Editing Plantar wart

{{Redirect|Verruca||Veruca (disambiguation)}}
{{Infobox medical condition (new)
| name            = Plantar wart
| image           = Largeplanterwart.jpg
| caption         = Close up image of a large plantar wart
| synonyms        = Verruca myrmecia, verruca plantaris<ref name="andrews">{{cite book |author1=James, William D. |author2=Berger, Timothy G. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |pages=405 |isbn=978-0-7216-2921-6|display-authors=etal}}</ref>
| field           = [[Dermatology]], [[Podiatry]]
| symptoms        = Skin colored lesion, may be painful<ref name=V2016/>
| complications   = Trouble walking,<ref name=V2016/> transmission to other parts of the body, callus formation
| onset           =
| duration        = Two years<ref name=V2016/>
| types           =
| causes          = [[Human papillomavirus]] (HPV)<ref name=V2016/>
| risks           = Communal showers and pools, [[barefoot]] walking, [[sandals|open footwear]], prior warts, [[immunocompromised|poor immune function]]<ref name=V2016/><ref name=Fer2018/>
| diagnosis       = Based on symptoms<ref name=Fer2018/>
| differential    = [[Callus]], [[molluscum contagiosum]], [[squamous cell carcinoma]]<ref name=V2016/>
| prevention      =
| treatment       = [[Salicylic acid (medical use)|Salicylic acid]], [[chemotherapy|chemo]]-based [[Fluorouracil]] and [[bleomycin]],<ref name="fluorouracil">{{cite journal |last1=Salk |first1=Robert S. |last2=Grogan |first2=Kirk A. |last3=Chang |first3=Thomas J. |title=Topical 5% 5-Fluorouracil Cream in the Treatment of Plantar Warts: A Prospective, Randomized, and Controlled Clinical Study |journal=Journal of Drugs in Dermatology |date=May 2006 |volume=5 |issue=5 |pages=418–24 |pmid=16703777 |url=https://jddonline.com/articles/dermatology/S1545961606P0418X }}</ref> [[cryotherapy]], surgical removal<ref name=V2016/>
| medication      =
| prognosis       =
| frequency       = Common<ref name=AO2017/>
| deaths          =
}}
<!-- Definition and symptoms -->

A '''plantar wart''' is a [[wart]] occurring on the [[sole (foot)|bottom]] of the [[foot]] or [[toe]]s.<ref name=AO2017>{{cite web|title=Plantar Warts|url=http://www.aofas.org/footcaremd/conditions/ailments-of-the-big-toe/Pages/Plantar-Warts.aspx|website=AOFAS|access-date=11 November 2017|language=en-us|archive-url=https://web.archive.org/web/20171111204815/http://www.aofas.org/footcaremd/conditions/ailments-of-the-big-toe/Pages/Plantar-Warts.aspx|archive-date=11 November 2017|url-status=dead}}</ref> Its color is typically similar to that of the [[Human skin|skin]].<ref name=V2016/> Small black dots often occur on the surface.<ref name=AO2017/> One or more may occur in an area.<ref name=V2016/> They may result in pain with pressure such that walking is difficult.<ref name=V2016/>

<!-- Cause and diagnosis -->
They are caused by the [[human papillomavirus]] (HPV).<ref name=V2016>{{cite journal|last1=Vlahovic|first1=TC|last2=Khan|first2=MT|title=The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management.|journal=Clinics in Podiatric Medicine and Surgery|date=July 2016|volume=33|issue=3|pages=337–53|doi=10.1016/j.cpm.2016.02.003|pmid=27215155}}</ref> A break in the skin is required for infection to occur.<ref name=V2016/> Risk factors include use of communal showers, having had prior warts, and [[immunocompromised|poor immune function]].<ref name=V2016/><ref name=Fer2018>{{cite book|last1=Ferri|first1=Fred F.|title=Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1|date=2017|publisher=Elsevier Health Sciences|isbn=9780323529570|page=1375|url=https://books.google.com/books?id=wGclDwAAQBAJ&pg=PA1375|language=en}}</ref> Diagnosis is typically based on symptoms.<ref name=Fer2018/>

<!-- Treatment and epidemiology -->
Treatment is only needed if it is causing symptoms.<ref name=Fer2018/> This may include [[Salicylic acid (medical use)|salicylic acid]], [[cryotherapy]], [[chemotherapy|chemo]]-based [[fluorouracil]] or [[bleomycin]], and surgical removal.<ref name=V2016/> The skin atop the lesion should generally be removed before treatment.<ref name=V2016/> In about a third to two-thirds of cases, they go away without specific treatment, but this may take a few years.<ref name=V2016/> Plantar warts are common.<ref name=AO2017/> Children and young adults are most often affected.<ref name=Fer2018/>

