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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/17 17:30:27」(JST)

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A plantar wart also known as veruca, myrmecia and veruca plantaris^[1]^:405 is a wart caused by the human papillomavirus (HPV) occurring on the sole (Latin planta) or toes of the foot. HPV infections in other locations are not plantar; see human papillomavirus. Plantar warts are usually self-limiting, but treatment is generally recommended to lessen symptoms (which may include pain), decrease duration, and reduce transmission.^[2] Infection occurs in an estimated 7–10% of the US population, and genetics plays an important role in determining susceptibility.

Cause

Plantar warts are benign epithelial tumors generally caused by infection by human papilloma virus types 1, 2, 4, 60, or 63,^[3] but have also been caused by types 57,^[4] 65,^[5] 66,^[6] and 156.^[7] These types are classified as clinical (visible symptoms). The virus attacks compromised skin through direct contact, entering through possibly tiny cuts and abrasions in the stratum corneum (outermost layer of skin). After infection, warts may not become visible for several weeks or months. Because of pressure on the sole of the foot or finger, the wart is pushed inward and a layer of hard skin may form over the wart. A plantar wart can be painful if left untreated.^[2]^[8]

Warts may spread through autoinoculation, by infecting nearby skin or by infected walking surfaces. They may fuse or develop into clusters called mosaic warts.^[3]

A plantar wart. Striae (fingerprints) go around the lesion.
Mosaic warts cluster
Young plantar warts

Diagnosis

A plantar wart is a small lesion that appears on the surface of the skin and typically resembles a cauliflower, with tiny black petechiae (tiny hemorrhages under the skin) in the center. Pinpoint bleeding may occur when these are scratched. Plantar warts occur on the soles of feet and toes. They may be painful when standing or walking.

Plantar warts are often similar to calluses or corns, but can be differentiated by close observation of skin striations. Feet are covered in skin striae, which are akin to fingerprints on the feet. Skin striae go around plantar warts; if the lesion is not a plantar wart, the striations continue across the top layer of the skin. Plantar warts tend to be painful on application of pressure from either side of the lesion rather than direct pressure, unlike calluses (which tend to be painful on direct pressure instead).

Prevention

HPV is spread by direct and indirect contact from an infected host. Avoiding direct contact with infected surfaces such as communal changing rooms and shower floors and benches, avoiding sharing of shoes and socks and avoiding contact with warts on other parts of the body and on the bodies of others may help reduce the spread of infection. Infection is less common among adults than children.^[8]

As all warts are contagious, precautions should be taken to avoid spreading them. The British National Health Service recommends that children with warts:

cover them with an adhesive bandage while swimming
wear flip-flops when using communal showers
should not share towels.^[9]

Plantar warts are not prevented by inoculation with currently available HPV vaccines because the warts are caused by different strains of the human papillomavirus. Gardasil protects against strains 6, 11, 16, and 18; and Cervarix protects against 16 and 18; whereas plantar warts are caused by strains 1, 2, 4, and 63.

Treatment

First-line therapy	Over the counter salicylic acid
Second-line therapy	Cryosurgery, intralesional immunotherapy, or pulsed dye laser therapy
Third-line therapy	Bleomycin, surgical excision

Treatments that have been found to be effective^[10] include:

Medications

Salicylic acid—The treatment of warts by keratolysis involves the peeling away of dead surface skin cells with Keratolytic chemicals such as salicylic acid or trichloroacetic acid. These are available in over-the-counter products or, in higher concentrations, may need to be prescribed by a physician. A 12-week daily treatment with salicylic acid has been shown to lead to a complete clearance of warts in 10–15% of the cases.^[11]

Cantharadin (blister beetle extract) applied to a wart by a doctor causes a blister after 4–6 hours. One formulation is known as Cantharone (0.7% Cantharidin); a more powerful one is Cantharone PLUS which contains the same active ingredient as Cantharone, but it also contains Podophyllin (5%) and Salicylic Acid (30%).

Immunotherapy—Intralesional injection of antigens (mumps, candida or trichophytin antigens USP) is a new wart treatment which may trigger a host immune response to the wart virus, resulting in wart resolution. It is now recommended as a second-line therapy.^[12]

Surgery

A ~7mm plantar wart surgically removed from patient's footsole after other treatments failed

Liquid nitrogen—This, and similar cryosurgery methods, is a common surgical treatment which act by freezing the external cell structure of the warts, destroying the live tissue. Up to three sessions may be required.

Electrodesiccation and surgical excision may produce scarring.

Laser surgery—This is generally a last resort treatment, as it is expensive and painful, but may be necessary for large, hard-to-cure warts.^[13]

Cauterization—This may be effective as a prolonged treatment. As a short-term treatment, cauterization of the base with anaesthetic can be effective, but this method risks scars or keloids. Subsequent surgical removal is unnecessary, and risks keloids and recurrence in the operative scar.^[14]

Relative effectiveness

A 2006 review of the effects of different local treatments for cutaneous, non-genital warts in healthy people concluded: ^[15]

there is a lack of evidence (many trials were excluded because of poor methodology and reporting).
the average cure rate using a placebo was 27% after an average period of 15 weeks.
the best treatments are those containing salicylic acid. They are clearly better than placebo.
there is little clinical trial data for the absolute efficacy of cryotherapy
two trials comparing salicylic acid and cryotherapy showed no significant difference in efficacy.

