Conway McLean, DPM

By Dr. Conway McLean, FAPWHc, FAMIFAS

Viral infections are big news these days, what with a nasty cold going around and some potentially deadly strains of influenza circulating this flu season. Then, of course, there’s Covid, which is still causing illness and hospitalizations, primarily for the unvaccinated. Viral infections have plagued mankind for centuries.

Clinically speaking, viral infections of the skin are usually caused by the human papilloma virus (HPV). Viral infections have been a thorn in the sole of humanity for recorded history. This is your common everyday plantar wart, a viral infection of skin on the bottom (e.g. the plantar surface) of the foot. The symptoms associated with a wart are primarily the result of its location.

These organisms are picked up by surface contact. But skin to skin contact as the means of transmission is not required. More often, someone walks on a surface upon which rests the HPV virus, and they later develop the skin lesion. The viral particles were left there by someone afflicted with the virus who walked on the supporting surface without proper shoe gear.

Warts growing on a surface of the body other than the bottom of the foot are easily accessed and so more easily treated. When occurring on the sole, they are pushed into the tissues of the foot, and thus protected from our therapies. As should be expected, these can be painful lesions since you’re walking on a hard, resistant lump of callused tissue. This hard material is a predictable response to the pressure produced by the wart.

For decades, our therapies have focused on eradication of the infected skin cells, generally a painful, messy process involving the repeated application of some noxious agent. The goal is the death of the afflicted skin cells. An acid is the material most often used but there are others. Freezing of the lesion is another, as is the use of a laser, but the goal is the same: destroy the infected tissue. All are painful, as most of these techniques generally are.

Along these same lines, a blistering agent derived from a beetle is used. One could call it ‘Beetlejuice’! (Just not three times!). This causes a blood blister to form, which eventually, it is hoped, will include all of the infected skin. But blood blisters on the bottom of the foot can be remarkably painful so this is not a popular technique. Bandaging is usually required making it even less desirable. But it can work to resolve the wart permanently, with persistence and a bit of good luck.

Regardless of the technique, warts are notoriously infamous for recurrence. They just keep coming back. This is largely because, if even one infected skin cell remains after completing your course of treatment, in which no wart is visualized, it will eventually return to prominence. Because your body doesn’t know what is wart, you can never be certain you “got it all!”

How to know which cells have been usurped by the virus? Not only is it impossible to determine visually, your body isn’t able to either. Invasion by the virus does not change the surface of the skin cell sufficiently to be recognized as “not you.” Consequently, your immune system doesn’t attack the infected cells. Quite the opposite, your own skin grows blood vessels into the wart to feed it. Those are the small, dark spots seen on the surface of a wart, sometimes referred to as “the roots” of the lesion.

Because this is an infection, spread of the virus is quite common, although unpredictable. The immune system of a child is different from an adult so warts are more volatile and can double in number overnight. Or disappear altogether. After adolescence, warts are more predictable but also more enduring. Although not common, warts have the potential to evolve into a type of skin cancer, if left untreated.

Because most of the wart is submerged beneath the surface, our topically applied treatments have a tough time getting to the lesion. Plus, the callus which develops over and around these pesky lesions is, too often, what we are treating with our medicines and lasers, the liquid nitrogen freezes, the blistering beetle juice.

Finally, modern technology has come to the rescue. We have changed the treatment paradigm for plantar warts. Approved over a decade ago, the SwiftTM device provides a whole new approach to the treatment of warts. It causes your warts to be recognizable as foreign, thus harnessing the power of the immune system. Your own body treats the wart. No bandaging or downtime is needed, and recurrence is rare.

Times change, and so does our understanding of science and medicine. Numerous technological advances have come down the pike, changing the nature of healthcare. An obvious example: our ability to examine every layer of the human body, without any dangerous radiation, with MRI technology. The Swift technology may not be at that level, but ask most sufferers of this all-too-common skin condition what they think. What would they do for a reliable, safe, painless treatment?

Our therapies for plantar warts have traditionally caused discomfort….and are frequently unsuccessful (which explains the distaste most physicians have for treating them). For centuries, these painful, challenging skin growths have tortured humanity. Many things have changed, and some haven’t: warts still exist. But there’s a very different option now for treatment of a plantar wart. How will you treat yours?