Verrucae are a perennial problem that can affect a person at any age, although the more often you are barefoot in communal surroundings, the more likely you are to catch them. The reason our hearts sink when we see one, is that they can be really tricky to shift. Below is a copy of a client information sheet that we have put together to explain a little more about what they are, and the different treatment options. We haven’t included all the many and varied ‘Old Wives Tales’ remedies, but they can also be worth a try. One client tried a course of cryotherapy to no avail, but a couple of weeks of applying freshly minced garlic every night (covered by a plaster) seemed to do the trick!
What are verrucae?
A verruca (or wart) is caused by a viral infection of the skin. They can occur anywhere on the foot, but if they are on the sole they will be flatter from being pushed into the foot, and are more likely to have a covering of hard skin, or callus, over them. The build-up of callus may cause discomfort, but more often they are purely a cosmetic problem.
Why can they last so long?
Your body’s immune system is designed to fight viruses, but the verruca virus has evolved to limit its growth to the upper layers of skin (epidermis). This means that it can evade detection by the immune system and may live in the skin for several months or several years.
What are the treatment options?
Treating a verruca is not straightforward and the easiest option is simply to ignore them and wait for them to go of their own accord. It should be noted that up to 50% of verrucae will disappear within two years. If you decide to try to speed up the process, most treatments involve some method of destroying the skin cells that the virus is living in.
Most over the counter verruca treatments contain an acid, commonly salicylic acid, which is applied to the skin on a daily basis. To be effective, it is necessary to rub down the build up of callus so that the acid can work on the affected living skin cells. We find that most people give up too quickly and are not diligent in the daily application. You should be prepared to treat the verruca for 3 months of daily application to increase your chance of success.
If you have not achieved a resolution of the verruca after 3 months, then a stronger concentration of acid can be applied by a Podiatrist. An aperture pad is applied around the verruca to shield the healthy surrounding skin and 60% salicylic acid is applied to the verruca. Tape is applied over the pad to hold everything in place and you will be advised to keep the dressing dry for a few days. After this time the dressing can be removed and the ointment washed off. This is generally repeated at 2-3 weekly intervals.
This method freezes the infected skin cells using a spray of very cold gas. When the skin cells are frozen, the fluid inside the cell expands and bursts the cell wall, exposing the virus inside to the immune system.
For particularly stubborn verrucae that have resisted all other treatments, needling can be considered in some suitable cases. Local anaesthetic is injected into the ankle to numb the foot. The verruca is then perforated with a needle to break it down and to push the viral fragments deeper into the tissue so that the immune system can come into contact with it and produce the cells required to destroy it. The wound produced by needling requires careful dressing and can take 2-3 weeks to fully heal.
Swift Microwave Therapy
This is now our treatment of choice at the clinic. Offering a 76% resolution rate, treatment is quick, clean and repeated at monthly intervals. Read more here
Are there any Risks or Contraindications?
As the methods described above all require destruction of skin cells, the following contraindications apply: people with diabetes, or anyone with impaired circulation or poor healing abilities.
Over the counter preparations – these vary depending on the product used, but should generally not be used on children under 2. Products containing salicylic acid should be avoided if you have an allergy to aspirin. There is a risk of irritation, particularly if the product comes into contact with healthy skin.
60% Salicylic acid – not to be used on younger children. It can cause skin irritation in some people. Because the overlying callus is pared back as far as possible, there is also the possibility of some bleeding.
Cryotherapy – not usually administered to younger children. Callus paring can cause some bleeding. Freezing skin tissue carries a risk of discomfort and blistering.
Needling – not performed on children under 16. The verruca site will bleed and there is a greater risk of pain and possible scarring. The above contraindications apply plus also anyone who is immuno-compromised, taking steroids, anticoagulants/antiplatelets, have liver or kidney complaints or have a history of problems with local anaesthetic.
Swift Microwave Therapy -suitable for most people. As a guideline, we can treat children over the age of 10. There is short, sharp discomfort whilst the energy is applied to the skin. Treatment can’t be carried out if there is underlying metal implants, or if the client has a pacemaker.