"Will my verruca or wart ever go away?"
This is a question I get asked a number of times in my practice, will my verruca ever go away? or how long will it take for it to go away?
You might already know a bit about verruca and warts, but if you are here reading this blog, then you want to find out more… so please do keep on reading.
This famous painting of Oliver Cromwell was commissioned to Peter Lely, a Dutch painter in the 1600s. Cromwell instructed Lely to paint a true likeness of him, with no flattery “…pimples, warts and everything else…” I found this somewhat intriguing when I read the history of the painting – so a blog on warts won’t be complete without mentioning Sir Oliver Cromwell.
In the next five minutes, I am going take a deep dive into the world of warts and all…
Warts, Verruca or Verrucae, what are they?
Verruca are benign warts, a common skin infection caused by the Human Papillomavirus (HPV).
There are over 200 sub-types discovered so far, according to the literature. Some identified strains that appear on the foot are known as HPV Type 1, 2 and 4.
Warts can be found on the face, hands, legs and feet. On the foot, they are called verruca plantaris (plantar wart). They can appear on any part of the foot, but commonly on the soles and the toes – as a single verruca, or grouped together – verrucae.
Verrucae appear as white patches on the skin, often with multiple black dots. They tend to be flat but can also be raised – causing pain if on a weight bearing part of the foot, especially where there is a build-up of hard skin.
The black dots in the verruca are the ends of very small capillary vessels, which invade the viral cells. These can bleed easily, if the hard skin is filed down or paired away.
The virus affects the cells found in the superficial layer of the skin, where it remains dormant. Due to the biological makeup of this layer of the skin, the virus is able to avoid detection by the body’s immune system.
How do verrucae develop?
We know that the virus is contagious, and can be found on surfaces we come into contact with every day, on door handles, lift buttons etc, it is therefore impossible to completely eradicate it from our surroundings.
The virus needs a portal of entry to take hold, this can be dry skin on your feet, or an abrasion or a cut, invisible to the naked eye. Simply walking along non-slip tiles in the house, or around a swimming pool is enough to cause minor abrasions to the skin, allowing the virus to enter the skin.
The virus can lay dormant in the skin unknown for several weeks, before presenting as a physical verruca or wart.
We can conclude, that the school of thought which states verrucae can only be picked up from swimming pools, or communal areas such as gyms is a myth!
Certain people appear to be more susceptible to developing verrucae than others, the reason for this remains unknown.
Should I have my verruca treated or not?
If the verruca does not cause pain or discomfort, the best approach is no treatment at all. However, we know that some verrucae can be painful depending on the type and location, and it can interfere with every day activities. It can be unsightly and cause embarrassment – in these situations, treatment can be considered.
NHS guidelines state that majority of verrucae may resolve spontaneously within a given period of time.
Research shows that in children, about 50% of those presenting with verrucae will resolve within a year, and the remaining half up to 2 years. In adults, it can take longer, and on average can last for over 2 years.
So, what do we know about verrucae so far? we know…
- they are not dangerous
- they are viral, not bacterial or fungal in origin
- they can spread
- they can be painful
- they have small capillary vessels that can bleed easily
- the body may need some help in detecting them, and
- some may spontaneously resolve
How long does treatment take, before I start seeing results?
It is difficult to give a definite time of how long it will take to resolve a verruca or verrucae, however, if a particular treatment does not show any sign of improvement after 2-3 months (depending on the treatment) it is most likely that particular treatment will not be successful.
Choice of treatment is subject specific. Some treatments are not suitable for everyone- in the very young and pregnant women, some treatments are not recommended.
It is always advisable to seek guidance from your podiatrist to discuss treatment options available to you, as they can recommend the best option to suit your specific needs.
Treatment can be a prolonged process depending on the length of time the verruca has been present, the size, and how deep it is. Furthermore, different treatment modalities work with varying success rates.
Keeping in mind that SOME verrucae will spontaneously resolve – by adopting a ‘watch and wait’ approach, these may disappear in time of their own accord.
I’ll share a couple of recent case histories of spontaneous regression with you.
Two of my regular patients decided not to pursue treatment, but asked to have the hard skin paired away every 4 – 6 weeks, to make the area comfortable to walk on. At their request, the hard skin over the verruca/e was paired away at each visit.
