Sorry Mark/Abhijeet,
Here are some details from the link .................
Response from Michael Rudzinski, PA-C, RPh
Adjunct Faculty, Physician Assistant Program, D'Youville College PA Program, in Buffalo, New York, and a practicing PA in orthopaedics and pain management at the VA Medical Center in Buffalo.
Plantar warts are benign lesions on the plantar surface of the foot, caused by the human papilloma virus (HPV). There are over 70 distinct HPV types currently recognized. HPV type 1 is the most common cause of plantar warts. Symptoms include a cosmetically unpleasant growth on the sole of the foot. The patient may also complain of a painful feeling, like "walking on a stone."
Because the pressure of walking and weight bearing flattens plantar warts, the wart may or may not appear elevated above the surface of the skin on examination. Plantar warts are rough, bumpy, and spongy. Most are gray or brown, and they have a center with one or more dark pinpoints. These pinpoints are tiny capillaries that supply blood to the wart. Warts will obliterate the skin lines in the involved area, whereas corns and calluses will not. Lateral pressure on a wart causes pain, but pinching a plantar corn is painless.
Patient education is an important first step in the treatment plan. Explain to the patient the etiology of the lesion, point out its relative benign nature, and suggest the possibility that the patient's own immune system has a 50% likelihood of eradicating the wart over a 2-year period. In addition, educate the patient about the risks and benefits of the various treatment options. Risks include cost, time demands, and side effects such as pain and dysfunction. Benefits include ease of treatment, minimal pain, no loss of function, and some general idea on the likelihood of success.
With this information, a patient who is bothered only minimally by the wart may be quite happy and satisfied with simply observing it over time. Those patients with mild discomfort from the wart can have the pain controlled by periodically removing the callous formation on the wart by shaving it with a blade or filing with a pumice stone or emery board. Warts causing more pain can be treated by various methods.
Keratolytic therapy using salicylic acid solution is an initial conservative therapy for plantar warts. This treatment is nonscarring, usually effective, and requires that the patient apply the solution for many weeks. In the office, the clinician pares the wart with a blade, pumice stone, or emery board. At home, the affected area should then be soaked in warm water to facilitate penetration of the medicine. A drop of the salicylic acid solution is applied nightly, using the applicator to cover the entire wart. The efficacy of the solution may be enhanced by covering the treated wart with adhesive tape. White keratin forms in a few days and should be pared down to pink skin after which the salicylic acid solution is reapplied. A follow-up visit is indicated in 2-4 weeks.
Therapy with 40% salicylic acid plasters is also a safe nonscarring treatment. This treatment requires many weeks, but is effective and may be less irritating than salicylic acid solution treatment.
Cryotherapy with liquid nitrogen is a quick, low cost, highly successful therapy that has a low relapse rate, but it may be painful and interfere with mobility. In cryotherapy, the lesion may be anesthetized locally by injection of lidocaine. The wart is pared down and frozen with liquid nitrogen to the point where there is a 1- to 3-mm ring of frozen area around the wart that is maintained for approximately 30 seconds. The wart is then thawed and refrozen, and the patient is reexamined in 2-4 weeks. The single lesion cure rate is 80% with 1 treatment.[1]
Blunt dissection is a surgical alternative that is fast, effective (90% cure rate), [2] and usually nonscarring. It is superior to electrodesiccation, curettage, and excision, because normal tissue is not disturbed.
Electrodesiccation and curettage is another treatment option. After anesthesia, the wart is hyfercated (electrocauterized) and the resultant charred tissue is scraped. This procedure results in more scarring and hypopigmentation.
For years, a variety of acids has been used to treat warts successfully. Home application of acids is too dangerous so, weekly or biweekly visits to the office are required. Bichloracetic acid is one such agent. The technique is to pare down the wart and protect the surrounding area with petrolatum. The entire lesion is covered with acid and the acid is worked into the wart with a toothpick, repeating this procedure every 7 days. Other topical treatments include 5-FU 5%, topical retinoic acid liquid 0.05%, and 10% formalin.
Other treatment options probably outside the realm of primary care include immunotherapy, laser treatment, and intralesional bleomycin sulfate. In my experience, I will try salicylic acid applications first, followed by cryotherapy, and then electrocautery.
In laser treatment, a CO2 laser is used to cut and vaporize the wart. Side effects may include mild burn or blister. Success rates using pulsed dye lasers are reported as high as 95%. Patients can pursue any activity the following day after pulsed dye laser treatment.
Intralesional bleomycin may be considered when all other treatments fail. It has a 48% cure rate for plantar warts.
Alternative treatment with self-hypnosis, visualization techniques, or topical application of vitamin A capsule fluid to the wart has anecdotal reports of success but little scientific verification.
-- Wed Mar 04, 2009 13:42 --
Shamsher wrote:I guess you need to be generous and share your "nick" & PW with us for that site
Google helps
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