Plantar Warts




Patient Story



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A 15-year-old boy presents with painful growths on his right heel for approximately 6 months (Figure 119-1). It is painful to walk on and he would like it treated. He was diagnosed with multiple large plantar warts called mosaic warts. The lesions were treated with gentle paring with a #15 blade scalpel and liquid nitrogen therapy over a number of sessions. He and his mom were instructed on how to use salicylic acid plasters on the remaining warts.




FIGURE 119-1


Plantar warts. Note small black dots in the warts that represent thrombosed vessels. Large plantar warts such as these are called mosaic warts. (Used with permission from Richard P. Usatine, MD.)






Introduction



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Plantar warts (verruca plantaris) are human papilloma virus (HPV) lesions that occur on the soles of the feet (Figures 119-1 to 119-5) and palms of the hands (Figure 119-6).




FIGURE 119-2


Close-up of plantar wart on the side of the heel. Note the disruption of skin lines and black dots. (Used with permission from Richard P. Usatine, MD.)






FIGURE 119-3


Close-up of a plantar wart demonstrating disruption of normal skin lines. Corns and callus do not disrupt normal skin lines. The black dots are thrombosed vessels, which are frequently seen in plantar warts. (Used with permission from Richard P. Usatine, MD.)






FIGURE 119-4


A mosaic wart is formed when several plantar warts become confluent. (Used with permission from Richard P. Usatine, MD.)






FIGURE 119-5


Multiple plantar warts on the ball of the foot and toes. The thrombosed vessels within the warts appear as black dots. (Used with permission from Richard P. Usatine, MD.)






FIGURE 119-6


Multiple plantar warts on the palms of an HIV-positive young man. (Used with permission from Richard P. Usatine, MD.)






Synonyms



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Palmoplantar warts, myrmecia.




Epidemiology



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  • Plantar warts affect mostly adolescents and young adults, affecting up to 10 percent of people in these age groups.1



  • Prevalence studies demonstrate a wide range of values, from 0.84 percent in the US2 to 3.3 to 4.7 percent in the United Kingdom,3 to 24 percent in 16- to 18-year-olds in Australia.4





Etiology and Pathophysiology



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  • Plantar warts are caused by HPV.



  • They usually occur at points of maximum pressure, such as on the heels (Figures 119-1 to 119-4) or over the heads of the metatarsal bones (Figure 119-5 and 119-6), but may appear anywhere on the plantar surface including the tips of the fingers (Figure 119-7).



  • A thick, painful callus forms in response to the pressure that is induced as the size of the lesion increases. Even a minor wart can cause a lot of pain.



  • A cluster of many warts that appear to fuse is referred to as a mosaic wart (Figures 119-1 and 119-4).





FIGURE 119-7


Close-up of plantar wart on a finger that also shows disruption of skin lines and black dots. (Used with permission from Richard P. Usatine, MD.)

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Dec 31, 2018 | Posted by in PEDIATRICS | Comments Off on Plantar Warts

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