References

^ James, William D.; Berger, Timothy G. et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
^ ^a ^b Warts, Plantar at eMedicine
^ ^a ^b Human Papillomavirus at eMedicine
^ Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T (1998). "Human papillomavirus 57 identified in a plantar epidermoid cyst". Br. J. Dermatol. 138 (3): 510–4. doi:10.1046/j.1365-2133.1998.02135.x. PMID 9580810.
^ "Human Papillomaviruses Compendium" (PDF). Los Alamos National Laboratory. Retrieved 2013-02-05.
^ Davis MD, Gostout BS, McGovern RM, Persing DH, Schut RL, Pittelkow MR (2000). "Large plantar wart caused by human papillomavirus-66 and resolution by topical cidofovir therapy". J. Am. Acad. Dermatol. 43 (2 Pt 2): 340–3. doi:10.1067/mjd.2000.100534. PMID 10901717.
^ Chouhy D, Bolatti EM, Piccirilli G, Sánchez A, Fernandez Bussy R, Giri AA (2013). "Identification of human papillomavirus type 156, the prototype of a new human gammapapillomavirus species, by a generic and highly sensitive PCR strategy for long DNA fragments". J. Gen. Virol. 94 (Pt 3): 524–33. doi:10.1099/vir.0.048157-0. PMID 23136368.
^ ^a ^b "Understanding Plantar Warts". Health Plan of New York. Retrieved 2007-12-07.
^ "Clinical Knowledge Summaries: Previous version – Warts (including verrucas)" (PDF). National Health Service. January 2007. p. 2. Retrieved 2010-12-05.
^ Bacelieri R, Johnson SM (2005). "Cutaneous warts: an evidence-based approach to therapy". Am Fam Physician 72 (4): 647–52. PMID 16127954.
^ Cockayne S, Curran M, Denby G, Hashmi F, Hewitt C, Hicks K, Jayakody S, Kang'ombe A, McIntosh C, McLarnon N, Stamuli E, Thomas K, Turner G, Torgerson D, Watt I (2011). "EVerT: Cryotherapy versus salicylic acid for the treatment of verrucae--a randomised controlled trial". Health technology assessment (Winchester, England) 15 (32): 1–170. doi:10.3310/hta15320. PMID 21899812.
^ Bacelieri R, Johnson SM (2005). "Cutaneous warts: An evidence-based approach to therapy". American family physician 72 (4): 647–652. PMID 16127954.
^ "Laser Surgery for Warts", webmd.com
^ Kunnamo, Ilkka (2005). Evidence-based Medicine Guidelines. John Wiley and Sons. p. 422. ISBN 978-0-470-01184-3.
^ Gibbs S, Harvey I, Sterling JC, Stark R (2006). Gibbs, Sam, ed. "Local treatments for cutaneous warts". Cochrane Database Syst Rev 3 (2): CD001781. doi:10.1002/14651858.CD001781.pub2. PMID 16855978.

External links

Plantar warts at the Mayo Clinic website
Warts at The Merck Manual

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 皮膚疣贅 cutaneous warts
2. 患者情報：皮膚疣贅（いぼ）（詳細） skin warts beyond the basics
3. ヒトパピローマウイルス感染の疫学 epidemiology of human papillomavirus infections
4. 爪疾患の概要 overview of nail disorders
5. 小児における尖圭コンジローム（肛門性器疣贅） condylomata acuminata anogenital warts in children

English Journal

Immune therapy for human papillomaviruses-related cancers.

Rosales R1, Rosales C1.
World journal of clinical oncology.World J Clin Oncol.2014 Dec 10;5(5):1002-19. doi: 10.5306/wjco.v5.i5.1002.
Human papillomaviruses (HPVs) are a large family of double strand DNA viruses comprising more than 180 types. Infection with HPV is very common and it is associated with benign and malignant proliferation of skin and squamous mucosae. Many HPVs, considered low-risk such as HPV 6 and 11, produce wart
PMID 25493236

Verruca plana as a complication of CO2 laser treatment: A case report.

Winn AE1, Kentosh J, Bingham JL.
Journal of cosmetic and laser therapy : official publication of the European Society for Laser Dermatology.J Cosmet Laser Ther.2014 Dec 8:1-3. [Epub ahead of print]
Carbon dioxide (CO2) laser treatment is a common therapeutic modality for many dermatologic conditions. It uses a high energy, infrared beam of light, which selectively targets water-containing tissue resulting in controlled ablative resurfacing. This modality, however, can manifest significant cosm
PMID 25393826

Health Utilities Lost and Risk Factors Associated With HPV-Induced Diseases in Men and Women: The HPV Italian Collaborative Study Group.

