W#15 Pathophysiology replies

Running head: PLANTAR WARTS 1

PLANTAR WARTS 2

POST # 2 ALCINA

The purpose of this paper is to present information on plantar warts and will include pathophysiology, signs and symptoms, diagnostics, treatment plan as well as current treatment guidelines, etiology and prevention.

Hubert and VanMeter report that plantar warts or verrucae spread from shedding of the skin that has been infected with the human papilloma virus or HPV (2018).

Hellwig and Zeltser indicate that plantar warts grow on the soles of the feet and appear to be flat and fleshy papules that can grow on the heels are hard to the touch and painful when walking puts pressure on them (2020).

Diagnostics of plantar warts include a medical exam of the feet and providers may slice a small part of the wart with a scalpel and send to the lab for analysis (Mayo Clinic, 2020).

Current treatment for plantar warts according to Hubert et al. include laser removal, liquid nitrogen to freeze the wart or ASA (acetylsalicylic acid) compounds that can be applied topically (2018).

Dr. Kormos indicates that plantar warts are caused by the human papilloma virus that enters the body via small cuts on the foot or heels (2017).

Witchey and colleagues indicate that individuals are exposed to HPV in the environment but not everyone becomes infected because the immune system prevents the spread of the virus with humeral immune responses (2018). Keratinocytes are skin cells that can be infected by the HPV virus; once the virus enters the cells, it establishes itself and starts to replicate (Witchey et al., 2018). The skin of the feet shed and along with it so does the virus which can land on other parts of the sole of the foot, shoes, towels or on surfaces that are warm and moist waiting to infect others (Witchey et al., 2018). Infection by the virus happens by direct contact with surfaces and persons that have virus and micro traumas on the feet allow for the virus to enter the body via the basal epithelial layer where stem cells are located and actively dividing (Witchey et al., 2018). The virus incubates on the host epithelial cells for up to 20 months utilizing the keratinocytes to replicate its DNA and producing only HPV E1 and HPV E2 proteins which prevents the immune system from detecting the virus on the basal stem cells allowing HPV to continue to replicate by increasing the local numbers of keratinocytes which overproduce keratin and develop into a wart (Witchey et al., 2018). As the wart keeps growing it tunnels up the skin and becomes hard causing pain when walking and in some rare occasions skin cancer may develop (Witchey et al., 2018).

Plantar warts are mostly benign and many times resolve on their own, however, some people require medical treatment by cryotherapy (liquid nitrogen to freeze the wart) (Kormos, 2017).

To prevent plantar warts, one must keep the feet free of cuts and avoid contact with the virus by wearing shoes when walking in public places and plastic sandals in public restrooms (Hellwig et al., 2020). The quadri-valent vaccine for HPV has produced good results in reducing the number and size of plantar warts in people with co-morbidities in hopes to prevent skin cancer (Hayashi et al., 2020).

Another recommendation is for medical providers to teach their patients to assess their feet and their children feet for warts especially for athletes who are at higher risk for contracting HPV as they share public bathing areas (Kormos, 2017).

References

Hayashi, A., Matsumoto, K., & Mitsuishi, T. (2020). Three cases of recalcitrant cutaneous warts treated with quadrivalent human papillomavirus (HPV) vaccine: the HPV type may not determine the outcome. The British Journal of Dermatology, 182(5), 1285–1287. https://doi.org/10.1111/bjd.18645

Hellwig, J. M. S. . R., & Zeltser, R. M. D. . F. (2020). Plantar warts. Salem Press Encyclopedia of Health.

Hubert, R.J. & VanMeter, K.C. (2018). Gould's pathophysiology for the health professions. Elsevier Saunders.

Kormos, W. (2017). What are the best ways to treat plantar warts? Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/what-are-the-best-ways-to-treat-plantar-warts

Mayo Clinic. (2020).Plantar warts. https://www.mayoclinic.org/diseases-conditions/plantar-warts/diagnosis-treatment/drc-20352697#:~:text=In%20most%20cases%2C%20your%20doctor,it%20to%20a%20laboratory%20for

Witchey, D. J., Witchey, N. B., Roth-Kauffman, M. M., & Kauffman, M. K. (2018). Plantar warts: Epidemiology, pathophysiology, and clinical management. The Journal of the American Osteopathic Association, 118(2), 92–105. https://doi.org/10.7556/jaoa.2018.024