What are the other Names for this Condition? (Also known as/Synonyms)

• Deep Foot Wart
• Myrmecia
• Plantar Wart

What is Verruca Plantaris? (Definition/Background Information)

• Verruca Plantaris is a common benign skin infection that is caused by human papilloma virus (HPV). It is frequently seen in adolescents and young adults. The skin lesions appear as firm papules on the soles of the feet
• Verruca Plantaris, also known as the Plantar Wart, can affect all individuals. Those with poor immune systems can present with larger lesions. This infectious condition can spread through direct contact with infected individuals or through contaminated surfaces
• Verruca Plantaris lesions can ulcerate and bleed, if irritated. It has been established that some longstanding cases even have the potential to develop into verrucous carcinomas. It can be diagnosed through medical history evaluations, complete physical exam, and rarely, confirmed through a skin biopsy
• Topical salicylic acid application, excision of the warts, or the use of cryotherapy are some of the treatment methods used. The prognosis of Verruca Plantaris is generally excellent with suitable treatment. Some cases are self-limiting and may recede on their own (especially in children)

Who gets Verruca Plantaris? (Age and Sex Distribution)

• Verruca Plantaris is a common skin infection that affects children, adolescents, and young adults; it can occur in older adults too
• In general, both males and females are affected this condition
• There is no racial or ethnic predilection; it is observed worldwide

What are the Risk Factors for Verruca Plantaris? (Predisposing Factors)

Risk factors identified for Verruca Plantaris include:

• Immunocompromised individuals
• Repeated trauma to the feet, such as due to regular participation in sports
• Swimming in public pools, communal showers
• Contact with HPV-infected individuals
• Sharing infected items such as towels and bed sheets
• Excessive sweating or other moist conditions of the feet

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Verruca Plantaris? (Etiology)

• Verruca Plantaris is a viral infection that is caused by the human papilloma virus (HPV)
• The virus can be transmitted through direct contact with an HPV-infected individual
• It can also spread from infected surfaces, shared objects, etc.

What are the Signs and Symptoms of Verruca Plantaris?

The signs and symptoms of Verruca Plantaris include the following:

• The presence of single or multiple papules on the skin
• They can range in between 2-20 mm in size
• These papules are observed on the underside or soles of the feet (plantar aspect) or on the toes
• These papules may occur as clusters with small islands of normal skin between. Such cases are called Mosaic Warts
• Itching is the most common symptom associated with the lesions. Pain on bearing weight is also common
• The skin lesions may be present for a long period and can ulcerate and bleed, if traumatized
• Wearing footwear and walking may be difficult; one may feel pressure sensation of stones in the footwear

How is Verruca Plantaris Diagnosed?

The diagnosis of Verruca Plantaris may involve the following procedures:

• The diagnosis usually entails a good physical examination and comprehensive evaluation of one’s medical history
• Examination of the skin by a dermatologist using a special magnified lens (dermoscopy)
• Skin biopsy: A biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• A biopsy is rarely needed. However, non-pigmented (amelanotic) melanomas or squamous cell carcinomas of the plantar surface can mimic Plantar Warts. A careful examination can help determine if a confirmatory biopsy is necessary

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Verruca Plantaris?

The complications of Verruca Plantaris may include the following:

• Intense scratching of the lesions can lead to secondary bacterial or fungal infections
• Pain with weight bearing can affect walking, running, or participating in sports and recreational activities
• The longstanding lesions can cause emotional stress and psychological trauma in some individuals, leading to depression
• It can cause cosmetic issues in some individuals
• There is a higher chance of longstanding Verruca Plantaris lesions developing into invasive verrucous carcinoma
• Warts can recur at the original site, or arise in new locations

How is Verruca Plantaris Treated?

The treatment strategies that may be used for Verruca Plantaris include:

• Application of salicylic acid: This can be used as a liquid or an adhesive patch. Tape is applied to cover the area. Moisture causes the thick non-living stratum corneum to soften and slough off. This treatment must be consistent, and carried on for weeks or longer, as needed
• Topical retinoids or imiquimod can be applied along with salicylic acid to augment its effectiveness
• Canthrone, an extract of blister beetles, can be applied to the warts. The agent causes painless blistering of the epidermis, which can lift off the wart-infected cell. For this to be effective, salicylic acid or another method must be used to help the canthrone penetrate into the living skin
• Small dilute amounts of bleomycin, a chemotherapy drug, can be injected directly into the warts. This causes the living portion of the epidermis to die and slough off. This treatment must not be used in pregnant women. Multiple injection sessions may be needed
• Candida antigen, an allergy test material, can be injected into the warts. As most patients have been exposed to Candida, they will develop a low-grade allergic reaction to the area, which will stimulate the immune system to attack and cure the warts. Multiple injection sessions may be needed
• Cryotherapy, where the very low temperature of liquid nitrogen is used to treat the benign lesions. Multiple sessions may be required
• Some Plantar Warts can recede and altogether disappear on their own spontaneously (particularly in children)
• Surgical excision of the warts can be performed if needed
• Carbon dioxide lasers can be used to vaporize the wart-infected skin
• All treatments are susceptible to failure, or may warrant multiple visits and treatment sessions
• The expense of treatments can be high
• The presence of chronic skin lesions may cause psychological discomfort; individuals may require reassurance to help with stress and anxiety

Follow-up care with regular screening and check-ups are important.

How can Verruca Plantaris be Prevented?

The following measures may help mitigate risks and help prevent Verruca Plantaris:

• Avoid contact with human papilloma virus (HPV) infected individuals
• Do not share infected items such as shoes, socks, and bedspreads
• Avoid being barefoot while using public showers or while walking by the poolside
• Wear the right footwear to prevent trauma to the feet from sports
• Maintain good personal hygiene and care
• Vaccines available for HPV do not prevent warts except certain subtypes of genital warts. These vaccines are used to prevent genital warts which can degenerate into cervical cancer in females

What is the Prognosis of Verruca Plantaris? (Outcomes/Resolutions)

• The skin lesions in Verruca Plantaris are not life-threatening and the prognosis is generally excellent with their complete excision
• Sometimes, the warts are known to disappear on their own without treatment

Additional and Relevant Useful Information for Verruca Plantaris:

• Avoiding scratching of the ‘itchy’ lesions
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition