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Suggest treatment for plantar warts

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Posted on Thu, 12 Nov 2015
Question: Hi Doctor

I am reaching out for second consultation for my wife wart issue.

In Febuary 2015 we noticed what appears to be corn in her foot, we reached out to health care magic (https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=171333) for consultation. It was advised to use Salicylic acid 17% and then we had follow-up consultation again in March 1, 2015 as salicylic acid exaggerated the pain and swelling (https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=173166) and again on March 2 (https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=173326)

On march 11 we travelled to USA and even after application of dr Scholl corn remover we were not getting relief so we visited Podiatric here in US (picture attached April_Foot.jpg) and it was diagnosed that she has wart in her foot, After few visit and local application of medicine like Aldara, not much relief was there, Podiatric advised us to get wart removed using Electrocautery. We got wart removed and skin almost healed with only minor point on skin remaining (picture attached Aug_Foot.jpg). We even travelled to XXXXXXX in August without any much problem.

On return from XXXXXXX we again start noticing two black dots around the same region with some pain where there was original wart, Podiatric diagnosed it as scar and prescribed DermacinRx medicine (Triamcinolone Acetonide Cream 0.1% and separate Dimethocone 5.0% cream). After application of medicine for over month we noticed that initially it improved but later we started having pain and those two dots have become yellow and now pain is there if we press or some objects hit the area where have dots.

We visited Podiatric again today and he after scrapping the area diagnosed it with wart and this time there are two of them (picture attached - Oct_Foot_1.jpg and Oct_Foot_2). He advised us to undergo surgery where he would cut and take the wart out. As per discussion with him, he said we have used salicylic acid, dr scholl remover, aldara medicine, electric removal and finally DermacinRx medicine. This wart is very persistent and came back, so best option would be to surgically remove it. He is not prescribing again Electrocautery as that may leave thick scar which would be painful if it comes.

Based on the history and details provided, please advice us what we should do? If there is some other better option for us please advice?

We have few options here,

1. Wait for 2-3 months and then on return to XXXXXXX we get it treated. In this case do we have risk of this wart spreading internally and getting worse or creating complication?
2. Get surgery done in USA for Podiatric to cut and remove the wart. As per Podiatric re-occurrence change is rare but since virus is in blood it can happen again with any treatment. This would required at least 3 week to heal. What are the complications which can arise or precaution we need to take for this option?
3. Podiatric also mentioned that his colleague is using some other technique which involves putting injection where the wart is for treatment, He would discuss my wife case with his colleague and based on his experience would advice whether that would be advisable in our case? Is this procedure recommended?

Please let me know if you would want additional details for provide us complete and sound consultation.
In case I need to reach out to some other specialist like General Surgeon, please let me know OR if you want to me to consult some other specialist along with your advice, please do let me know
doctor
Answered by Dr. VINAY KUMAR (30 minutes later)
Brief Answer:
Here are the best options and their pros and cons

Detailed Answer:
Hi

Welcome to the site!
I am Dr V XXXXXXX I am a Sr Consultant Dermatologist of three decade long standing and experience in dealing issues like the one that you currently are facing.

I think that the diagnosis is indeed correct and what we are dealing with are warts, that have re-emerged despite earlier treatments.
Plantar warts are known to recur and are some what tougher to get rid of.

From your details, I understand that you are currently out of the country and obviously have little idea and lesser access to healthcare services which has become a concern

I am concerned about your problem and will share my views on what best is possible.

1 If you wait for now, then that would be a good option. The reason is that warts are only in the skin and there is no element of the same in blood. The risk of infection spreading to other areas by blood is nonexistent.

In the meantime, you may pare (cutting horizontally parallel to the surface)the wart using a surgical blade. Of course, it requires skill which I am sure anyone can acquire easily and after a couple of procedures on do it yourself basis, you should be able to manage the problem. It would be helpful if you use salicylic acid preparation under occlusion for 24-36 hours strictly on top of the wart before attempting to pare so that the tissue is softened. This might be done twice a week

At all times, wear cotton socks to avoid secondary infection. It is mandatory to not permit the right and left socks get interchanged because of risk of spread.

With this, though there is a risk of carrying the infection for long, but still it is better to seek care in the home country where you can possibly attend someone with whom you are more comfortable.

