Breeann and Jessica are sisters in name only. Jessica is older and is very athletic.
She is one of those teenagers who is always on the soccer or softball fields. As an
athlete she is used to a little pain now and then. When she has an injury or a problem she
wants it taken as soon as her busy schedule would allow. Breeann is her younger sister and
definitely not into sports. Breeann is also not into pain. She will do almost anything, as
a matter of fact, to avoid anything painful, including athletics. With two sisters so
different it is no wonder that when they recently developed plantar warts they developed
two distinctly different types.
Viruses cause warts. There are more than 50 different types of wart viruses. Usually a
patient gets infected with a single type. Some wart viruses like the hands, some the skin
of the face, some the genital area and four or five types love the bottom of the feet.
The wart virus enters the skin through a small, imperceptible crack in the skin. The
virus works its way down to the living layer of skin cells and attaches to one of the
cells. Then a mysterious thing happens. The wart virus, like all viruses, injects its DNA
or RNA into a living cell. The invading DNA or RNA takes over the reproductive machinery
of the cell. The cell, in this case a skin cell, tries to reproduce itself. Instead of
dividing into two new cells, it can only make new viruses. When the cell is chock full of
new viruses it ruptures, freeing the newly minted virus particles that go on to invade
neighboring cells. The cycle continues until there are millions of skin cells with wart
virus. At this point the lump of cells is visible to the eye as a wart. The whole process
is akin to a microscopic science fiction movie.
Back to our sisters. Jessica had one very large wart lesion under her heel. It is about
a third of an inch in diameter and nearly as deep. It hurt when she walked, let alone
played goalie. Her pediatrician tried a couple of times to freeze it with liquid nitrogen.
Liquid nitrogen treatments are painful and with thick warts fail more often than they
succeed. Because of this wart’s thickness, topical acids are also bound to fail. The
quickest and surest way to get rid of such a lesion is to gently remove it. The wart is
simply scooped out after first preparing the area with local anesthesia. The local
anesthesia hurts for a few seconds and then there is no more pain. What is left is a void
that will fill in with regular skin in a week or two. Done properly the wart comes out as
a single, firm mass and the deep layer of the skin is left completely intact. Only if the
deep layer is accidentally penetrated during removal can there be a painful scar. Make
sure your doctor has plenty of experience in removing plantar warts before he or she
attempts this. Jessica’s wart was removed in this very manner and it went well. She
gritted her teeth and uttered nary a word. I expect her to be back on the soccer field in
a little over a week.
Breeann probably is infected with a different type of wart virus. She has multiple,
thin warts scattered all over the bottom of her toes and the ball of her foot. Thin warts
frequently respond to topical treatment with one of the many acid preparations available
at the pharmacy. The trick to making it work is soaking the feet in hot water prior to the
application of the acid. I recommend 15 minutes in water between 105°
-109° F. This temperature is slightly warmer than hot tub
temperature and should be monitored by a hot tub thermometer available at any pool store.
The soaking is followed by the application of a drop of the acid onto each wart. After
allowing it to dry, a second drop is applied. I also suggest supplementing the diet with
extra vitamin A. As the days go by here is an accumulation of debris on top of the warts.
Every week the warts should have the top layers of this debris shaved off. I do this in
the office with a scalpel blade. I know some doctors give parents a disposable scalpel
blade, but I think this is a bit risky. The shaving should be done down to the level where
there is painless, pinpoint bleeding from the little blood vessels that grow in the
warts. I stress to patients like Breeann that this method looks like it should hurt but it
is, indeed, painless. After the first session their confidence is restored. With this
method the warts can be eliminated in as few as three weeks, but they can often take
longer. While Breeann has a different wart, a different temperament and a different
treatment, I expect that she will soon share a trait with her sister…being a former
wart patient.
