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Plantar Wart

Disease Details

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Description: Plantar warts are small growths that usually appear on the heels or other weight-bearing areas of the feet and are caused by the human papillomavirus (HPV).
Type: Plantar warts are not a genetically transmitted condition. They are caused by a viral infection from human papillomavirus (HPV), specifically types 1, 2, 4, 60, and 63.
Signs And Symptoms: Their colors are typically similar to that of the nearby skin. Small, black dots may occur on their surfaces. One or more may occur in an area. They may result in pain with pressure such that walking may be difficult.
Prognosis: Plantar warts, caused by the human papillomavirus (HPV), typically have a good prognosis. They often resolve on their own without treatment, although this can take several months to years. Various treatment options, such as salicylic acid, cryotherapy, and laser therapy, can expedite healing. Recurrence is possible, especially if the virus persists in the skin, but serious complications are rare. Consulting a healthcare provider can help determine the best course of action for persistent or troublesome warts.
Onset: Plantar wart, also known as verruca plantaris, typically has a gradual onset. It is caused by the human papillomavirus (HPV), which infects the outer skin layer. The wart may take several weeks to months to become noticeable after the initial HPV infection, often appearing as a small, rough growth on the sole of the foot.
Prevalence: The prevalence of plantar warts is generally difficult to pinpoint with exact figures, but it is estimated that warts affect around 7-10% of the general population at any given time. Plantar warts, which specifically occur on the soles of the feet, are particularly common in children and young adults. They are caused by the human papillomavirus (HPV) and are more likely to develop in individuals who frequently walk barefoot in communal areas such as swimming pools or locker rooms.
Epidemiology: Plantar warts are caused by infection with human papillomavirus (HPV), specifically types 1, 2, 4, 60, and 63. They are commonly found in children, teenagers, and people with weakened immune systems. The virus enters through small cuts or abrasions on the feet, particularly those that come into contact with communal surfaces like locker room floors or public showers. The prevalence of plantar warts is higher among people who frequently walk barefoot in these environments.
Intractability: Plantar warts are not typically considered intractable. They can often be effectively treated with various methods, including over-the-counter salicylic acid treatments, cryotherapy, or minor surgical procedures. However, some cases may be persistent and require multiple treatments or more aggressive approaches to fully resolve.
Disease Severity: Plantar warts are generally considered mild in terms of disease severity. They are caused by the human papillomavirus (HPV) and usually appear on the soles of the feet. Though they can be painful, especially when walking or standing, they are not life-threatening and often resolve on their own or with treatment.
Healthcare Professionals: Disease Ontology ID - DOID:13775
Pathophysiology: Plantar warts, or verrucae, are caused by the human papillomavirus (HPV), specifically types 1, 2, 4, 60, and 63. The virus infects the superficial layer of the skin, the epidermis, leading to a rapid proliferation of keratinocytes. This results in the formation of a thickened, rough lesion typically found on the soles of the feet. The virus enters the skin through small cuts or abrasions, and the pressure from walking and standing causes the wart to grow inward, making it painful.
Carrier Status: Carrier status for plantar warts is not applicable ("nan" or not a number), as plantar warts are caused by a viral infection from the human papillomavirus (HPV) and are not associated with carrier status in the way genetic conditions are.
Mechanism: A plantar wart, caused by the human papillomavirus (HPV), typically develops on the weight-bearing areas of the foot, such as the heel or ball. The virus enters the skin through tiny cuts or abrasions. Once inside, HPV stimulates rapid growth of the skin cells on the outer layer of the skin, leading to the formation of a wart.

