plantar warts

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12R34Y

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  1. Attending Physician
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howdy

i'm a 2nd year med student and i got assigned to look up some common office treatments for plantar warts.

I've done a ton of lit searches and it seems to be a lost cause!

nothing kills these guys!?

CO2 laser, and pulsed-dye laser seem to have some good results, but jeez.

any experiencial advice on what is the best treatment for plantar warts?

later
 
hey heres what i have heard

-if the foot is hyperhydrotic...your gonna need to dry it out with 20% formaldehyde sol applied once daily....

-if the foot is not hyperhydrotic..combo of 40 and 60% salicylic acid under occlusion for 7 days..remove/ debride/ reapply

-curatage with application of 88%phenol

-aldara creme(imiquod) to the warts 2-3 times daily

-vit a/e too the warts 2X's daily

-electrodissection

-monochloracetic acid once daily to the warts

-canthradine(beetle extract) once daily

-5fu

-liquid nitrogen(painful)

these treatments can be used by themselves or in conjunction with one another
all of these can be used with good results when done consistently, and pt must be followed for 1month-2yrs

hope this helps
-j
 
I was reading some recent research and it seems that pulsed dye laser is the noninvasive way to go now.

it kills the vessels feeding the wart. one pod posted a 93% cure rate.

derm is using CO2 laser for this stuff also with good results.

i've been reading and all of the other treatments that you listed have dismal cure rates anywhere from 30-60%.

later
 
i think they work better in conjunction with each other
i am not sure of their rates though
goodluck regardless
 
just freeze those suckas with liquid nitrogen
 
oh hey by the way..i asked around

theres apparently alot of pain and scarring associated with the laser treament b/c its hard to control the depth of the burn
theres alot of lawsuits associated with the lasers too
anyways
goodluck
 
thanks for replies.

any other options/opinions?
 
As an experienced DPM, I would recommend the agressive approach. Local block (maybe with epinephrine to lessen the vascular flow) followed by BLUNT enucleation with a spatula. After coring out lesion, follow this with 2 or 3 applications of phenolic acid with a cotton-tipped swab, making sure to destroy the tissue around the periphery. It still might come back, but it has a decent result.

NEVER use a sharp blade to remove the infected tissue!!
 
why blunt? doesn't the spatula have to be fairly sharp to cut tissue?

just curious........please explain.

later
 
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After you pare down the callused area, you should see punctate hemorrhaging. At this point, you will see a fairly clear delineation of healthy tissue vs. infected tissue (it looks kind of like a plug of skin with a roughly circular, demarcating border). Using negative pressure with the hand holding the spatula (such as your hypothenar eminence on the sole of the foot), you can gently push down around the delineated periphery and move the spatula around the entire circumference. I say gently because it's not unheard of to push too hard and insert the spatula a bit too far (ouch). After traversing the entire area, you then push the spatula horizontally at the base of the lesion to completely free it from its attachment. There will be significant bleeding bedause of the neovascularization so prepare with an absorbant drop cloth and plenty of gauze. Your job now is to make sure (as best you can) to destroy all infected epithelial cells. I like using phenolic acid with a long cotton-tipped swab. Also, make sure to wash out the newly formed hole with saline to both counteract the chemical action of the phenolic acid (though, the hemorrhaging will also do this) and to further flush the wound.

Using a spatula has always worked for me, although the virus sometimes escapes my wrath and returns. A blunt spatula is more than adequate to remove the lesion. It is absolutely vital that you do not use a sharp instrument because, 1). You are only concerned with the epidermis - not the dermis, and 2) If you damage the dermis, you will likely get a scar out of it, which will act like a permanent verruca plantaris. This sucks for the patient.
 
The previous posts were exceptional, but here are the common treatments that we learned:

1) Surgical excision and electrodesiccation: The resulted scaring may be as painful as the wart and last longer.

2) Liquid nitrogen: Freezing, however, may cause painful hemorrhagic blisters.

3) Salicylic acid: a salicyclic/lactic acid combo, or salicyclic acid in a quick-drying base, can be applied nightly.

4) Cantharldin: 0.7% in acetone and flexible collodion may be applied daily, but may also spread warts centrifugally.

5) Podophyllum resin: contraindicated in pregnancy

6) Fluorouracil: 5% cream can often cause resolution after ~8 weeks of treatment, but this typically isn't much effective for plantar warts.

7) Dinitrochlorobenzene sensitization: still an experiemental treatment. Patients are sensitized with DNCB 2% applied under a bandage strip for 24 hours. Following this, 0.1% DNCB is applied to warts.

8) Laser (who doesn't like playing with lasers?!?)
 
i do appreciate the endless lists of treatments, but which ACTUALLY work.

the success rates on these various treatments are so super variable that it seems like there is NOT a good treatment option. sounds like a chronic problem that will NEVER EVER EVER go away.

you can't win with anything?
 
I can tell you from personal experience that the whole freezing option is a very painful way to go -- especially if you waited too long before seeking medical help.

I'd love it if there was a painless option for getting rid of these stupid things; maybe I'll discover one and make tons of money from it.
 
Duct tape seriously. It is actually a new treatment for verruca.

Em
 
hi all,
my husband has plantar warts..we started seeing a physician who prescribed tinamed application once a day..my husband has been religiously applying it since august..but it doesnt seem to help.we plan on seeing a podiatrist..but which docotr do we need to see..podiatric medicine or podiatric surgeon???and what is the best possible way to get rid of these warts..please help
thanx
 
yes it's true DUCT TAPE, used it on my own plantar warts and the suckers are gone and haven't been back since. there is published evidence as to the effectiveness of this treatment as well

-J
 
A podiatric surgeon or podiatric medicine doctor are the same thing, a podiatrist.
 
They are not the same. However, both ARE Podiatrist. Thats like saying an Internal medicine doc is the same as a GI specialist. The Podiatric Medicine doc could have completed a ppmr while the Podiatric Surgeon could have completed a PSR 12, 24, 36, 48
 
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Thanks for the correction. In regards to the poster, they are both duly qualified to handle your specific problem. 🙂
 
dood... when i was like 7 i had a plantar wart... and like, my dad was given a scalpal by the doc... so like once a day, my dad would scrap at it, until after a while, it was just gone... seemed to work cuz it didnt come back, and it didnt really hurt much at all... also very cheap....
 
So what do you do with the duct tape? Slap it on the wart and leave it there? For how long?

And does this work on other kinds of warts?

I had a plantar wart in college and my dr. (military FP) numbed the area, cut out what he could, and gave me mega-strong salicylic acid to paint on the area once/day. Worked like a charm, and not too painful...well, after the first couple of days...
 
I used Toejams scheme when I was in FP. I also feel that if it isn't painful then leave it alone. Frequently they will go away. I also used serial light cyrotherapy- less likely to scar-but really think spatula technique is best.
 
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