Overview
What is a verruca?
verruca is a firm, raised skin lesion resulting from HPV infection. Pressure from standing or walking often flattens the growth, creating a thickened patch of skin. Small black dots may appear on the surface, representing tiny clotted blood vessels. While mostly asymptomatic, verrucae can be painful when located on weight-bearing areas of the foot. Multiple verrucae may coalesce, forming mosaic warts, which can cause significant discomfort.
Verrucae are highly contagious and can be spread via direct contact with infected skin or through contaminated surfaces, such as swimming pools, showers, and gym floors.
Symptoms and Causes
Signs and symptoms
Verrucae typically present with the following characteristics:
- Roughened, raised patches of skin on the sole, toes, or edges of the foot.
- Small black spots, often called seed warts, representing clotted capillaries.
- Pain or tenderness when pressure is applied, particularly during walking or running.
- Thickened, callus-like skin over the wart.
- Multiple lesions may cluster together, forming mosaic verrucae.
Causes of verrucas
Verrucae are caused by infection with HPV, which enters the skin through tiny cuts, abrasions, or softened skin. Factors increasing the risk include:
- Communal wet areas: Walking barefoot in swimming pools, showers, or changing rooms.
- Skin trauma: Cracks, cuts, or macerated skin provide entry points for the virus.
- Pressure and friction: Frequent walking or standing on the same spot can trigger wart formation.
- Immune status: Children and those with weakened immune systems are more susceptible.
- Environmental exposure: HPV can survive on damp surfaces for extended periods, making infection more likely in public areas.
Diagnosis and Tests
A healthcare professional can usually diagnose a verruca through a visual skin examination. Key factors considered include the location of the lesion, especially on weight-bearing areas of the foot, the presence of black dots or seed-like spots within the wart, and any surrounding skin thickening or callus formation.
In most cases, no further testing is required, though a dermatologist may perform additional assessments if the diagnosis is uncertain or if the verruca is resistant to treatment.
Additional assessments
n certain situations, further evaluation may be required:
- Dermatoscopy: Uses a magnifying tool to view the lesion in detail, identifying typical vascular patterns.
- Podiatrist or dermatologist referral: For atypical or resistant verrucae that do not respond to standard treatment.
- Skin biopsy: Rarely necessary, used to rule out other growths such as corns, calluses, or malignant lesions.
Management and Treatment
Many verrucas resolve spontaneously over months or even years, particularly in children. Treatment is usually considered if the verruca:
- Causes significant pain or discomfort.
- Interferes with walking or daily activities.
- Persists despite self-care.
- Spreads or appears in multiple areas.
Treatment options
Home and over-the-counter treatments:
- Salicylic acid preparations: Applied daily after soaking and gentle filing, gradually dissolving the wart.
- Duct tape occlusion therapy: Covered for several days to promote peeling and immune response.
- Protection and hygiene: Wearing footwear in communal areas and keeping feet clean and dry.
Professional treatments:
- Cryotherapy: Freezing the wart with liquid nitrogen, often requiring multiple sessions.
- Laser therapy: Focused light destroys wart tissue, used for stubborn or recurrent lesions.
- Microwave therapy or needling: Stimulates immune response and accelerates clearance.
- Surgical removal: Reserved for rare, resistant cases or large mosaic warts.
Aftercare
Keep the affected area clean, dry, and protected from friction, avoid picking or scratching to prevent infection or spread, and follow your clinician’s guidance for dressings and activity modifications.
Outlook/Prognosis
Verrucae generally have an excellent outlook. In children, most verrucae resolve naturally within six to twelve months, while adults may require longer periods or professional treatment, sometimes up to two years. Recurrence is possible but uncommon when proper foot care, hygiene, and treatment are maintained. Complications are rare, though persistent pain, secondary infections, or interference with mobility can occasionally occur.
Prevention
Preventing verrucae involves reducing exposure and protecting the skin:
- Wear protective footwear in communal wet areas.
- Avoid sharing towels, socks, shoes, or foot care tools.
- Keep feet clean, dry, and thoroughly dried after washing.
- Cover existing verrucae with waterproof dressings when swimming.
- Treat cuts, cracks, or macerated skin promptly.
- Maintain general immune health through a balanced diet, exercise, and adequate sleep.
