Verrucae

verruca treatment

What are verrucas?

 

Verrucas are harmless warts on the foot which are caused by a few subtypes of the human papilloma virus (HPV). Warts are very common and can appear anywhere on the skin but are mostly seen on the hands and feet. When they are located on the sole of the foot they are called verruca(e) or plantar warts. Although generally considered harmless, verrucas can be painful and unsightly, causing distress and embarrassment. Evidence shows that many verrucas resolve without treatment within two years, particularly in children, but  they can be be difficult to manage and can persist for many years in adults.

Types of verrucae

Here are a few common types:

  • filiform warts are long and slender and protrude from the skin, they are common on the face but can be seen on the toes

  • mosaic warts occur where lots of very small verrucae on the sole of the foot coalesce to form larger plaques 

  • periungual warts occur around fingernails and toenails, and appear as thickened, cauliflower-like skin

  • plantar warts are solitary verruca on the sole of the foot, often heavily callused with black dots visible, they can be painful due to the build up of hard skin

verruca wart heel foot mosaic podiatrist

Signs and Symptoms:

Common features of verrucae include:

  • Loss of normal skin pattern (the lines which you can see in fingerprints)

  • Presence of many minute dark spots, which are tiny bleeds in the warts

  • Overlying thickened skin (callus)

  • Tend to be flat and hard with a rough surface and well-defined borders but can protrude if for example on the tops of toes.

 

How can you get them?

 

Verrucas are usually spread by direct skin to skin contact, or indirectly via contact with contaminated floors and surfaces. The virus gains entry to the skin through micro-abrasions (tiny breaks) in the skin which are not always visible to the naked eye. Walking on abrasive non slip flooring such as the type found at swimming pools can cause these abrasions, and is why we often associate verrucas with going swimming!

Who gets verrucas?

 

Anyone can catch verrucas. They are particularly common in children. 

It is estimated that between 7 and 12 % of the population have some form of warts. Approximately 7% of the population have a verruca at any one time and around 41% of people will get a verruca at some stage of their lives. 

Most verrucae generally resolve on their own, although this can take two years or more. In adults they can persist longer. In adults recalcitrant warts that have been present for over 6 months are more resistant to treatment than warts which have been present for less than 6 months.

Warts in children generally resolve without treatment within a few months to 2 years.

The virus invades the outermost layer of the skin (epidermis) and causes visible lesions to appear on the skin. A verruca usually appears as a plaque of hard skin, with an irregular border and can have black dots (which are small bleeds) scattered throughout. Our immune system is located slightly deeper in the skin. This means the virus can go unnoticed by the immune system. Having a verruca for a long time does not mean you have any problems with your immune system. The virus is just good at “hiding” from the immune system.

When should you treat a verruca?

 

Here at Michelle Reynolds Podiatry, we will consider treating the verrucae if they are painful, spreading, affecting your daily activities or if the appearance is greatly bothering you.

 

Treatment options

 

Verruca and warts are one of the most challenging dermatological skin conditions to treat. Treatment selection depends on verruca treatment history, health and age of patient plus the presentation of the infection. No treatment has been shown to be 100% effective, but Michelle and her colleagues now offer the three most successful treatments.

There are many treatments available for verrucae. There is a lack of high quality evidence evaluating verrucae treatments, and more research needs to be undertaken. Current evidence shows many traditional treatments are often not very effective.

After assessment the following treatment options may be considered:

No treatment: If the verruca is painless, and not bothering you, it is normally best to leave it alone and wait to see if it resolves over a period of a few months.

Swift Microwave Treatment for verrucas: Swift is the newest verruca treatment available. With a 76% resolution rate (some practitioners report up to 89% success) it is the most effective verruca treatment available. It can only be administered by trained & registered healthcare or medical practitioners. It is suitable for adults and older children. 

Swift uses microwave energy which is delivered through a special probe applied to the skin to treat the affected tissue in a very controlled and precise way. Swift does not involve weekly lengthy treatments, there is little after pain compared with other treatments, no dressings, no wounds to care for and whilst some discomfort is felt during treatment, it only lasts a couple of seconds per application. We are pleased to offer Swift at Michelle Reynolds Podiatry, please click the button below for more details about this innovative treatment!

Verruca Needling (Falknor's needling method): Verruca needling is a procedure carried out under local anaesthesia. With a sterile, empty hypodermic needle the verruca is punctured through to the lower layers of the skin multiple times. This creates a small wound and aims to introduce the virus to the immune system and create an immune response to the virus.

Verrutop®: Verrutop® is a new type of professional treatment for verrucae. It is suitable for adults and some children over 6 years of age. It is a topical treatment applied by the podiatrist every 7 to 14 days and contains a Nitrizinc complex.

Other Treatments: 

Salicylic acid: Many verruca treatments – including creams, gels, paints and medicated plasters available from pharmacies contain this ingredient. Salicylic Acid is a chemical that breaks down the skin. When applied directly onto the verruca(e) it allows water to enter the skin cells, and creates a macerated (soggy) white appearance allowing the infected skin cells to easily be removed. Treatment needs to be applied regularly by the podiatrist, for up to 8 weeks, with visits once or twice a week recommended. After treatment, dressings are applied which need to be kept dry for at least the first 48 hours after the acid is applied to allow it to work sufficiently.
Some padding will be applied around the verruca to prevent the chemical from spreading into the healthy tissue and a small amount of the salicylic acid will be put onto the verruca. This should be painless but can sting a little. If the acid spreads onto healthy skin it can create a wound or irritation. Success rates for this treatment are generally less than 50%. We do not currently offer this treatment, but other podiatry clinics may do.

Cryotherapy: Cryotherapy is a method of freezing the verruca. For this method, the hard skin over the verruca is gently scraped away using a sterile scalpel and then the verruca is frozen. Typically, 2-5 treatments may be required at monthly intervals (it is sometimes combined with acid therapy between visits). There can be some pain during and after the treatment. Success rates for cryotherapy are generally less than 50%. Blistering can occur. Cryotherapy is better suited to treatment of smaller verrucae and finger warts. We do not offer cryotherapy here, but other podiatrists may do, and your GP practice may also be able to provide this treatment should you wish to try it.

Other treatments are available, for example, laser therapy and other topical treatments such as silver nitrate, trichloroacetic & monochloroacetic acid. These are less commonly use due to lack of strong evidence of their effectiveness. There is no evidence currently to support any claims that homeopathy, hypnotherapy, or herbal remedies are effective. For the most troublesome verrucas, dermatology consultants can also access alternative treatments. 

Research is ongoing. We will update this information as new evidence becomes available.

Can I do anything to avoid getting a verruca?

It is difficult to prevent warts and verrucae completely, the following measures may help stop them from spreading:

  • avoid touching other peoples warts

  • do not pick or scratch your warts - this can spread the virus to other areas of your skin

  • wash your hands after touching your warts

  • avoid sharing towels, flannels, socks or shoes with anyone else

  • keep your hands and feet clean, and dry well after showering

  • change your socks every day

  • do not go barefoot in communal areas such as changing rooms, hotel rooms or swimming baths 

  • cover warts/verrucae with a waterproof plaster when swimming

If you think you have a verruca and want to discuss your treatment options please call us on 0161 427 4937 to book a consultation appointment.

*Please note verruca(s) are caused by viruses with no definite cure, and success rates for all verruca treatments will vary from person to person. We cannot guarantee success levels of the treatment and the verruca may not resolve after treatment. Resolution of your verruca does not mean you will not catch another one again in the future*