Marcellusi A1, Capone A2, Favato G2, Mennini FS3, Baio G4, Haeussler K4, Bononi M5; on behalf of the HPV Italian Collaborative Study Group.
Clinical therapeutics.Clin Ther.2014 Dec 5. pii: S0149-2918(14)00734-6. doi: 10.1016/j.clinthera.2014.11.002. [Epub ahead of print]
PURPOSE: A complete economic evaluation requires accurate data concerning the resources used, outcomes, and utilities (patient's preferences) to properly value the cost utility of human papillomavirus (HPV) vaccination strategies. This study was designed to measure the utility loss in health states
PMID 25487083

Japanese Journal

非細菌性血栓性心内膜炎により多発脳血管閉塞をきたした1剖検例

臨床神経学 56(3), 191-195, 2016
NAID 130005142035

非細菌性血栓性心内膜炎により多発脳血管閉塞をきたした1剖検例

臨床神経学 advpub(0), 2016
NAID 130005132734

多発性膿瘍，貧血性梗塞による神経症状を主徴とした敗血症の犬の1例

動物臨床医学 24(1), 15-19, 2015
NAID 130005139625

Related Pictures

★リンクテーブル★

リンク元

「疣贅」

Plantar wart
	Large plantar wart
Classification and external resources
Specialty	Dermatology
ICD-10	B07
ICD-9-CM	078.12
NCI	Plantar wart

　　[★]

日: ゆうぜい
英: wart, verrunca, vegetation
ラ: verrca, verruca
同: いぼ疣
関: 疣腫(日本循環器学会推奨); warts & hypogammaglobulinemia infections and myelokathexis syndrome WHIM

皮膚

HPVによる感染により生じる

循環器

感染性心内膜炎により病原体が心内膜に形成する小血栓。病原微生物が心内膜上(の血栓)に付着・増殖した後、フィブリン・線維性組織によって取り囲まれてできあがった硝子様の小血栓(YN.C-130)

[andrews-1] James, William D.; Berger, Timothy G. et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.

[emed_plantar-2] Warts, Plantar at eMedicine

[emed_hpv-3] Human Papillomavirus at eMedicine

[egawa-4] Egawa K, Kitasato H, Honda Y, Kawai S, Mizushima Y, Ono T (1998). "Human papillomavirus 57 identified in a plantar epidermoid cyst". Br. J. Dermatol. 138 (3): 510–4. doi:10.1046/j.1365-2133.1998.02135.x. PMID 9580810.

[compendium1994-5] "Human Papillomaviruses Compendium" (PDF). Los Alamos National Laboratory. Retrieved 2013-02-05.

[davis-6] Davis MD, Gostout BS, McGovern RM, Persing DH, Schut RL, Pittelkow MR (2000). "Large plantar wart caused by human papillomavirus-66 and resolution by topical cidofovir therapy". J. Am. Acad. Dermatol. 43 (2 Pt 2): 340–3. doi:10.1067/mjd.2000.100534. PMID 10901717.

[chouhy2013-7] Chouhy D, Bolatti EM, Piccirilli G, Sánchez A, Fernandez Bussy R, Giri AA (2013). "Identification of human papillomavirus type 156, the prototype of a new human gammapapillomavirus species, by a generic and highly sensitive PCR strategy for long DNA fragments". J. Gen. Virol. 94 (Pt 3): 524–33. doi:10.1099/vir.0.048157-0. PMID 23136368.

[hipusa-8] "Understanding Plantar Warts". Health Plan of New York. Retrieved 2007-12-07.

[nhs-9] "Clinical Knowledge Summaries: Previous version – Warts (including verrucas)" (PDF). National Health Service. January 2007. p. 2. Retrieved 2010-12-05.

[bacelieri-10] Bacelieri R, Johnson SM (2005). "Cutaneous warts: an evidence-based approach to therapy". Am Fam Physician 72 (4): 647–52. PMID 16127954.

[PMID_21899812-11] Cockayne S, Curran M, Denby G, Hashmi F, Hewitt C, Hicks K, Jayakody S, Kang'ombe A, McIntosh C, McLarnon N, Stamuli E, Thomas K, Turner G, Torgerson D, Watt I (2011). "EVerT: Cryotherapy versus salicylic acid for the treatment of verrucae--a randomised controlled trial". Health technology assessment (Winchester, England) 15 (32): 1–170. doi:10.3310/hta15320. PMID 21899812.

[12] Bacelieri R, Johnson SM (2005). "Cutaneous warts: An evidence-based approach to therapy". American family physician 72 (4): 647–652. PMID 16127954.

[13] "Laser Surgery for Warts", webmd.com

[kunnamo-14] Kunnamo, Ilkka (2005). Evidence-based Medicine Guidelines. John Wiley and Sons. p. 422. ISBN 978-0-470-01184-3.

[cochrane2006-15] Gibbs S, Harvey I, Sterling JC, Stark R (2006). Gibbs, Sam, ed. "Local treatments for cutaneous warts". Cochrane Database Syst Rev 3 (2): CD001781. doi:10.1002/14651858.CD001781.pub2. PMID 16855978.

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案内

案内

verruca