Verrucas

Warts are localised thickenings of the skin, and the term ‘plantar wart’ is used for those that occur on the soles of the feet (the ‘plantar’ surface). They are also known as verrucas. Chiropodist at Whelehans James Pedley is holding a Cryotherapy Clinic at Whelehans Pharmacy on Saturday May 30^th and will treat warts and verrucas. He will have a monthly cryotherapy clinic from then on the last Saturday of every month.

What causes verrucas?
Verrucas are a form of infection with a virus called the ‘human papilloma virus’ (HPV virus for short). Infection of the cells of the outermost layer of the skin (the epidermis) with this virus results in this top layer of skin growing and thickening, creating the non-cancerous skin growth that is a wart.

Plantar warts are caught by contact with virally-infected skin scales. These are usually encountered on such surfaces as the floors of public locker rooms, shower cubicles and the tiled areas around swimming pools. However, the virus is not highly contagious, and it is unclear why some people catch plantar warts while others do not. The virus enters the skin through tiny breaks in the skin surface. Moistness and maceration (softening of the skin due to moisture) on the feet make infection with the wart virus easier. People with weak immune systems are more likely to get warts. This is because the body is less able to fight off the HPV virus.

Symptoms of verrucas
Some plantar warts are uncomfortable, particularly if they are on a weight-bearing area (eg. sole of foot) when it may feel like having a stone in your shoe.

What do verrucas look like?
Plantar warts can occur anywhere on the soles and toes, and they often involve the weight-bearing areas. They vary in size from just a few millimetres to more than one centimetre. Each has a rough surface that protrudes slightly from the skin surface, surrounded by a horny collar. Close inspection of a plantar wart may reveal small black dots (which are blocked blood vessels).  An individual may have one or many verrucas, sometimes associated with warts elsewhere on the body.

Diagnosis of verrucas
Usually this is easy, and based simply on the appearance. However, sometimes it may be hard to tell a plantar wart from a corn. One helpful point is that plantar warts interrupt the fine skin ridges on the sole, whereas corns do not. Your Chiropodist may need to pare down the area to be certain of the diagnosis; he/she will be looking for the small black dots which confirm the diagnosis of a viral wart. No other investigations are needed.

Can verrucas be cured?
Yes, but no single treatment can be guaranteed to be effective in every case.  The highest cure rates are in young people who have not had their warts for very long. However, most verrucas will go away by themselves in due course, so it is very reasonable to leave them alone if they are not causing trouble.

Some of the more commonly used treatments
Over the counter treatments. A variety of creams, gels, paints and medicated plasters are available from pharmacies. Most of these contain chemicals such as salicylic acid or formaldehyde as their active ingredient and can take up to 3 months of continuous treatment to get rid of warts (eg) Duofilm^®, Salactol^®. Diabetics and people which poor circulation and peripheral nerve problems should not use these products without consulting a health professional as they can cause skin irritation in vulnerable patients.

Cryotherapy. I wrote about cryotherapy in this Health Blog before; ask in Whelehans for patient information leaflet on cryotherapy. Cryotherapy involves freezing the warts with liquid nitrogen, using either a cotton wool bud or a spray; your Chiropodist can do this. If the wart is particularly thick, he/she may pare it down before freezing it. Cryotherapy is, ideally, repeated every two to four weeks until the verruca disappears. It can be slightly painful and may lead to blistering afterwards, and so it may not be suggested by your Chiropodist for small children.

Removal under a local anaesthetic. If verrucas do not clear with the treatments described above, removal under a local anaesthetic may be considered; your Chiropodist will advise you and may refer you to see a consultant. The usual technique is to scrape the plantar wart away using a sharpened spoon-like instrument (a curette), and then to cauterize the remaining raw area. However, all surgical procedures leave scars and these may be painful on the sole. Furthermore, the wart may recur.

What can I do?
If you have a verruca:

·         Speak to your pharmacist or chiropodist.

·         Never try to cut it out or burn it off yourself.

·         Wear comfortable shoes that do not press on it.

·         Do not share shoes or socks with anyone else.

·         Special pads to relieve pressure on plantar warts can be bought at a pharmacy.

·         Keep your feet clean and dry, and change socks daily.

·         Do not go barefoot in public places. Plantar warts should be covered with waterproof plasters or rubber ‘verruca socks’ if you go swimming.

·         Do not pick at your verrucas.

·         Sanding with sand paper or emery board will also have living wart virus on it, and so do not use it for any other purpose, or you may spread the virus. Take care not to damage the surrounding skin, as doing so might result in the warts spreading.

·         If you have children, check their feet periodically for viral warts.

 Whelehans Cryotherapy Clinic this Saturday May 30^th

Whelehans Cryotherapy Clinic takes place in our private treatment room this Saturday May 30th from 9am. An appointment takes approximately 20 minutes. Cost is €45 euro for first treatment (this includes assessment) and then €35 for follow up treatments should you need them. Our Chiropodist James can treat adults and children. James can treat warts on your hand and verrucae on your feet. Follow up clinic will be last Saturday of each month. There are no discounts for medical card, children or old age pensioners.

Chiropodist James Pedley has a twice weekly chiropody clinic on Tuesdays and Thursdays with reduced rates on Tuesdays for over 60s. Call 04493 34591 to book a chiropody appointment.

