anywhere on the plantar surface of the foot, but are usually located at the highest pressure points, such as heels, pads of the feet and toes. Plantar warts are often similar to corns or keratinization, but they are easily distinguished upon close examination of the papillary patterns on the skin, which bypass the warts. If the damage is not a wart, the DNA of the cells does not change, and the grooves continue to appear on the upper layer. Also plantar warts usually hurt during compression, but not with direct pressure (this is what distinguishes them from corns, which usually hurt with direct pressure).
Treatment
Plantar warts are more difficult to cure than common warts. There are several methods of dealing with plantar warts.
- Treatment of the first level: keratolysis - exfoliation of dead skin cells with the help of keratolytic substances , such as salicylic or trichloroacetic acid .
- Treatment of the second level: cryosurgery , intrafocal immunotherapy or therapy with a pulsed dye laser .
- Level 3 treatment: bleomycin , surgical removal .
Salicylic acid is often used as an initial treatment, which is widely available and can be used by the patient before seeking professional help. The following procedure is recommended: daily soaking the feet in warm water for 5-10 minutes, drying, sanitizing the hyperkeratotic tissue with pumice, followed by applying salicylic acid and applying an occlusive dressing or patch. The top layer of the lesion must be removed daily by pumice stone to facilitate absorption of the drug. The most important condition for therapy is adherence to the patient's treatment regimen. Daily use of salicylic acid for 12 weeks leads to the complete removal of warts in 10-15% of cases.
As a local remedy, a 0.7% solution of cantharidin can be used, which is applied to dried plantar warts for 24 hours, the treatment is repeated every 1-3 weeks until the warts are destroyed. There are no registered drugs based on cantharidin in Russia, in some other countries they are available only by prescription.
Another common treatment for plantar warts is cryotherapy . In this case, liquid nitrogen, which has a temperature of −196 ° C, is used to freeze their internal cellular structure, destroying living tissue. The freezing time is selected in such a way until a white halo of about 1-2 mm appears around the wart (with a further increase in the frozen area, pain and blistering increase). The procedure is usually repeated every 2-3 weeks, it may take up to three sessions.
There are several immunotherapy options for treating plantar warts. One of them is imiquimod , an immunomodulator that stimulates the production of interferon-alpha and other cytokines. Imiquimod as a cream is applied to the pre-treated area of the lesion three times a week.
Modern studies show the effectiveness of such immunotherapeutic agents for the treatment of plantar warts, such as intra-focal injections of antigens (mumps antigens, candidiasis or trihofitina). Such injections can trigger the host’s immune system to react to the virus that caused the wart to appear. Although no randomized controlled studies to evaluate the effectiveness of these antigens in the treatment of plantar warts have yet been carried out, such treatment may be useful for patients with lesions that are resistant to other treatments.
Another immunotherapeutic agent is fluorouracil in the form of 5% cream, which was recently recognized as effective in the treatment of plantar warts, according to a randomized controlled trial, in which patients applied fluorouracil twice a day under an occlusive dressing with regular sanation of damage.
Forecast
Most plantar warts ultimately disappear from a few months to several years, but if they cause discomfort, they can be treated or surgically removed. The resolution of plantar warts is determined by the restoration of normal capillary pattern.
Prevention
It is necessary to observe proper level of foot hygiene. You can not walk barefoot in public bathrooms and locker rooms, you must wear appropriate shoes, such as slippers for the shower or sandals (when walking on dirty ground) to avoid direct contact of contaminated surfaces with skin as far as possible. You should not share shoes and socks, you should also avoid direct contact with warts on other parts of the body or other people.
Since warts are contagious, care must be taken to prevent their spread. Any items that come into contact with plantar warts, such as socks or towels, should be thoroughly washed with soap and hot water to prevent the spread of infection.
Notes
- ↑ Disease Ontology release 2019-05-13 - 2019-05-13 - 2019.
- ↑ Monarch Disease Ontology release 2018-06-29sonu - 2018-06-29 - 2018.
Links
- Vanessa Lichon, Amor Khachemoune. Plantar Warts: A Focus on Treatment Modalities // Dermatology Nursing. - 2007. - Vol. 19 , No. 4 . - p . 372−375 .