ACORN Article

February 2000

I owe this article to my son's unfortunate sinus infection. Christopher is almost 8 and for the last three weeks he has had a headache due to a sinus infection. It is keeping us home this weekend from the YMCA Snow Camp trip in the local mountains. He is certainly on the mend but we sure missed a lot of snow. I told him we would make it up in a few weeks, as long as the snow holds out. That looks like a safe bet.

Today I am writing about warts. They are probably as ancient a condition as any but finally, maybe, there is a new treatment for them. Recently on the market is the first medication in a new class of medications called immune response modifiers. These products modify the body's ability to deal with infections.

An infectious virus causes warts. It apparently gets into the skin through small, and often unnoticed, cut or abrasion. The virus causes a growth of skin that can be mistaken for calluses, corns, splinters or a host of other conditions. It sometimes takes a skilled eye to tell a wart from other conditions. If you have a wart you are probably leaving a little trail of wart particles on the floor as you walk. When others step on them they can also develop warts. This is why, if you have warts and like to walk barefoot, you should carry a supply of my business cards around with you.

There are more than 55 different types of wart virus. Some prefer the skin of hands, some feet and some the genital regions. While any wart type can by found anywhere, they tend to be found in their particular favor sites. There are at least five types that love the bottom of the feet. In medical-speak the bottom of the foot is called the plantar surface, so warts found here are called plantar warts.

There are many ways to treat warts: acid pastes, surgery, electrical burning, freezing, laser and many others I can't think of. Which is best? There is an axiom in medicine that goes: if there are many ways to treat something then none of them must be very good. Obviously if one were particularly superior, it would be the only therapy.

My favorite treatments are surgical and the hot water therapy. Surgery involves removing the wart from the skin after first putting the area to sleep with a little Xylocaine, a local anesthetic. The procedure leaves a little hole in the skin that fill in over a few days. The surgical option is best done for a half-dozen warts or fewer. It is done in the office and rarely results in more than an annoying amount of discomfort.

My method for treating multiple or very large warts is more complicated. Since plantar warts are usually sensitive to heat, I ask patients to soak their feet in 105° to 109° Fahrenheit for 15 minutes. After the soak I ask them to apply a drop of an over-the-counter art medicine and take oral Vitamin A. Trimming the wart every week or two seems to speed the process.

Occasionally there is a particularly difficult wart: a wart that recurs after surgical removal or resists the hot water treatment. Quite possibly the pharmaceutical division of the 3M company (who knew they had one) will come to the rescue. They recently introduced the first of a whole new class of drugs: immune response modulators. Aldara, as it is called, is rubbed on the skin surrounding the wart. The compound works by stimulating the white blood cells to attack the same wart that they were just ignoring. This medicine is currently FDA approved only for genital warts, but there is no reason, the company tells me, that it should not work on plantar warts as well. They are currently sponsoring research on plantar warts and the early results are quite promising. With their blessing I have started using it on some of my more difficult plantar warts and it seems to be working.

Imagine that, a new medication for plantar warts. It is nice to know that there are companies out there that care about your sole.