==Signs and symptoms==
Their colors are typically similar to that of the nearby [[Human skin|skin]].<ref name=V2016/> Small, black dots may occur on their surfaces.<ref name=AO2017/> One or more may occur in an area.<ref name=V2016/> They may result in pain with pressure such that walking may be difficult.<ref name=V2016/>
<gallery mode="packed">
Veruca right foot detail.jpg|A plantar wart: [[striae]] ([[fingerprint]]s) go around the lesion.
File:Plantarwartscluster.jpg|Mosaic wart cluster
File:Wart-IMG 1676.JPG|Young plantar warts
File:30 year old plantar wart.jpg|30-year-old plantar wart
File:Painful plantar warts.jpg|Deep, painful plantar warts
File:Plantar wart at heel.jpg|Deep plantar wart on heel
</gallery>

==Cause==
Plantar warts are benign [[epithelial]] [[tumors]] generally caused by infection by [[human papillomavirus]] types 1, 2, 4, 60, or 63,<ref name="emed_hpv">{{EMedicine|MED|1037|Human Papillomavirus}}</ref> but also by types 57,<ref name="egawa">{{cite journal |vauthors=Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T | title = Human papillomavirus 57 identified in a plantar epidermoid cyst | journal = Br. J. Dermatol. | volume = 138 | issue = 3 | pages = 510–4 | year = 1998 | pmid = 9580810 | doi = 10.1046/j.1365-2133.1998.02135.x | s2cid = 19998825 }}</ref> 65,<ref name="compendium1994">{{cite web |url=http://pave.niaid.nih.gov/lanl-archives/compendium/94PDF/1/sm1g.pdf |title=Human Papillomaviruses Compendium |access-date=2013-02-05 |publisher=Los Alamos National Laboratory }}</ref> 66,<ref name="davis">{{cite journal |vauthors=Davis MD, Gostout BS, McGovern RM, Persing DH, Schut RL, Pittelkow MR | title = Large plantar wart caused by human papillomavirus-66 and resolution by topical cidofovir therapy | journal = J. Am. Acad. Dermatol. | volume = 43 | issue = 2 Pt 2 | pages = 340–3 | year = 2000 | pmid = 10901717 | doi = 10.1067/mjd.2000.100534 }}</ref> and 156.<ref name="chouhy2013">{{cite journal |vauthors=Chouhy D, Bolatti EM, Piccirilli G, Sánchez A, Fernandez Bussy R, Giri AA | title = Identification of human papillomavirus type 156, the prototype of a new human gammapapillomavirus species, by a generic and highly sensitive PCR strategy for long DNA fragments | journal = J. Gen. Virol. | volume = 94 | issue = Pt 3 | pages = 524–33 | year = 2013 | pmid = 23136368 | doi = 10.1099/vir.0.048157-0 | doi-access = free | hdl = 11336/4852 | hdl-access = free }}</ref> These types are classified as clinical (visible symptoms). The virus attacks compromised skin through direct contact,  possibly entering through tiny cuts and abrasions in the [[stratum corneum]] (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot or [[finger]], the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated.<ref name="emed_plantar">{{EMedicine|EMERG|641|Warts, Plantar}}</ref><ref name="hipusa"/>

Warts may spread through [[autoinoculation]], by infecting nearby skin, or by contaminated walking surfaces. They may fuse or develop into clusters called mosaic warts.<ref name="emed_hpv"/>

==Diagnosis==
A plantar wart is a small lesion that appears on the surface of the skin and typically resembles a [[cauliflower]], with tiny black [[petechia]]e (tiny [[hemorrhage]]s under the skin) in the center. Pinpoint bleeding may occur when these are scratched. Plantar warts occur on the soles of feet and toes. They may be painful when standing or walking.{{cn|date=May 2021}}

Plantar warts are often similar to [[callus]]es or [[Corn (pathology)|corns]], but can be differentiated by close observation of skin striations. Feet are covered in friction ridges, which are akin to [[fingerprint]]s of the feet. Friction ridges are disrupted by plantar warts; if the lesion is not a plantar wart, the striations continue across the top layer of the skin. Plantar warts tend to be painful on application of pressure from either side of the lesion rather than direct pressure, unlike corns (which tend to be painful on direct pressure, instead).{{cn|date=May 2021}}

