Use Locally - Issue 83 March 2020
Top Tips for Verruca Treatment Gruesome, miserable, nasty, painful – common words used when people describe their verruca. A verruca is a wart which LV JURZLQJ RQ \RXU IRRW ° RIžFLDOO\ termed a ‘plantar wart’ – and it’s caused by the Human Papilloma Virus (HPV). The HPV virus lives happily for ORQJ SHULRGV RQ GDPS ÂżRRUV VXFK as those around swimming pools or communal showers. The virus enters the skin and then travels into the deeper layers. It causes keratinisation – keratin is the hard protein in hair, skin and nails – which is why warts feel hard to the touch. Although 80% of verrucas regress spontaneously over two years, they can be persistent and resist treatment. The virus is adept at escaping detection by your body’s immune system. Diagnosis A verruca is a single, slightly raised patch anywhere on the sole of the foot. The skin may be pale, yellowy/skin-coloured or have a cobblestoned appearance, sometimes with some central black dots. Verrucas are sometimes painful when pressure is applied, for example when you walk or if you VTXHH]H WKHP EHWZHHQ žQJHU DQG thumb. 32
Management without treatment 7KH žUVW VWHS LV WR WDNH JRRG care of your foot/feet so that you minimise pain and avoid spreading the virus, both on your own feet and to others. The British Association of Dermatologists has a useful guide available at tiny. cc/foot-care. If you’re generally healthy and not in pain, it’s worth doing nothing as most veruccas will disappear spontaneously. However, you should seek medical help if you have diabetes or a weakened immune system e.g. HIV infection, chemotherapy, radiotherapy etc. Active treatments If you decide that your verucca can’t just be left to recover by itself, there are forty-one recognised wart treatments. First Choice Treatment: Salicylic Acid (SA) SA kills off the outer skin layers, causing them to peel away. It also helps the immune system detect the virus. SA has proven to be more effective for veruccas than a placebo (dummy) treatment (Cochrane Review 2012) e.g. in one study, 49% of verrucas had disappeared after treatment with SA compared to 23% using a placebo.
Second Choice Treatments These are not routinely offered on the NHS. • Cryotherapy: a liquid nitrogen spray freezes and destroys infected skin cells. Clearance rates of around 65% are reported. It’s sometimes painful, and there’s also a 30% chance of recurrence. The Cochrane 2012 review concluded that cryotherapy was no better than SA at treating verrucas, was painful, and caused blistering and scarring. • Other local options: many other agents have been used such as silver nitrate, Cantharidin, phenol, glycolic acid, pyruvic acid and trichloroacetic acid (TCA). • Surgical removal: surgery is not usually advised because verrucas often recur afterwards. • SWIFT is a new microwave treatment for the verruca. It’s quick, relatively painless and seems to be effective on stubborn verrucas. See www. treatwithswift.com. • Laser therapy aims to destroy the blood vessels supplying the verruca, plus the heat causes local tissue damage. 80% clearance rates have been reported. • Immunotherapy: various treatments claim to stimulate the antibody response to speed up viral destruction. Where to Obtain Verruca Treatments From 1st April 2019, the NHS has listed verrucas as one of the seventeen treatments it will no longer provide, so these are the options other than your GP. • Visit your local Community Pharmacy • Find a Podiatrist: cop.org. XN žQG D SRGLDWULVW • Find a Chiropodist: iocp.org.uk • Private Consultant Dermatologist: www.bupa. co.uk/health/payg/dermatology References available on request By Dr Daisy Mae
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