Dr. Jacqueline Gerhart: Treat Warts, But Don't Worry
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I have these dots on the bottoms of my feet that look rough like callouses, but they actually go into the soles of my feet. It's like I stepped on tiny pebbles and they made small holes in my skin. Sometimes they hurt when I walk; otherwise, they just stay there. Do I need to be concerned?
Dear Reader: Based on your description - without seeing your feet or having a skin sample - it seems you may have plantar warts. "Plantar" is from the Latin word "planta," which means sole of foot.
Warts, or verrucae as we call them in medical literature, were first described prior to 900 A.D. There are multiple types of warts and they are defined based on where they are on the body. Plantar warts are on the soles of the feet, genital warts are in the groin area and common warts are on other areas of skin including hands, arms, legs and face.
Warts are contagious. They are transmitted by a virus called HPV, which stands for Human Papilloma Virus. This virus can be spread by shaking the hand of someone with warts; however, the transmission is most likely if you have a break or cut in your skin.
Often times, warts are "bumps" that can be skin-colored or a variation from white to brown/black. People describe them as looking like "cauliflower." If you look really closely, warts are actually made of multiple smaller bumps or growths. These growths are caused by the virus infecting normal skin cells and causing them to replicate abnormally.
Warts sometimes have small black dots in them. These are actually abnormal blood vessels that have been disrupted by the virus. In your case, you do not describe a "bump" or "cauliflower" appearance but rather "small holes." It is common for people with plantar warts not to have large bumps, but rather to have small holes or depressions in their feet. This is because we create pressure when walking, forcing the wart to grow into our feet rather than outward.
Because warts are caused by a virus, why don't they just go away in a few of days, like the virus that causes the common cold?
Well, unfortunately, the virus grows deep into the skin cells and destroys them. So we must get rid of those skin cells, or let them fall off, in order to get rid of the wart. Therefore, most treatments focus on removing these skin cells.
One common over-the-counter treatment is salicylic acid, which is what is in the product Compound W, for example. This allows for increased sloughing of the skin at a faster rate. Your doctor also may recommend freezing the wart, called cryotherapy, which is performed in a primary-care clinic or at a dermatology office using liquid nitrogen.
In some cases, the wart may need to be cut out, burned off or subjected to laser treatment. Regardless of treatment type, warts may need multiple rounds of treatment before they are eliminated.
Without treatment, some warts go away in months to years, but some warts will never go away on their own. So, if your symptoms have not improved over time, I suggest getting help.
As with any skin finding, it's always best to have your health care professional see it in person. Usually, going to your primary-care physician is a great place to start.
If he or she does diagnose plantar warts, you shouldn't be worried. Plantar warts do not lead to cancer or other concerning diagnoses. Thanks for the question, and good luck.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 08/14/2012