==Prevention==
HPV is spread by direct and indirect contact from an infected host. Avoiding direct contact with contaminated surfaces such as communal changing rooms and shower floors and benches, avoiding sharing of shoes and socks and avoiding contact with warts on other parts of the body and on the bodies of others may help reduce the spread of infection. Infection is less common among adults than children.<ref name="hipusa">{{cite web |url=http://www.hipusa.com/webmd/encyclopedia/plantar_warts/index.html |title=Understanding Plantar Warts |access-date=2007-12-07 |publisher=Health Plan of New York }}</ref>

As all warts are contagious, precautions should be taken to avoid spreading them. Recommendations include:
* Cover them with an [[adhesive bandage]] while swimming
* Wear latex swimming socks
* Wear [[flip-flops]] when using communal showers
* Do not share towels.<ref name="nhs">{{cite web |title=Clinical Knowledge Summaries: Previous version – Warts (including verrucas) |url=http://www.cks.nhs.uk/clinical_knowledge/clinical_topics/previous_version/warts_and_verrucae.pdf |publisher=National Health Service |access-date=2010-12-05 |page=2 |date=January 2007 |url-status=dead |archive-url=https://web.archive.org/web/20110601150216/http://www.cks.nhs.uk/clinical_knowledge/clinical_topics/previous_version/warts_and_verrucae.pdf |archive-date=2011-06-01 }}</ref>

Plantar warts are not prevented by inoculation with [[HPV vaccine]]s because the warts are caused by different strains of HPV. [[Gardasil]] protects against strains 6, 11, 16, and 18, and [[Cervarix]] protects against 16 and 18, whereas plantar warts are caused by strains 1, 2, 4, and 63.{{dubious|date=September 2020}}<!-- contradicts https://www.mayoclinic.org/diseases-conditions/plantar-warts/diagnosis-treatment/drc-20352697 -->

==Treatment==
{{further|Wart#Treatment}}
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
| First-line therapy  || [[Over-the-counter drug|Over-the-counter]] [[Salicylic acid (medical use)|salicylic acid]]
|-
| Second-line therapy || [[Prescription drug|Prescribed]] 60% salicylic acid,  intralesional [[immunotherapy]]
|-
| Third-line therapy  || [[Fluorouracil|Fluorouracil cream]], [[cryotherapy]], [[laser]] therapy
|-
| Fourth-line therapy  || [[Bleomycin|Bleomycin injection]], surgical excision
|}
[[Image:Wart cryotherapy.jpg|thumb|Cryotherapy being applied to a plantar wart with a [[cotton swab]]]]
A number of treatments have been found to be effective.<ref name="bacelieri">{{cite journal |vauthors=Bacelieri R, Johnson SM |title = Cutaneous warts: an evidence-based approach to therapy |journal = Am Fam Physician |volume = 72 |issue = 4 |pages = 647–52 |year = 2005 |pmid = 16127954 |url = http://www.aafp.org/afp/20050815/647.html}}</ref> A 2012 review of different treatments for skin warts in otherwise healthy people concluded modest benefit from salicylic acid, and cryotherapy appears similar to salicylic acid.<ref>{{cite journal |last1=Kwok |first1=Chun Shing |last2=Gibbs |first2=Sam |last3=Bennett |first3=Cathy |last4=Holland |first4=Richard |last5=Abbott |first5=Rachel |title=Topical treatments for cutaneous warts |journal=Cochrane Database of Systematic Reviews |date=12 September 2012 |volume=2020 |issue=9 |pages=CD001781 |doi=10.1002/14651858.CD001781.pub3 |pmid=22972052 |pmc=8101088 }}</ref>

===Medications===
Salicylic acid, the [[treatment of warts by keratolysis]], involves the peeling away of dead surface skin cells with [[keratolytic]] chemicals such as salicylic acid or [[trichloroacetic acid]]. These are available in over-the-counter products, but in higher concentrations may need to be prescribed by a physician.  A 12-week daily treatment with salicylic acid has been shown to lead to a complete clearance of warts in 10–15% of the cases.<ref>{{cite journal |last1=Cockayne |first1=S |last2=Curran |first2=M |last3=Denby |first3=G |last4=Hashmi |first4=F |last5=Hewitt |first5=C |last6=Hicks |first6=K |last7=Jayakody |first7=S |last8=Kang’ombe |first8=A |last9=McIntosh |first9=C |last10=McLarnon |first10=N |last11=Stamuli |first11=E |last12=Thomas |first12=K |last13=Turner |first13=G |last14=Torgerson |first14=D |last15=Watt |first15=I |author16=EVerT team |title=EVerT: cryotherapy versus salicylic acid for the treatment of verrucae – a randomised controlled trial |journal=Health Technology Assessment |date=September 2011 |volume=15 |issue=32 |pages=1–170 |doi=10.3310/hta15320 |pmid=21899812 |doi-access=free }}</ref>