To our amazement, the verruca/e on their feet started to resolve spontaneously. It so happened that they both developed an infection elsewhere in the body- patient 1, see picture below developed a toothache; and the other patient had a severe viral infection. In both patients, it took 9 -12months to see spontaneous regression of the verrucae from when they first came to the clinic.
Now, I’m not saying we should all pray for an infection to get rid of a verruca!, but in these two cases it appears to have given the body a jolt into fighting the viral foot infection as well.
61-year-old patient with longstanding verrucae (unable to say how long they were present for, however patient says ‘years’)
Spontaneous resolution seen after regular pairing away of the hard skin over the verrucae.
In these two scenarios, my theory is – their immune system was triggered, and the body was able to fight off the virus – consequently mounting an immune response to the virus in their foot.
If you do decide to have your verruca treated, podiatrists/chiropodists are well placed to offer this type of service. Many try various over-the-counter self-treatments, before seeking professional treatment, and that’s okay.
If I choose to have it treated, will they go away? what treatments are available?
You will find that in the UK, most NHS services no longer offer verrucae treatments, and treatment is mostly provided by independent podiatrists or chiropodists in private practice like myself.
Several treatment options have been tried and tested over the years, these include cryosurgery (freezing), chemical cautery (use of chemicals), Falknor’s or dry needling, electrosurgery, laser, homeopathy, and a range of alternative therapies.
No treatment modality can guarantee a 100% success rate due to the nature of the virus. However, most research around some of these treatment modalities, have been found to be between 60 – 70% successful.
Majority of the treatments available are based on facilitating and inducing an immune response to the virus, and when a response is adequately mounted, destruction of the affected cells within the skin follows – the body is able to fight off the virus.
In this blog, I will be focusing on the first three treatment modalities mentioned above. These are treatments I offer at the foot clinic. Treatment is tailored to each individual, and progress is reviewed regularly.
Salicylic acid ointment
This is an acid based topical treatment which is applied to the affected area in the form of an paste.
This can be left on for a period of three to five days; it acts by gradually lifting the layers of affected skin. The process is repeated on a weekly basis until the verruca is resolved.
This is another acid treatment which acts on the protein within the viral tissue. It is applied after pairing or filing down the hard skin over the affected area.
This forms a black waterproof cap over the verruca, making it an ideal treatment for self- treatment at home with no requirements for prolonged dressing use.
By sealing off the verruca, there is a lower risk of spreading the virus to other parts of the body, or to others in the household.
The use of silver nitrate should only be undertaken after consultation with a podiatrist or pharmacist.
Cryosurgery is the freezing of the viral cells within the verruca, destroying the virus cell structure – the body is able to detect its presence, and start the process of healing.
The number of sessions required will depend on the size and duration of the verruca/e, and the body’s ability to heal it adequately.
I use the CroPen for cryosurgery at the clinic (see image opposite). This is precise in treating the affected area through the nozzle shaped tip. It is known to be a very safe method of treatment.
Falknor’s Dry Needling
This method of treatment is increasingly being used as a form of treatment for verrucae. I have experienced high success rates with this particular treatment.
The verruca is broken down under local anaesthetic, allowing the body’s own defence system to recognise the presence of the virus, thereby fighting against the infection.
Below are two case studies of patients who had dry needling treatment at the clinic. Consent to share information and pictures, has been gained from both patients.
Disclaimer: I will like to say, not all patients have the same healing rates, or respond to certain treatments.
Research shows, treatment modalities for verrucae are known to have approximately 70% success rates.
Case Study 1
18-year-old with longstanding verrucae for over 2 years.
The verrucae were painful to walk on, causing distress. They had tried several over-the-counter treatments and creams from their doctor, which proved to be unsuccessful.
This particular patient had dry needling of one verruca on the right foot, after a few weeks, the verrucae on both feet resolved.
Picture on the left was taken at their first appointment, and second picture at week 16 – verrucae had resolved, they were free of pain.
Case Study 2
13-year-old with long standing multiple verrucae- over 3 years, pictures at week 4 and 16 respectively. Unfortunately a picture was not taken on day one of treatment.
Treatment: dry needling of verrucae after various unsuccessful treatments at home.
Total resolution was noted at their 16-week check-up.
To find out more about treatment offered at the clinic or to book an appointment, call 07988 916 198, you can also book online.
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To find a list of HCPC registered podiatrists and chiropodists near you, check out the NHS website here.
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