Plantar Warts: Epidemiology, Pathophysiology, and Clinical Management. Witchey DJ, Witchey NB, Roth-Kauffman MM, Kauffman MK. The Journal of the American Osteopathic Association 2018; 118(2): 92-105.
Verrucae plantaris (plantar warts) are common cutaneous lesions of the plantar aspect of the foot that are caused by the human papillomavirus (HPV). Ubiquitous in our environment, asymptomatic infection with HPV occurs frequently, with most infections controlled or cleared by cellular and humoral immune responses. However, certain populations have been observed to manifest plantar warts at higher rates compared with the general population, placing them at increased risk for wart-induced pain and complications.
Plantar warts shed HPV, which can then infect other sites in the plantar region or spread to other people. Although controlling risk factors is useful in preventing infection, the pervasive nature of HPV makes these preventive measures frequently impractical. This literature review outlines the current knowledge regarding the relationship between plantar wart pathophysiology, HPV transmission, and epidemiologic characteristics.
Given the high propensity for treatment resistance of plantar warts and no established, practical, and reliable method of prevention, HPV prophylaxis for populations that demonstrate high rates of plantar warts may be of benefit in controlling the spread of lesions.
Warts Transmitted in Families and Schools: A Prospective Cohort. Bruggink SC, Eekhof JAH, Egberts PF, van Blijswijk SCE, Assendelft WJJ, Gussekloo J. Pediatrics. 2013; 131(5): 928-934.
Background and Objective: Cutaneous warts are common in primary schoolchildren; however, knowledge on the routes of transmission of human papillomavirus (HPV) causing warts is scarce. This study examines the association between the degree of HPV exposure and incidence of warts in primary schoolchildren to support evidence-based recommendations on wart prevention.
Methods: In this prospective cohort study, the hands and feet of all children in grades 1 to 7 (aged 4–12 years) of 3 Dutch primary schools were inspected for the presence of warts at baseline and after 11 to 18 months of follow-up. Data on the degree of HPV exposure included information obtained from parental questionnaires: preexistent warts, warts in family, prevalence of warts at baseline in the class, and use of public places (eg, swimming pools).
Results: Of the 1134 eligible children, 97% participated; the response rate from parental questionnaires was 77%, and loss to follow-up was 9%. The incidence for developing warts was 29 per 100 person-years at risk (95% confidence interval [CI] 26–32). Children with a white skin type had an increased risk of developing warts (hazard ratio [HR] 2.3, 95% CI 1.3–3.9). Having family members with warts (HR 2.08, 95% CI 1.52–2.86) and wart prevalence in the class (HR 1.20 per 10% increase, 95% CI 1.03–1.41) were independent environmental risk factors.
Conclusions: The degree of HPV exposure in the family and school class contributes to the development of warts in schoolchildren. Preventive recommendations should focus more on limiting HPV transmission in families and school classes, rather than in public places.
Warts are benign lesions that occur in the mucosa and skin. Warts are caused by the human papillomavirus (HPV), with over 100 types of HPV identified. HPV may occur at any site. The primary manifestations of HPV infection include common warts, genital warts, flat warts, deep palmoplantar warts (Myrmecia), focal epithelial hyperplasia, Epidermodysplasia verruciformis, and Plantar cysts. Warts may be transmitted by direct or indirect contact. Events that disrupt the normal epithelial barrier increase the likelihood of developing warts. Treatment may be difficult. Warts often resolve spontaneously within a few years. Some high-risk HPV subtypes are associated with malignancies, including types 6, 11, 16, 18, 31, and 35. Malignant transformation usually is seen in patients with genital warts and immunocompromised patients. HPV types 5, 8, 20, and 47 have oncogenic potential leading to epidermodysplasia verruciformis.