[[Formic acid]], topical, is a common treatment for plantar warts, which works by being applied over a period of time, causing the body to reject the wart.<ref>{{cite journal |last1=Bhat |first1=RM |last2=Vidya |first2=K |last3=Kamath |first3=G |title=Topical formic acid puncture technique for the treatment of common warts |journal=International Journal of Dermatology |date=June 2001 |volume=40 |issue=6 |pages=415–9 |pmid=11589750 |doi=10.1046/j.1365-4362.2001.01242.x |s2cid=42351889 }}</ref>

[[Fluorouracil]] cream, a [[chemotherapy]] agent sometimes used to treat [[skin cancer]], can be used on particularly resistant warts, by blocking [[virus|viral]] [[DNA]] and [[RNA]] production and repair.<ref name="fluorouracil" />

[[Bleomycin]], a more potent chemotherapy drug, can be injected into deep warts, destroying the viral DNA or RNA. Bleomycin is notably not US [[FDA]] approved for this purpose. Possible side effects include [[necrosis]] of the digits, nail loss, and [[Raynaud syndrome]]. The usual treatment is one or two injections.<ref>{{cite journal |last1=Soni |first1=Prasoon |last2=Khandelwal |first2=Kanika |last3=Aara |first3=Naushin |last4=Ghiya |first4=Bhikam C |last5=Mehta |first5=Rajesh D |last6=Bumb |first6=Ram A |title=Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts |journal=Journal of Cutaneous and Aesthetic Surgery |date=2011 |volume=4 |issue=3 |pages=188–191 |doi=10.4103/0974-2077.91250 |pmid=22279384 |pmc=3263129 |doi-access=free }}</ref><ref>Champion, R. H., et al. (1998). ''Rook's Textbook of Dermatology''.  Blackwell Science, p. 1044, {{ISBN|0-632-06429-3}}</ref>

[[Immunotherapy]], as intralesional injection of [[antigen]]s ([[mumps]], ''[[Candida (genus)|candida]]'' or [[trichophytin]] antigens USP), is a wart treatment that may trigger a host immune response to the wart virus, resulting in wart resolution. It is now recommended as a second-line therapy.<ref>{{cite journal |vauthors=Bacelieri R, Johnson SM |title = Cutaneous warts: An evidence-based approach to therapy |journal = American Family Physician |volume = 72 |issue = 4 |pages = 647–652 |year = 2005 |pmid = 16127954 |url = http://www.aafp.org/afp/2005/0815/p647.html }}</ref>

===Surgery===
[[File:Plantar wart papilloma.jpg|thumb|right|A 7 mm plantar wart surgically removed from the sole of a person's foot after other treatments failed]]
[[Liquid nitrogen]]  and similar [[cryosurgery]] methods are common surgical treatments, which act by freezing the external cell structure of the warts, destroying the live tissue.{{cn|date=May 2021}}

[[Electrodesiccation]] and surgical excision may produce scarring.{{cn|date=May 2021}}

[[Laser surgery]] is generally a last resort treatment, as it is expensive and painful, but may be necessary for large, hard-to-cure warts.<ref>[http://www.webmd.com/skin-problems-and-treatments/laser-surgery-for-warts "Laser Surgery for Warts"], webmd.com</ref>

[[Cauterization]] may be effective as a prolonged treatment. As a short-term treatment, cauterization of the base with anesthetic can be effective, but this method risks scarring or [[keloid]]s. Subsequent surgical removal, if necessary, also risks keloids and/or recurrence in the operative scar.<ref name="kunnamo">{{cite book |title=Evidence-based Medicine Guidelines |last=Kunnamo |first=Ilkka |year=2005 |publisher=John Wiley and Sons |isbn=978-0-470-01184-3 |pages=422 |url=https://books.google.com/books?id=frYEiHYtOv0C&pg=PA422 }}</ref>
{{-}}

==References==
{{Reflist}}

== External links ==
{{Medical resources
| ICD10   = B07
| ICD9    = {{ICD9|078.12}}
}}
* [http://www.mayoclinic.com/health/plantar-warts/DS00509 Plantar&nbsp;warts] at the [[Mayo Clinic]] website
* [https://www.merckmanuals.com/home/skin-disorders/viral-skin-infections/warts?query=Warts Warts] at ''[[Merck Manual]]''

{{Viral cutaneous conditions}}
{{Human papillomavirus}}

{{DEFAULTSORT:Plantar Wart}}
[[Category:Virus-related cutaneous conditions]]
[[Category:Foot diseases]]
[[Category:Papillomavirus-associated diseases]]
[[Category:Wikipedia medicine articles ready to translate]]