WHAT IS A VERRUCA
A verruca is a virus that affects the epidermal layer of our skin. It is known as the Human Papilloma Virus (HPV) and there are more than 90 types of HPV.
Viruses are microscopic. But what you can see are the distorted skin cells that the verruca has invaded. There may be small black dots which are capillaries (tiny blood vessels). A verruca may be a single lesion (plantar wart) which on weight bearing areas can be quite deep and covered with hard skin. Or grouped together as multiple or mosaic warts (cutaneous warts) which are generally more superficial.
Verrucas are spread by the transfer of a virally infected cell in a damp environment. So, cover it with a plaster if you are sharing a shower or bathing area. A verruca can clear up on its own especially in children, but this is less likely in adults and rarely seen in the immune-suppressed. You may decide to treat if you are experiencing pain, interference with normal walking/ running, cosmetic embarrassment or to prevent further spreading.
Over the counter treatments can be successful but require you to follow the instructions to the letter and you really need to be persistent. A podiatrist has access to treatments which are unavailable in the chemist or which you would be unable to do yourself. The aim of all treatments is to cause a disruption to the epidermis (the outside layer of skin where the virus lives), alert your immune system to the presence of the virus and stimulate an immune response from you. Sometimes it's difficult to know if 'that thing' on your foot is indeed verruca.
Don't be embarrassed to book in purely for a diagnosis. This will allow you to choose a treatment option. You may opt to leave your verruca alone and it may resolve itself, or you may choose an over the counter treatment from the chemist. If you choose to have your verruca treated in clinic we offer the two most successful and well tolerated treatments.
Caustic treatments are applied weekly and can be painless depending on the treatment used. 24hr occlusion is required each time. Falknor's needling technique is carried out under local anaesthetic and is reviewed after two and four months. Resolution usually occurs at this point.
Verrucas (verrucae) or plantar warts are small, rough, raised or flattened lumps that occur over the pressure areas of the feet. These are commonly caused by infections with different strains of the human papilloma virus (HPV).
The virus may be isolated from the skin cells of verruca. Around half of these disappear on their own in a year. Two thirds of the verruca persist for at least two years and disappear without therapy. The other one third persists for more than 2 years and is resistant to therapy.
Who gets verrucas?
Most people will get a verruca at some point in their lives and women get it slightly more commonly than men. The peak incidence is seen in children with 4 to 5% affected but infants are usually spared.
Causative organism of verrucas
There are over 100 different types or strains of HPV that have been identified. Different strains of HPV are responsible for causing different types of warts. For example, types 1 and 2 are commonly implicated for causes plantar warts or verruca. Type 4 is also found in some cases.
The virus invades the top most layer of the skin called the epithelium and starts replicating within these epithelial cells. This may lead to multiplication of the cells and formation of plaques or papules or the flattened warts. The incubation period is often up to a year.
This means from the time of invasion of the virus to formation of the warts, the time taken may be up to a year. HPV is highly contagious.
Method of spread of verrucas
HPV from the verruca may spread through close skin-to-skin contact. These warts are contagious as long as they are present on the body as they contain the live virus within them. Sometimes the virus may also spread by sharing objects like towels, socks, shoes, baths and community showers with infected persons. In addition, those who have wet, soft, ulcerated or sore skin of the feet are more likely to get the infection than those with dry and intact skin of the feet.
The virus particularly spreads to more than one part of the same individual’s body if they scratch, itch, bite (nails with finger warts), suck (fingers with warts) or shave (face or the legs with warts) over the warts. This is called auto-inoculation. This trauma usually leads the warts to break up and bleed and helps spread the virus to other parts of the body or to other individuals. Despite spread due to sharing community showers or baths and pools, the National Curriculum suggests that all children should learn to swim as it helps to prevent death from drowning and risk of verrucas should not deter children from acquiring this skill.
Cryotherapy Treatment
Cryotherapy is one of the treatments available to treat a Verruca. Cryotherapy is the controlled destruction of the tissues using very low temperatures, i.e. freezing of the skin. Ice is formed inside and outside of the cells, disrupting the cell where the virus is living. The aim is to freeze as quickly as possible so that the cells have no time to defend themselves. Ideally, the treatment ruptures the cells and releases the virus into the bloodstream. The body’s immune system is then thought to fight off the skin infection.
Treatment is normally a course, with weekly or fortnightly visits. Unfortunately, as with all verruca treatment, a cure cannot be guaranteed. The freeze normally lasts between 30 seconds and a minute and may be repeated. Because the freezing liquid is very cold, it can be uncomfortable during the treatment, feeling a bit like a burn, and can sometimes throb a few hours later. Painkillers can be taken, but not anti-inflammatory, as this could reduce the effectiveness of the inflammatory response.
What will happen during the treatment?
Skin preparation: removing all calluses, dead skin surrounding the verruca.
Freezing: The freezing starts and it usually lasts a few minutes with cycles of application/rest.
Dressing: We then cover the area with a small plaster to keep on for the first day.
Dressings and follow up.
We do not recommend any specific dressing in between sessions unless we instruct some additional treatment.
However, you might find it more comfortable to apply a plaster on the verruca to protect it.
