Is it a verruca? The signs to look for and how to treat them
Verrucae are a common issue that our patients come to us for help with. Here we share what they are, how to spot them and some simple treatments you can try at home before you call in the professionals.
What are they?
Verrucae are a viral wart, part of the Human Papilloma Virus (HPV) family. There are lots of types of the HPV virus and a small number of these will affect the feet and hands. The virus is spread with contact with infected skin cells and can take a few months after you came into contact with it to appear in your skin. They are usually referred to as verrucae or a verruca on the feet and as a wart on the rest of the body.
What are the signs?
The virus causes new skin cells to grow which are infected with the virus. On many parts of the body they will blossom out of the skin, often looking like a cauliflower in shape. This is often how they will look on the toes. In the areas of the feet with thicker skin, like the soles of your feet, they will tend to be flatter and look like a distortion in the skin. More like a knot in a piece of wood with the lines of your skin bending around it, or still with the cauliflower like pattern but one that has been flattened. They are usually the same colour as your skin but in darker skin tones, can be slightly darker than your natural skin tone. If they are in an area that takes a lot of pressure, like the sole of your foot, your body may build up dead skin over the top of the verrucae. This is known as callus. In lighter skin tones it will appear yellow in colour. The darker your skin tone, the darker the callus can appear.
Many people look for 'black dots' as a sign of a verrucae but not all will have these. When the infected skin cells grow they push up through the skin in a similar way to a volcano. They will disrupt the structure of the skin and sometimes this brings small blood vessels with them. These are the 'black dots' that are often described and not all verrucae will have them.
Verrucae often do not hurt however if they are in an awkward location, or have a lot of dead skin build up on them, they can be quite painful.
Is it possible to have more than one?
Yes, we will often see multiple verrucae on the one foot. They can come in any size too. A large verrucae may be one or it could be a dozen small ones all next to each other. We see lots of different types. Sometimes the dead skin over the top will make them look larger than they actually are.
Are they contagious?
Yes. They are spread by contact with the infected skin and the shed skin cells from them. This is why so many people have them. The best way to avoid getting a foot infection such as a verrucae is to avoid walking barefoot in public places. Changing rooms, shared showers, swimming pools, gyms and hotels are all common places to pick up foot infections. Trying on shoes barefoot in shops is another easy way to spread infection. Use pool shoes or swim shoes in the shower and changing rooms at the gym or swimming. Make sure to take socks or 'pop socks' with you to try on shoes and if you are staying at a hotel, wear socks or slippers when you are in your hotel room.
If you have a verrucae then you can do the following to stop it spreading to others:
- Keep your feet covered in public places. Use pool shoes, swim shoes or verrucae socks at the swimming pool.
- Barefoot sports? Gymnastics, martial arts, yoga and pilates are just some of the activities that are usually carried out barefoot. Cover your verrucae with medical tape or look at appropriate grip socks to wear for your activity. Your instructor can recommend which ones are safe to use.
- Don't share towels with others in your household.
- Avoid walking barefoot at home if you live with other people.
- Don't pick the verrucae and wash your hands after touching it. It can spread to other areas of your body through picking and scratching your skin.
So how do I get rid of them?
Verrucae do not have a cure. Your body's immune system will often take care of the infection within 6-12 months of them appearing. Children in particular will often see theirs resolve with a bit of time and patience and without the need for treatment.
Many treatments available from the pharmacy are able to be used safely at home to try treating them first. However if you are pregnant they are best not to be treated at this time. If they grow rapidly, or are causing you pain, or if you have a health condition that affects your immune system (such as cancer, auto-immune conditions or take medicine to suppress your immune system), your blood supply or nerves in your feet (such as diabetes or circulation and heart problems) then you are best to see a podiatrist to have them assessed before trying any treatments.
What can I try at home?
With any home treatment, verrucae are highly unlikely to disappear after a few uses. Often it will take months of following the instructions, despite the advertising stating 'from one treatment'. The treatments work by damaging the skin to alert your immune system to the area. You should never try to cut your verrucae out, or take any sharp instruments to it. Not only is it dangerous, but you could actually spread the verrucae as well as injure yourself.
First, take a photo of your verrucae if you can with a ruler beside it. You might need to ask for some help. Hold a camera phone about 5 inches from the foot and use the zoom until the verrucae fills the screen as much as possible, ideally with the ruler beside it so you can see the markings. Make sure the camera focuses on the verrucae to make it clear, you may need to tap the screen to do this. This will help you remember the size and shape of how it looked before you began your treatment so you can tell if they are working.
Over-the-counter treatments from the pharmacy which contain salicylic acid (such as Bazuka) can be effective. These are often applied daily and dry quickly. Be careful using these if you are travelling to warmer climates than you are used to as the acid can work in a different way and cause a burn. If your skin becomes painful or irritated then stop the treatment.
Covering the verrucae up so that it can't get wet is another option, especially in children. Using waterproof medical tape or quick drying clear nail varnish both work well to seal the skin. If you don't have sweaty skin then blister plasters can be used instead, even though they are not sold for use on verrucae. This is known as 'occlusion therapy' and works by sealing the skin's own moisture into the verrucae which in turn damages the skin.
Over-the-counter freeze treatments are also commonly available but can make little impact on verrucae on the soles of the feet. The versions available to the public are not very strong and work better on areas with thinner skin such as the tops of the toes.
None of these worked! What can a podiatrist do?
As the medical experts in feet, podiatrists have access to a range of stronger treatments. We use a range of different treatments at Stirling Podiatry and our podiatrists can advise on which of the treatments you are suitable for based on your medical history and verrucae type.
These include stronger acids than the ones available in the pharmacy, including Verrutop, freeze therapy (cryotherapy), needling and Swift microwave therapy.
