Plantar Warts & Treatments
A plantar wart is a wart caused by the human papillomavirus (HPV) occurring on the sole or toes of the foot. Plantar Warts are harmless and self-limiting, but should be treated to lessen symptoms, which may become painful. They can shed the virus into the skin of your foot before they're treated, prompting new warts to grow as fast as the old ones disappear. Untreated warts can swell to over an inch in circumference. The viral spreading can lead to clusters of warts called mosaic warts.


Plantar warts can be persistent. The best defense is to treat new warts as quickly as possible so that they have little time to spread. They may also become extremely painful. If you have lots of plantar warts, the pain may make it difficult for you to walk or run.

See your doctor if your warts are painful or change in appearance or color. Also see your doctor if warts persist, multiply or recur, despite home treatment, or if warts interfere with your activities. If you have diabetes or a circulatory disorder, don't try to treat any plantar warts at home. See your doctor for advice.

Some treatments that have been found to be effective include:

First-line therapy: Over the counter Salicylic Acid Plaster e.g. Mediplast

Second-line therapy: Cryosurgery is a minimally invasive procedure, and is often preferred to more traditional kinds of surgery because of its minimal pain, scarring, and cost; however, as with any medical treatment, there are risks involved, primarily that of damage to nearby healthy tissue.

Third-line therapy:
For several physicians the next step is a compounded prescription of 5 FU, CIMETIDINE, SALICYLIC ACID, 2 DEOXY D GLUCOSE in Transdermal Base.

Rational for these ingredients

5FU

Topical 5% 5-fluorouracil cream in the treatment of plantar warts: a prospective, randomized, and controlled clinical study.
Salk RS, Grogan KA, Chang TJ.

Northern California Foot and Ankle Center, San Francisco and Santa Rosa, CA, USA. drsalk@yahoo.com

Topical 5-fluorouracil (5-FU) is an antineoplastic antimetabolite that inhibits DNA and RNA synthesis, thereby preventing cell replication and proliferation. This mechanism of action may allow topical 5-FU to be utilized in the treatment of human papilloma virus (HPV). We conducted a study comparing 5% 5-FU cream under tape occlusion versus tape occlusion alone in 40 patients presenting with plantar warts. Nineteen out of 20 patients (95%) randomized to 5% 5-FU with tape occlusion had complete eradication of all plantar warts within 12 weeks of treatment. The average time to cure occurred at 9 weeks of treatment. Three patients (15%) had a recurrence at the 6-month follow-up visit; accordingly, an 85% sustained cure rate was observed. It is concluded that use of topical 5% 5-fluorouracil cream for plantar warts is safe, efficacious, and accepted by the patient.

PMID: 16703777 [PubMed - indexed for MEDLINE

CIMETIDINE

Cimetidine treatment for viral warts enhances IL-2 and IFN-gamma expression but not IL-18 expression in lesional skin.
Mitsuishi T, Iida K, Kawana S.

Department of Dermatology, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan. tmitsu@nms.ac.jp

Cimetidine has been shown to improve various types of human neoplasms and more recently it has been shown to be effective in treating recalcitrant or multiple viral warts in some reports. However, it is not well understood why cimetidine is effective on those kinds of viral warts. We investigated 55 patients with multiple viral warts treated only with oral cimetidine for up to 4 months to examine the efficacy of treatment. The patients were divided into two groups: group A received oral cimetidine (<20 mg/kg/day) and group B received the drug (30 to 40 mg/kg/day). In addition, using real time PCR, we measured mRNA levels of the cytokines interleukin-2 (IL-2), IL-18, and interferon (IFN)-gamma taken from selected punch biopsy specimens before and during treatment. As a result, 34.5% (19/55) of the patients had a dramatic clinical improvement or complete remission (CR) of their viral warts and 23.6% (13/55) of the patients had partial responses (PR) within 4 months of cimetidine therapy. IL-2 and IFN-gamma mRNA levels were significantly increased and IL-18 mRNA levels were decreased in tissues of effectively treated viral warts. Our results show that the higher dose of oral cimetidine was more effective in treating multiple viral warts, that cimetidine activates Th1 cells to produce IL-2 and IFN-c and that their expression correlates with wart remission. These results suggest that cimetidine is an effective treatment for viral warts. In addition, based on the decrease in IL-18 mRNA elicited by the drug, IL-18 might be expressed by keratinocytes infected with HPV.

PMID: 14693487 [PubMed - indexed for MEDLINE]

Cimetidine therapy for multiple warts in children
[Article in French] Kharfi M, Chtourou O, Kamoun F, Mokhtar I, Fazaa B, Ben Salem M, Kamoun MR.

Service de dermatologie, H˘pital Charles Nicolle, 1006 Tunis.

Various treatment modalities are used to treat warts and this indicates that none is uniformly effective. Cimetidine, an H2-receptor antagonist, has been tried to treat warts because of its immunomodulatory effects. Sixty children with multiple and recalcitrant warts were included in a placebo-controlled, double-blind study. Patients were randomly allocated to treatment groups equally. The groups received cimetidine, 25 to 30 mg/kg daily, or placebo for 2 months. At the end of the therapy, only 10 cimetidine-treated and 9 placebo-treated were examined. Cure rates obtained were 60% in the cimetidie-treated group and 33% in the placebo-treated group. Among our data and the review of the literature, we believe that cimetidine is not appropriate as standard therapy for warts, but it may be an interested therapy for multiple and recalcitrant warts of children.

PMID: 12416358 [PubMed - indexed for MEDLINE]

Salicylic Acid

Salicylic acid is classified as a keratolytic, or peeling agent, and works by causing the outer layer of skin to shed. It is dispensed in both prescription and over-the-counter (OTC) medications as an active ingredient in creams, gels, lotions, ointments, pads, plasters, shampoos, soaps, and topical solutions.

2-DEOXY-D-GLUCOSE (2DG)

The antiviral action of 2-deoxy-D-glucose has been known for 20 years, however, its clinical use has not been explored. Evidence indicated that 2-deoxy-D-glucose (2-dG) inhibited the multiplication of several enveloped viruses by interfering with the process of virus glycosylation as an anti-metabolite of mannose rather than glucose. Glucosamine had two different inhibitory mechanisms, in blocking the maturation of virus glycoproteins such as 2-dG and in inhibiting virus RNA synthesis by reducing the UTP pool in the infected cells (for review, see Scholtissek, I975).

Fourth-line therapy: Surgical excision