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relating to or occurring on the undersurface of the foot; "plantar warts can be very painful"

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足の裏の,足底の
(特に足の裏の)たこ,いぼ

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/03 23:29:33」(JST)

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A plantar wart also known as verruca, myrmecia and verruca 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 often occur on the soles of feet and toes, and can occur on hands and fingers. When they occur on feet 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

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1. 皮膚疣贅 cutaneous warts
2. 活動的な小児または骨格発達の未成熟な思春期における踵痛：原因の概要 heel pain in the active child or skeletally immature adolescent overview of causes
3. 患者情報：皮膚疣贅（いぼ）（詳細） skin warts beyond the basics
4. 疣贅状表皮発育異常症 epidermodysplasia verruciformis
5. 皮膚の良性病変の概要 overview of benign lesions of the skin

English Journal

Detection of human papillomavirus infection in trichilemmomas and verrucae using in situ hybridization.

Stierman S, Chen S, Nuovo G, Thomas J.Author information Department of Dermatology, Wayne State University, Dearborn, MI, USA. sstierman@med.wayne.eduAbstractBACKGROUND: It is hypothesized that trichilemmomas are 'burned out' verrucae. By performing in situ hybridization using HPV type-specific probes, we explored this concept.
Journal of cutaneous pathology.J Cutan Pathol.2010 Jan;37(1):75-80. doi: 10.1111/j.1600-0560.2009.01348.x. Epub 2009 Jul 13.
BACKGROUND: It is hypothesized that trichilemmomas are 'burned out' verrucae. By performing in situ hybridization using HPV type-specific probes, we explored this concept.METHODS: Verrucae vulgaris and plantaris were positive controls, and inverted follicular keratoses (IFKs) were negative controls.
PMID 19615037

Deep plantaris ulceration secondary to the topical treatment of wart with glutaraldehyde.

Fujisawa Y, Furuta J, Kawachi Y, Otsuka F.
The Journal of dermatology.J Dermatol.2009 Nov;36(11):618-9. doi: 10.1111/j.1346-8138.2009.00711.x.
PMID 19878398

Buschke Lowenstein tumor: unusual bilateral localization.

Ali Sbai M, Balti W, Dhahak S, Ben Romdhane S, Tabib M, Balti H.Author information Department of Orthopaedic Surgery, Maamouri Hospital, Nabeul.AbstractBACKGROUND: The tumor of buschke lowenstein or giant condyloma acuminata is a pseudo-épitheliomatous profileration bilonging to verrucous carcinoma group due to their aggressive local evolution. A malignant change as micro invasive carcinoma or epidermoid kératinizing carcinoma well-differentiated was reported. Diagnosis and surgical treatment represents an efficient alternative at the moment that must be precocius and large due to the frequencies of local recurrences and malignant change.
La Tunisie médicale.Tunis Med.2009 Sep;87(9):627-9.
BACKGROUND: The tumor of buschke lowenstein or giant condyloma acuminata is a pseudo-épitheliomatous profileration bilonging to verrucous carcinoma group due to their aggressive local evolution. A malignant change as micro invasive carcinoma or epidermoid kératinizing carcinoma well-differentiated
PMID 20180387

Japanese Journal

症例報告足底疣贅様外観を呈したamelanotic melanomaの1例

山本瑞枝,鬼頭昭彦,谷岡未樹 [他]
臨床皮膚科 57(6), 516-518, 2003-05
NAID 40020002241

足底疣贅の表層薄切材料による組織学的, 免疫組織化学的検討

榊哲彦,重見文雄,玉田伸二,佐野寿昭
西日本皮膚科 47(2), 268-271, 1985
足底疣贅の表層薄切標本を用いて検討した結果, 組織学的に特徴的とみなされる像が得られ, PAP法による免疫組織化学的検討ではウイルス抗原の核内局在をみとめた。表層薄切材料は足底疣贅の診断に有用で, PAP法の併用はウイルス性疣贅の診断に有用な方法であると思われた。
NAID 130004473123

最近20年間における60才以上の皮膚疾患教室例の統計的観察

森洋子,麻上千鳥,西岡和恵,今村英一,藤田英輔
西日本皮膚科 46(Suppl), 161-163, 1984
昭和38年4月より同57年12月までの約20年間に, 山口大学医学部付属病院皮膚科を受診した60才以上の患者について統計的観察を行い, 以下の結果を得た。<BR> 1) 60才以上の患者数は7,653例で, 外来患者総数の13%を占めていた。<BR> 2) 疾患別症例数に対する60才以上の患者症例の占める割合が高値を示した疾患はボーエン病をはじめとして, 老人性角化腫, ペ …
NAID 130004473054