Verruca Needling
Falknor`s needling procedure is an innovative and effective treatment for verruca, which are benign types of the Human Papilloma Virus (HPV) group. It is a form of soft tissue therapy which is intended to break down the verruca and create a controlled inflammatory response which, in turn, stimulates the body’s immune system to recognise the virus and destroy it.
Verruca Needling treatment has been around for over 45 years (being first described in a medical journal in America in 1969) and is used routinely with great success by practitioners internationally. It has been reported to be highly effective, even for long-standing verruca.
Verruca Needling is different from other treatment options such as cryotherapy or salicylic acid as it requires only one or occasionally two sessions. This makes it an ideal treatment option for busy people. The treatment is carried out under local anesthetic. Most people report only minor soreness for 2 to 3 days post-treatment.
WHAT WILL HAPPEN DURING THE TREATMENT?
There are three stages to the Verruca Needling procedure:
1. You will be given an injection of local anaesthetic which will make your verruca and surrounding area numb.
2. Once the verruca is numb, the podiatrist will carefully needle the verrucae to implant the virus into the dermal layer of the skin so that the body’s immune system can come into contact with the virus.
3. A dressing will be applied to the verruca once the procedure is completed. you are advised not to drive when the foot or part of the foot has been anaesthetised. Our advice is to get a taxi or a lift home and avoid walking.
WILL IT BE PAINFUL AFTERWARDS?
Some patients can experience soreness once the anaesthetic wears off. This soreness can best be described as a bruised feeling that can last for up to 7/10 days however most patients describe soreness only for 2 to 3 days after the procedure. Painkillers such as Paracetamol are normally sufficient to reduce any discomfort. Use of Ibuprofen or any other anti-inflammatory medication is not advisable, but you can use Paracetamol.
FUNGAL INFECTIONS
Athlete's foot
Athlete's foot (tinea pedis) is a fungal infection that usually begins between the toes. It commonly occurs in people whose feet have become very sweaty while confined within tight fitting shoes. Signs and symptoms of athlete's foot include a scaly rash that usually causes itching, stinging and burning. Athlete's foot is contagious and can be spread via contaminated floors, towels or clothing.
Athlete's foot is closely related to other fungal infections such as ringworm and jock itch. It can be treated with over-the-counter antifungal medications, but the infection often recurs. Prescription medications also are available.
Symptoms
Athlete's foot usually causes a scaly red rash. The rash typically begins in between the toes. Itching is often the worst right after you take off your shoes and socks. Some types of athlete's foot feature blisters or ulcers. The moccasin variety of athlete's foot causes chronic dryness and scaling on the soles that extends up the side of the foot. It can be mistaken for eczema or dry skin.
The infection can affect one or both feet and can spread to your hand — especially if you scratch or pick at the infected parts of your feet.
Causes
Athlete's foot is caused by the same type of fungus that causes ringworm and jock itch. Damp socks and shoes and warm, humid conditions favor the organism's growth. Athlete's foot is contagious and can be spread by contact with an infected person or from contact with contaminated surfaces, such as towels, floors and shoes.
Risk factors
You are at higher risk of athlete's foot if you:
Are a man
Frequently wear damp socks or tight-fitting shoes
Share mats, rugs, bed linens, clothes or shoes with someone who has a fungal infection
Walk barefoot in public areas where the infection can spread, such as locker rooms, saunas, swimming pools, communal baths and showers
Complications
Your athlete's foot infection can spread to other parts of your body, including:
Your hand. People who scratch or pick at the infected parts of their feet may develop a similar infection in one of their hands.
Your nails. The fungi associated with athlete's foot can also infect your toenails, a location that tends to be more resistant to treatment.
Your groin. Jock itch is often caused by the same fungus that results in athlete's foot. It's common for the infection to spread from the feet to the groin as the fungus can travel on your hands or on a towel.
Prevention
These tips can help you avoid athlete's foot or ease the symptoms if infection occurs:
Keep your feet dry, especially between your toes. Go barefoot to let your feet air out as much as possible when you're at home. Dry between your toes after a bath or shower.
Change socks regularly. If your feet get very sweaty, change your socks twice a day.
Wear light, well-ventilated shoes. Avoid shoes made of synthetic material, such as vinyl or rubber.
Alternate pairs of shoes. Don't wear the same pair every day so that you give your shoes time to dry after each use.
Protect your feet in public places. Wear waterproof sandals or shoes around public pools, showers and lockers rooms.
Treat your feet. Use powder, preferably antifungal, on your feet daily.
Don't share shoes. Sharing risks spreading a fungal infection.
HOW YOU CAN PREVENT ATHLETE'S FOOT YOURSELF
DO...
dry your feet after washing them, particularly between your toes – dab them dry rather than rubbing them
use a separate towel for your feet and wash it regularly
take your shoes off when at home
wear clean socks every day – cotton socks are best
DON'T...
do not scratch affected skin – this can spread it to other parts of your body
do not walk around barefoot – wear flip-flops in places like changing rooms and showers
do not share towels, socks or shoes with other people
do not wear the same pair of shoes for more than 2 days in a row
do not wear shoes that make your feet hot and sweaty