From the Guidelines
Plantar warts on the feet in adolescents are primarily caused by the human papillomavirus (HPV) and can be treated with various methods, including salicylic acid, cryotherapy, and combination therapies.
Causes and Risk Factors
- The primary cause of plantar warts is the human papillomavirus (HPV)
- Risk factors include walking barefoot, sharing personal care items, and having a weakened immune system
Treatment Options
- Salicylic acid (15-40%) topical paints or ointments are a common treatment for plantar warts, with cure rates lower at this site due to the thicker cornified layer 1
- Cryotherapy is another effective treatment, with a clearance rate of 86% reported in a retrospective analysis of cases treated with both cryotherapy and salicylic acid (SA) 1
- Combination therapies, such as cryotherapy and SA, can be more effective than standard regimens, but may have worse side-effects 1
- Other treatments, such as dithranol, 5-FU, formaldehyde, glutaraldehyde, hyperthermia, laser, PDT, podophyllotoxin, and topical immunotherapy, may also be used, but the evidence for their effectiveness is limited 1
- 5-Fluorouracil (5-FU) has been used to treat plantar warts, with a clearance rate of 95% reported in one study 1
- Surgical interventions, such as curettage, cautery, and CO2 laser, may be used, but the evidence for their effectiveness is limited 1
- Formaldehyde soaks have been used to treat plantar warts, with a cure rate of 80% reported in an open study of 646 children 1
Recommendations
- Paring should be used to remove excess skin from warts before treatment, but care should be taken to avoid damaging surrounding skin 1
- Cryotherapy should be used fortnightly for 3-4 months, with a gentle freeze for young children 1
- Salicylic acid should be used at a concentration of 15-40% for plantar warts, with application prior to pulsed-dye laser (PDL) therapy appearing to decrease the number of laser treatments needed 1
From the Research
Causes of Plantar Warts
- Plantar warts are caused by the human papillomavirus (HPV) 2
- HPV is ubiquitous in the environment, and asymptomatic infection occurs frequently, with most infections controlled or cleared by cellular and humoral immune responses 2
- Certain populations have been observed to manifest plantar warts at higher rates compared with the general population, placing them at increased risk for wart-induced pain and complications 2
Treatment Options for Plantar Warts
- Monochloroacetic acid (MCA) is an effective alternative to cryotherapy for common and plantar warts, with comparable effectiveness and less treatment pain 3
- Topical treatments such as zinc and nitric complex, cantharidin, and bleomycin have been shown to be effective in treating plantar warts, with varying levels of pain and patient satisfaction 4
- A nitric-zinc complex solution has been shown to be an effective treatment for plantar warts, with a cure rate of 59.2% and an average of 5.9 applications required 5
- Other treatment options include cryotherapy, salicylic acid, cantharidin-podophyllin-salicylic acid formulation, laser, topical antivirals, intralesional bleomycin, and intralesional immunotherapy, with varying levels of effectiveness and evidence 6
Considerations for Treatment
- The choice of treatment should be personalized according to the patient's needs and preferences, taking into account factors such as pain tolerance and treatment burden 3, 4
- The effectiveness of different treatments can vary depending on the individual patient and the specific characteristics of the plantar wart 4, 6
- Further research is needed to evaluate the effectiveness of different treatments and to establish evidence-based guidelines for the management of plantar warts 6