Foot Warts
A Better Way to Eliminate Them
Hello, the goal of this blog post is to provide my readers with insightful information that they won’t typically find through a simple Google search; so I won’t waste too much of your time going over the online medical definition of a wart, but rather I’ll share with you my 30 years of experience in treating these lesions and try to explain the best I can on how foot warts affect the quality of your life and the best treatment methods available, even for the most difficult cases.
So what are warts really? Warts are skin lesions caused by the Human Papillomavirus. However this form of the virus is not the same as the one involved in sexually transmitted infections or cervical cancer. This form of HPV is found in the blood of roughly 80% of the population and is usually harmless; that is until it forms a wart on our skin.
Why this happens is a cause for great debate among researchers.
Why do some people get warts and others don’t?
Why do children get more warts than adults?
The current theory regarding the origins of warts is that there is some kind of immune deficiency present or possible hereditary process involved that generates the warts, but the research is still ongoing.
Warts are often confused for calluses. However, it’s important to note the main differences between the two. The first difference between the two is that they hurt a lot more and secondly, they have a ”grainy” salt and pepper appearance, called “pin point petechiae.” The petechias are due to capillary fragility, causing tiny bleeding on the surface of the wart due to friction. Therefore, since they contain a live virus, they have their own blood supply. This allows the wart to cause secondary skin infections because of the active bleeding.
Most warts that grow on the hands are small and “solitary” in nature. They can be eliminated with simple over the counter products containing salicylic acid. However, warts growing on your feet are considered “mosaic” in nature. Meaning that they are larger, representing a whole colony of smaller “solitary” warts that co-exist together. This can make them more difficult to treat with over the counter products, particularly when they are growing on the bottom of the foot.
The goal of medical treatment for warts is to destroy the papillomavirus located at the deep base or bottom of the wart. The wart develops a multi layered callus in order to protect this viral tissue. You kill the virus and the wart is gone. Current medical treatments can be categorized into three categories:
- Obliteration or burning
- Surgical Excision
- Immunotherapy
Obliteration involves the burning of the lesion to the level of the virus. Common modalities used can be lasers, cryotherapy (freezing) with liquid nitrogen, hyfrecator (electrical burn) and chemicals such as acids.
Surgical excision is fairly self explanatory. The lesion is totally removed past the dermal layer using a punch biopsy type of procedure. This usually involves skin closure with sutures.
Immunotherapy involves the destruction of the virus via the delivery of an anti viral agent either topically or via the blood stream. Examples of immunotherapy range from using topical application of anti-viral agents such as imiquimod up to IV treatments using a chemotherapy agent such as bleomycin. The use chemotherapy agents in resistant warts is based on the fact that structurally the wart virus is very similar to a cancer cell.
So how does a doctor select what is the best treatment for a particular wart?
In theory, it is based on the size, penetration, and resistance of the wart prior to treatment. Meaning, the bigger and harder to destroy a wart is, the more aggressive the treatment will be. However, in reality there is no real treatment algorithm to follow, but rather the doctor’s personal preference. This is where I believe the trouble lies. Treatments that involve invasive removal of the lesion are painful (particularly if done on the bottom of the foot) and can cause painful scars later on. And if this wasn’t enough, I have observed that warts can sometimes become larger when traumatized this way! I believe the reason that happens is because the virus tends to increase its callus covering and divides rapidly in order to protect itself from the mechanical threat. This is particularly true in children with warts.
I’ve been treating children’s warts using a compounded topical medication system that delivers 2% 5-fluorouracil to the wart virus via a special adhesive gel called Remedium.
Remedium dries and remains on the treatment site allowing for maximum penetration. This system is an FDA approved patented system developed by a compound pharmacy. It has a documented 95% success rate in children and adults. During the last 5 years, I’ve started using it on my adult wart patients with the same success rate. The treatment is simple and painless. The medication is dispensed to the patient to apply for 7-14 days (depending on the size of the wart). The patient returns to the office usually after 10 days where the dead wart tissue is painlessly debrided without the need for an anesthetic. If after shaving away the dead wart tissue it is determined that the wart is not completely gone, the patient continues using the gel for another 7-10 days; although this is a rare occurrence. With this type of treatment there is no pain or scarring involved. And the best thing about this treatment is that can be used for both simple and complicated warts.
This medication isn’t covered by insurances at the moment, however, it is modestly priced at around $195.00 and will save the patient money in co-pays from multiple office visits in the long run.
I will state that I have encountered warts that are resistant to this type of treatment, but I’d estimate it at a mere 5% for which this treatment doesn’t work. If I do encounter this then I resort to more advanced immunological studies in order to figure out why this patient’s warts are so resistant. However, my approach is still to try to tailor non-invasive treatment plan. When it comes to wart treatments my philosophy is in line to the oath I took, “ Do No Harm.”
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