Molecular mechanisms involve the interaction between the virus and the host's cellular machinery. HPV infects the basal layer of the epithelium. Its viral DNA integrates into the host cell's genome and uses the host cell's replication machinery to proliferate. HPV can inhibit p53 and retinoblastoma protein (pRb), which are crucial for cell cycle control, leading to uncontrolled cell division and wart formation. Furthermore, the virus can evade the host's immune response, allowing persistence and growth of the wart.
Treatment: A number of treatments have been found to be effective. 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.
Compassionate Use Treatment: For plantar warts, compassionate use treatments and off-label or experimental options may include:

1. **Topical Imiquimod (Aldara)**: Although primarily used for treating genital warts and certain types of skin cancer, imiquimod is sometimes used off-label for plantar warts to stimulate an immune response against the wart.

2. **Cidofovir Cream**: This antiviral medication, typically used for viral infections in immunocompromised patients, can be used off-label as a topical treatment for recalcitrant plantar warts.

3. **Intralesional Immunotherapy**: Agents such as Candida antigen, MMR vaccine, or bleomycin are injected directly into the wart. These treatments stimulate an immune response that may help to clear the wart.

4. **Laser Therapy**: Pulsed-dye laser and CO2 laser treatments target the blood vessels feeding the wart or directly vaporize the wart tissue. These treatments are considered experimental in some cases and are not universally available.

5. **Photodynamic Therapy**: This involves applying a photosensitizing agent to the wart and then exposing it to a specific wavelength of light. This can help to destruct wart tissue, although it is generally considered experimental.

These treatments are usually considered when conventional therapies fail and should only be administered by experienced healthcare professionals.
Lifestyle Recommendations: **Lifestyle Recommendations for Plantar Warts**:

1. **Keep Feet Clean and Dry**: Regularly wash your feet with soap and water, and make sure to dry them thoroughly, especially between the toes.

2. **Avoid Walking Barefoot in Public Areas**: Wear shower shoes or flip-flops in communal areas such as gyms, pools, and locker rooms to prevent contracting or spreading the virus.

3. **Change Socks Daily**: Wear fresh, clean socks every day to reduce moisture and prevent the environment that warts thrive in.

4. **Use Proper Footwear**: Ensure your shoes fit well and provide good ventilation to keep your feet dry.

5. **Avoid Direct Contact**: Do not touch, pick, or scratch the warts to prevent spreading the virus to other parts of your body or to other people.

6. **Protect Your Feet**: If you have an existing plantar wart, consider covering it with a waterproof plaster or an adhesive bandage to prevent infection and spreading.

7. **Boost Immune System**: Maintain a healthy diet, exercise regularly, and get adequate sleep to support your immune system in fighting off the virus.

8. **Avoid Sharing Personal Items**: Do not share towels, shoes, socks, or nail clippers with others.

Implementing these lifestyle changes can help manage and prevent plantar warts.
Medication: 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.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.Fluorouracil cream, a chemotherapy agent sometimes used to treat skin cancer, can be used on particularly resistant warts, by blocking viral DNA and RNA production and repair.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.Immunotherapy, as intralesional injection of antigens (mumps, 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.
Repurposable Drugs: There are no widely recognized repurposable drugs specifically for plantar warts. Treatment for plantar warts generally includes topical salicylic acid, cryotherapy, laser therapy, or other forms of medical intervention.
Metabolites: Plantar warts are caused by the human papillomavirus (HPV). The metabolic pathways specific to plantar warts or HPV are not well-elucidated, and there are no specific metabolites exclusively attributed to the presence of plantar warts. They primarily involve the keratinized tissue of the sole of the foot but do not distinctly alter systemic metabolic processes in a way that is currently well-characterized by identifiable metabolites.
Nutraceuticals: Nutraceuticals have not been conclusively proven to treat or prevent plantar warts. While some vitamins and supplements, such as vitamin C, zinc, or garlic, are believed to boost the immune system, their effectiveness in specifically targeting plantar warts remains unclear. Consult with a healthcare professional for the most appropriate treatment options.
Peptides: For plantar warts, there is currently limited research on the use of peptides specifically for treatment. Traditional methods include topical salicylic acid, cryotherapy, and laser treatment. If further interest in peptide-based treatments arises, consultation with a healthcare provider or specialist in dermatology might be necessary to explore advanced options.