Disclaimer: Information in this article is general; consult with your healthcare professional before making any changes recommended.

This article is shortened. For more detailed information, logon to www.whelehans.ie or contact Whelehans at 044 93 34591 or info@whelehans.ie and we will forward you a more detailed copy for free

What is cryotherapy?

The term ‘cryotherapy’ literally means ‘treatment using low temperature’, and refers to the removal of some skin lesions by freezing them. This can include the removal of warts and verrucae. The most common product used by the Chiropodist is liquid nitrogen. Chiropodist at Whelehans James Pedley is holding a Cryotherapy Clinic at Whelehans Pharmacy on Saturday May 30^th and will treat warts and verrucae. James provided me with the information for this article and we reference the British association of Dermatologists.

What is liquid nitrogen?
Liquid nitrogen is the liquid state of gaseous nitrogen, which occupies 78% of the air we breathe. Liquid nitrogen is extremely cold, boiling at minus 196°c. It is necessary to store and transport it in special flasks.

What conditions can be treated with cryotherapy?
A wide variety of superficial benign (non-cancerous) lesions can be treated with cryotherapy.

What does the procedure involve?
Cryotherapy is done during the course of a consultation with your Chiropodist, without any special preparation. Liquid nitrogen is usually applied to the skin by using a spray gun or a metal probe. A cotton bud can sometimes be used instead.

Although there is slight local pain felt, cryotherapy does not normally require a local anaesthetic, and the procedure itself lasts a matter of seconds; the precise time depending on the thickness and size of the lesion. The frozen skin becomes white and takes one to two minutes to thaw to normal skin temperature. Your Chiropodist may suggest that the process is repeated once the skin has thawed out.

Over the following days, a scab will form, and this will take one to two weeks (and occasionally a little longer, especially on the legs) to fall off. Usually, the treated area will eventually look normal, although slight scarring and discolouration is possible, particularly on the legs. Depending on the type and size of the wart or verruca, more than one treatment may be necessary, and this is usually repeated at regular intervals.

How should the treated area be cared for?
Your Chiropodist will explain how s/he would like you to care for the treated areas. It is important not to pick at the scab as this will encourage scarring. A dressing or plaster is not usually necessary, but may be advisable if the treated area is likely to be knocked or rubbed by clothing.

What are the side effects of this treatment?
Immediate side effects:
Pain - cryotherapy is usually well-tolerated, but can sometimes cause slight pain if a deep freeze has been used. This discomfort can occur both at the time of treatment and for a variable time thereafter. Painkillers (such as paracetamol) taken for the first 24 hours may relieve that discomfort; also taking a painkiller an hour or so prior to anticipated treatment can reduce the discomfort.

Swelling and redness - this is a normal immediate response to freezing the skin, and usually settles after two to three days. For a short while the treated area may ooze a little watery fluid.

Blistering - this is also a common consequence of cryotherapy and blisters settle after a few days as the scab forms. Some people blister more easily than others and the development of blisters does not necessarily mean that the skin has been frozen too much. Occasionally the blisters may become filled with blood; this is harmless and only if a blister was very uncomfortable would it be necessary to puncture it, using a sterile needle. It is best not to puncture it yourself.

Infection - uncommonly, infection can occur, resulting in increased pain and the formation of pus: this may require topical antiseptic or antibiotic therapy.

Subsequent side effects:
Scarring - rarely, a slight scar will form, especially if a deep freeze has been used.

Pigmentation changes - the skin at and around the treatment site may lighten or darken in colour slightly, especially in dark skinned patients.

Treatment may not be effective with all patients or the condition may recur if the infection is reintroduced by recurrent cross infection. Your Chiropodist will advise you at the time of treatment. 

 More about warts and verruca

Warts are flesh coloured areas of raised, rough and hardened skin. They are caused by a virus called the human papilloma virus. The virus causes a tough shell of abnormal skin cells to be produced as it replicates. A wart on the sole of the foot is called a verruca. Genital warts are sexually transmitted warts found on the genitals and around the rectum. Warts are usually harmless, but they can look unattractive. They often clear up by themselves, although treatment can help to get rid of them more quickly. Warts are not normally painful, although verrucae can sometimes hurt.

Whelehans Cryotherapy Clinic on Saturday May 30^th

Whelehans Cryotherapy Clinic takes place in our private treatment room on Saturday May 30th from 9am. An appointment takes approximately 20 minutes. Cost is €45 euro for first treatment (this includes assessment) and then €35 for follow up treatments should you need them. Our Chiropodist James can treat adults and children. James can treat warts on your hand and verrucae on your feet. Follow up clinic will be last Saturday of each month. There are no discounts for medical card, children or old age pensioners.

Chiropody Clinic at Whelehans

A chiropodist assesses diagnoses and treats diseases and abnormalities of the feet and lower limbs. A chiropodist can significantly improve a person’s quality of life by alleviating painful symptoms and promoting and maintaining mobility. Whelehan’s pharmacy has chiropodist James Pedley in store in our private treatment room every Tuesday and Thursday with a reduced rate of €25 for over 60’s on Tuesdays. You can make an appointment in store or by phoning us at 04493 34591.

Thanks to Chiropodist at Whelehans James Pedley for his help with this article. Call 04493 34591 to book a chiropody appointment.