2 Having a surgery performed will mean that three weeks of your tour are nearly cut short due to limitation on mobility. In addition, no one can say for sure that wart will not recur.It might be quite expensive too.

3 I would not favor going for any procedure that is not well established. As far as I presume, here most likely the reference is to some kind of immunomodulator and that again may or may not work.

I hope I have understood your dilemma from your perspective and offered you the best solution but again you are the best judge of your situation. Just to remind you, the warts are viral and they do not spread by way of blood.

I hope this helped.

Our best wishes, always!



Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. VINAY KUMAR (11 hours later)
Thanks Dr XXXXXXX for your advice. I am currently in USA for work and my family has full access to medical facility. We have full medical insurance in USA which provides extensive medical coverage (provided by my employer).

I reached out for second consultation since I was not sure of the analysis as one month back i was told my wife has scar and now once it has gone severe i am being told its a wart again. Since you confirmed the analysis of podiatrist here, so i would assume its the physical appearance which might have led podiatrist to infer it as scar one month back .

I am here in usa for at-least 3-4 months more. so, if surgery is the best way to get rid of wart, then i can get it done. I am also concerned that if my wife carries this wart for another 3-4 month, can it spread to other areas of body or to other family members? (we have 3 year old child with us)

Is there any process which can ensure wart some come up again after surgery or anything which we can do?

Manual pare process, i would want to avoid since i am not in home country and any complication would create problem for us.

Please let us know based on additional details provided what is best for us in our condition
doctor
Answered by Dr. VINAY KUMAR (1 hour later)
Brief Answer:
Feedback was helpful in offering further suggestions

Detailed Answer:
Hi

I welcome you again with the query!
In the light of additional details, it is definitely desirable to have it removed as any infection of this nature can involve other areas on one's own skin or that of another.

It would be good to get it removed completely and then follow up with the surgeon as and when mutually convenient and necessary in the background of your situation.

There is little that one can do to prevent a recurrence except for some basic hygiene and precautions as suggested above.

Once completely removed, there is generally a durable recovery but in medical field, strange things can happen.

I am sure your healthcare provider will ensure that it is completely removed and all will be well thereafter.

Best wishes to both of you for a fast and lasting good health from our team!
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Dr. VINAY KUMAR

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Practicing since :1980

Answered : 480 Questions

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Suggest treatment for plantar warts

Brief Answer: Here are the best options and their pros and cons Detailed Answer: Hi Welcome to the site! I am Dr V XXXXXXX I am a Sr Consultant Dermatologist of three decade long standing and experience in dealing issues like the one that you currently are facing. I think that the diagnosis is indeed correct and what we are dealing with are warts, that have re-emerged despite earlier treatments. Plantar warts are known to recur and are some what tougher to get rid of. From your details, I understand that you are currently out of the country and obviously have little idea and lesser access to healthcare services which has become a concern I am concerned about your problem and will share my views on what best is possible. 1 If you wait for now, then that would be a good option. The reason is that warts are only in the skin and there is no element of the same in blood. The risk of infection spreading to other areas by blood is nonexistent. In the meantime, you may pare (cutting horizontally parallel to the surface)the wart using a surgical blade. Of course, it requires skill which I am sure anyone can acquire easily and after a couple of procedures on do it yourself basis, you should be able to manage the problem. It would be helpful if you use salicylic acid preparation under occlusion for 24-36 hours strictly on top of the wart before attempting to pare so that the tissue is softened. This might be done twice a week At all times, wear cotton socks to avoid secondary infection. It is mandatory to not permit the right and left socks get interchanged because of risk of spread. With this, though there is a risk of carrying the infection for long, but still it is better to seek care in the home country where you can possibly attend someone with whom you are more comfortable. 2 Having a surgery performed will mean that three weeks of your tour are nearly cut short due to limitation on mobility. In addition, no one can say for sure that wart will not recur.It might be quite expensive too. 3 I would not favor going for any procedure that is not well established. As far as I presume, here most likely the reference is to some kind of immunomodulator and that again may or may not work. I hope I have understood your dilemma from your perspective and offered you the best solution but again you are the best judge of your situation. Just to remind you, the warts are viral and they do not spread by way of blood. I hope this helped. Our best wishes, always!