At Maidenhead Podiatry and Chiropractic Clinic we are asked about verrucas and verruca treatment so frequently that we have put this ‘Guide to Verruca Treatment’ together to help decide on your best treatment option.
It is important to state, before you read further, that verrucas will disappear on their own if given enough time, especially in children. Consider leaving them untreated unless – 1. they are painful, 2. they are spreading, or 3. they are distressing.
Do I have a verruca?
Many of us have experienced a verruca, usually as a child, or know someone who has. They often have the appearance of a volcano, an irregular central area surrounded by dead skin.
There are so many opportunities to acquire a verruca from a variety of communal floors such as hotels, swimming pools and the gym.
In a similar way to a parasite, the virus that causes a verruca needs a healthy cell to infect that it can modify without killing it. The virus is quite hardy and can not only survive for months on floors without a host but can survive desiccation and freezing.
Verrucas can’t be ‘removed’ (other than surgically). Your body’s immune system is capable of dealing with them – it just hasn’t – and all treatments hope to stimulate an immune response, allowing the correct antibodies to be produced for a successful resolution.
The virus ‘turns off’ the cellular immune cascade that is a normal response to viral infection, and our treatments aim to turn it back on.
Verrucae are warts.
When they occur on the feet we call them a verruca and when on the hands, we call them warts. They are caused by infection with one or more of the 150-strong family of human papillomaviruses.
They vary in size from a pin-head to covering whole areas of the foot.
The virus infects a cell in the top layer of the skin, the epidermis. Usually the fourth layer, the stratum spinosum, the virus often enters through a tiny scratch or abrasion.
This triggers a rapid growth of skin/verruca cells, forming a harmless lump.
They occur most commonly in children and young adults, likely because this age group spend a lot of time padding around with bare feet, although they can occur at any age.
They are highly contagious and are transferred by skin-to-skin contact or by walking across the previously mentioned communal surfaces.
And as we don’t like imperfection on our bodies, an increasing number of adults are seeking treatment.
It is estimated that the verruca home treatment market is worth over £5 million a year – despite the fact that none of them work consistently.
Is it a verruca?
Warts on the underside of the foot will appear flat as weight bearing pushes them into the skin. On the top of the foot, or hands they will appear raised.
They may contain little black dots (but not always) which are tiny blood vessels and it is normal that when treated they will bleed. Squeezing them will also likely be painful.
Verrucae generally appear in two forms, a small single lesion with black dots within the central core, and the mosaic verruca, which is a more widespread infection, often affecting both feet and is characterised by clusters of verrucae.
Whichever you have, the treatment is the same.
What can I do?
The best treatment for most verrucae if they are not problematic is to leave them alone and given enough time they will go of their own accord.
They don’t often become painful and without treatment, verrucae usually disappear within two to 18 months as the immune system does its job although in rarer cases they can persist for over twenty years.
But if you have already had them for a number of years and you are experiencing pain from your verruca, they are spreading, or you simply want rid of it, read on.
How are they treated?
Treatments are based on either destroying the infected tissue (e.g. Bazuka, DuoFilm), locally acting poison (e.g. Gluterol) or stimulating an immune response (E.g. Swift, freezing, needling) and fall into – over the counter, old wives tales and professional.
Over the counter.
The over the counter, at-home chemical treatments such as DuoFilm or Bazuka contain salicylic acid which works by forcing moisture into the tissue disrupting viral cell function, and lactic acid, which breaks down the hard skin over the infection.
The active ingredient in Gluterol is Glutaraldehyde which is virucidal and so inactivates the wart virus. Once on the skin, it also acts as an anhidrotic, drying the warts and surrounding skin, thus reducing the spread of lesions.
Whichever one you choose, perseverance is the key as it can take months to work, during which time the verruca may go of its own accord anyway.
The strength of acid used in over the counter products is only up to 24%, but in a clinic, strengths of up to 70% can be used.
Before carrying out any treatment, remove the top layer of hard skin using a foot file to expose the verruca. Remember to wash or discard the file after every use.
Even so the success rate is variable.
Old wives tales.
Old wives tales suggest duct tape, banana and others each of which may work for some people but not others.
Some of the less conventional ideas do have science behind them, others not so much. Self resolution can suggest an unlikely remedy has worked.
A Podiatrist can use salicylic acid, cryosurgery, Verrutop, Swift and dry needling among others.
Salicylic acid works by forcing water into the tissue it is applied to, hyperhydrating it disrupting viral cell function and bursting the cells treated. Many over-the-counter treatments are saclicylic acid based which is why the skin turns white when applied. This is used mainly for children as it is well tolerated, but isn’t strong.
Cryosurgery or freezing undoubtedly can work but it needs to be done in a clinical environment by a podiatrist or a dermatologist as it involves temperatures down to -190oC depending on the medium used.
Verrutop® is a topical (applied directly) solution based on Nitrizinc Complex® for treating skin, palmoplantar and periungual warts (under or around the nail).
Nitrizinc Complex is the more popular name for – Nitric acid zinc solution – which includes nitric acids, organic acids, copper salts, and zinc.
When Verrutop® is applied to a wart, a chemical reaction takes place, which causes mummification of the tissue (dehydration and cellular destruction) leading to the wart changing colour (white/grey/yellowish).
Over time, mummification leads to the spontaneous detachment of a wart.
Swift uses microwaves to raise the temperature in the verruca stimulating a powerful immune response though heat stress reaction.
Dry needling pierces the verruca many times under local anaesthetic to stimulate an immune response. This is thought to work by inoculating the underlying tissue with the virus prompting an immune response.
Lasers can also be used to remove the verrucae by cauterising, but there is little evidence to show this works, and it can lead to scarring
Prevention is also a consideration.
Wear flip-flops in the gym, hotel room or swimming pool to reduce the risk of infection. Avoid walking barefoot on communal surfaces.
To prevent infecting other people cover the verruca with nail varnish or a plaster or wear socks.
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