What is a verruca (plantar wart)?

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From the Guidelines

A verruca, also known as a plantar wart, is a benign skin growth caused by the human papillomavirus (HPV) that appears on the soles of the feet, as defined by the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1.

Definition and Characteristics

These warts typically look like rough, grainy growths with tiny black dots (small clotted blood vessels) and may cause pain when walking or standing due to pressure.

  • Plantar warts differ from regular warts because the pressure from walking forces them to grow inward beneath callused skin.
  • The development of epidermal thickening and hyperkeratinization occurs following infection at the basal layer and clonal proliferation, which eventually results in a visible wart, weeks or even months later 1.

Treatment Options

Treatment options include:

  • Over-the-counter salicylic acid products (like Compound W or Dr. Scholl's), which should be applied daily for several weeks after soaking and filing the wart.
  • Cryotherapy (freezing with liquid nitrogen) performed by healthcare providers is another common treatment requiring multiple sessions.
  • For persistent warts, prescription-strength treatments like cantharidin, imiquimod, or surgical removal may be necessary, as outlined in the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1.

Prevention

Plantar warts can spread through direct contact with the virus, especially in warm, moist environments like swimming pools or communal showers, so wearing protective footwear in these areas can help prevent infection.

  • The virus typically enters through tiny breaks in the skin, and individuals with weakened immune systems are more susceptible to developing these warts 1.

From the Research

Definition of Verruca

  • A verruca, also known as a plantar wart, is a common cutaneous lesion on the plantar aspect of the foot caused by the human papillomavirus (HPV) 2, 3.
  • It is a type of benign foot hyperplasia that can be painful and may resist conventional treatments 4, 5.

Causes and Transmission

  • Verrucae are caused by the human papillomavirus (HPV), which is ubiquitous in the environment and can infect other sites in the plantar region or spread to other people 2.
  • The virus needs an epidermal abrasion and a transiently impaired immune system to inoculate a keratinocyte 3.

Treatment Options

  • Various treatment options are available for verrucae, including laser therapy, Candida albicans immunotherapy, topical therapy such as phytotherapy, and surgical excision 3.
  • Cantharidin cream has been shown to be an effective treatment for verruca plantaris, with a high cure rate and low recurrence rate 4.
  • Microwave therapy has also been investigated as a treatment for recalcitrant plantar warts, with promising results 5.
  • Topical imiquimod 5% cream has been used to treat non-genital warts, including verrucae, with successful outcomes 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management.

The Journal of the American Osteopathic Association, 2018

Research

Treatment of non-genital warts with topical imiquimod 5% cream.

European journal of dermatology : EJD, 2002

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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