Verruca plantaris B07

Warts on the soles of the feet, localized infectious disease caused by human papilloma viruses (HPV), with painful growth directed into the depth (development to the depth occurs because a "normal" exophytic growth is not possible due to the constant pressure load during walking). In short, a plantar wart could be described as an "indented" vulgar wart, which becomes painfully noticeable when walking, like a thumbtack placed there.

Human papillomavirus types 1,2,4,27 (57,60,63,65); see also Papillomaviruses, human.

In patients infected with human immunodeficiency virus, several strains of human papillomavirus have been associated with clinical manifestations of plantar warts (Dardet JP et al. 2020). More recent studies show an increased incidence of HPV-27 and -57 in this clientele. Less common is the detection of atypical HPV types such as HPV-66 and HPV-69 in plantar lesions (Dardet JP et al. 2020).

Preferred in children < 12 years; up to 20% of 12-year-olds are affected, in 20-year-olds only 2-3%. Transmission occurs through contact with virus particles in swimming pools, community showers or gymnasiums. In moisture and heat, infected keratinocytes are released by virus carriers and virus material can then penetrate the skin of the sole of the foot.

soles

Solitary, but mostly multiple, crater-shaped, 0.2-0.5 cm large horny lesions, also aggregated into 4-7 cm large, extensive patches with a lip-shaped rim due to raised normal epithelium. Whitish scaling, in larger beds also gray-yellow to gray-brown surface, pain on exertion. Initial changes can be recognized with magnification by the interruption of the normal inguinal relief (see illustration). Pinhead-sized dot hemorrhages are often visible in the lesions.

Mosaic warts are warts on the soles of the feet that are confluent to form flat wart beds.

In permanently immunosuppressed patients, unusually extensive, absolutely therapy-resistant wart beds can develop, so that immunodeficiency (e.g. HIV infection) can be suspected based on the severity alone (Dardet JP et al. 2020).

S.u. Wart

1. Dardet JP et al. (2020) Plantar Verrucae in Human Immunodeficiency Virus Infection: 25 Years of Research of a Viral Coinfection. Clin Podiatr Med Surg 37:317-325.

2. Grussendorf-Conen EL (1992) Age-dependent therapeutic response of plantar warts. Dermatology 43: 458

3. King CM et al. (2014) Human papillomavirus types 2, 27, and 57 Identified in plantar verrucae from HIV-positive and HIV-negative individuals. J Am Podiatr Med Assoc 104:141-146Serour F et al. (2003) Successful treatment of recalcitrant warts in pediatric patients with carbon dioxide laser. Eur J Pediatr Surg 13: 219-223
4. Smith EA et al. (2015) Evaluating the success of Nd: YAG laser ablation in the treatment of recalcitrant verruca plantaris and a cautionary noteabout local anaesthesia on the plantar aspect of the foot. J Eur Acad Dermatol Venereol 29:463-467
5. Wollina U et al. (2001) Treatment of common warts and actinic keratoses by Er:YAG laser. J Cutan Laser Ther 3: 63-66
6. Zamiri M, Gupta G (2003) Plantar warts treated with an immune response modifier: a report of two cases. Clin Exp Dermatol 28(Suppl1): 45-47