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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Warts are the WORST.

Based on the way I’m currently limping around, you’d think that I have a major lower extremity problem. I don’t think I’ve ever had this much foot pain before- right on the ball of my left foot- every time I put any amount of pressure on it or squeeze the area. Throbbing, sharp pain. Like the kind you see in movies when the bad guy’s about to have a career-ender.

Turns out I have a plantar wart. Singular. That’s it.

No risk of all-consuming infection or major fracture…

no sign of impending amputation….

Just a wart.

I’ve never had one before in my life, and it’s awful. So in THAT charming spirit, I thought I’d share it with you all as the inspiration for today’s discussion. Plantar warts are on the sole of the foot and palmar warts are on the hand. All set on the vocab now, so lets go.

Some people think that warts are caused by dirt or lack of hygiene, and that’s false.

They are caused by any one of at least 100 subtypes of the virus HPV (human papilloma virus, but an entirely different kind from the one that causes genital warts), and the virus infiltrates the top layers of the skin and causes an inflammatory reaction there. (Did I mention that it can be quite painful?) Warts are typically the size of of a pencil eraser and can occur anywhere on the skin, although typically on the foot they don’t look as raised as they do in other places since on the sole of the foot they are flattened from being stepped on. They often appear as a firm, rough, calloused area on the skin that occasionally have a darkened area in the middle, which is where there are a few pinpoint bleeding/blood clots from underlying capillaries.

dirty kid feet

The virus is transmitted from person to person, usually indirectly. That means that skin doesn’t have to touch in order for the HPV to be transferred. It can be picked up at a playground from touching equipment or in the shower at the gym locker room.  Lots of places. Many adults have built up immunity to the virus type that causes warts, and so warts are more common in children. At least half of all adults have been infected with warts in their lifetime. I guess I just lucked out for my first 40 years. I don’t recommend that people try to figure out where their wart(s) came from, since the incubation period between when the infection occurred and the emergence of the skin lesion can be quite long, months to even years.

Not all warts are painful.

(Mine is, just sayin’, in case I haven’t made that clear by now!)

Do you have to do anything about a wart if you get one? You don’t. Sometimes the body’s immune system will take care of the wart all on its own. That’s what happened with my kids: they both got a single plantar wart that I purposely ignored for MONTHS until just disappeared on its own. (#MOTY)

But sometimes you can’t ignore them, because they are either painful (#current) or they rub up against something and get irritated. If they are painful, place a donut shaped padded bandage (available at all drugstores) on the wart. There are a couple of treatment options:

  1. Soak the area for about 20 minutes in warm water, then rough up the area a little on the surface with a nail file or pumice stone, then cover them with duct tape. Very safe option. Small chance of it actually working, but no harm in trying. I know a few folks who swear by this, even though the data says otherwise.
  2. Get one of those over the counter freezer kits. This is a fairly simple aerosol with some freezing spray that contains salicylic acid that can sometimes help speed up the destruction process. Multiple treatments are typically required over a few weeks and if no improvement is seen, then it’s probably worth going to a doctor to get treated. Keep an eye on the skin surrounding the wart, because sometimes it can get irritated after repeated application of the freezing spray.
  3. Physicians will often use an acid preparation of dichloroacetic or trichloroacetic acid directly on and into the wart. That’s what my doctor did. He took a scalpel (cue dramatic music) and isolated the wart first by scraping away some of the thick skin surrounding it. Surprisingly this did not hurt due to his experience, technique and the thick skin on the sole of the foot, but embarrassingly I am wildly ticklish on my feet so I could barely tolerate it. Then he placed the acid onto the wart and put a bandage on top of that.  No big deal, right? Except he warned me that it would hurt a few days later.  And it did.  This often requires multiple treatments to get rid of the wart completely, and I go back for my second treatment in a few days. I am here to report that it is slightly better after just one treatment.
  4. Other techniques some clinicians will use are laser treatment (can cause scarring and isn’t cheap), liquid nitrogen (which will cause the wart to turn black and fall off and doesn’t scar), and curettage- which is physically cutting out the wart after the area has been anesthetized.
  5. Unfortunately, there are no oral medications that work to get rid of warts. Because nothing can be too easy and simple, right?
  6. Another less common treatment for warts is cantharidin, a blistering agent produced by beetles of the Coleoptera order. Used more often in Canada and other countries, the cantharidin is applied to the wart, and washed off several hours later after blistering forms, then the wart is removed. Sometimes a second or third application may be necessary for complete resolution. This substance is not harmless and should only be used in a physician office setting.

 

At the end of the day, the body’s immune system dictates the speed with which warts go away. All of these treatments mostly help to encourage the body process along. I now have new respect for how much pain these little bumps can cause and how disruptive they can really be. With every single step.

 

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