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PATIENT STORY

A 15-year-old boy presents with painful growths on his right heel for approximately 6 months (Figure 140-1). It is painful to walk on and he would like it treated. He was diagnosed with multiple large plantar warts called mosaic warts. The lesions were treated with gentle paring with a #15 blade scalpel and liquid nitrogen therapy over a number of sessions. He and his mother were instructed on how to use salicylic acid plasters on the remaining warts.

FIGURE 140-1

Plantar warts. Note small black dots in the warts that represent thrombosed vessels. Large plantar warts such as these are called mosaic warts. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Plantar warts (verruca plantaris) are human papillomavirus (HPV) lesions that occur on the soles of the feet (Figures 140-1, 140-2, 140-3, 140-4, 140-5) and palms of the hands (Figure 140-6).

FIGURE 140-2

Close-up of plantar wart on the side of the heel. Note the disruption of skin lines and black dots. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 140-3

Close-up of a plantar wart demonstrating disruption of normal skin lines. Corns and callus do not disrupt normal skin lines. The black dots are thrombosed vessels, which are frequently seen in plantar warts. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 140-4

A mosaic wart is formed when several plantar warts become confluent. This patient is HIV positive and the thrombosed vessels are visible in some of this large wart. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 140-5

Multiple plantar warts on the ball of the foot and toes. The thrombosed vessels within the warts appear as black dots. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 140-6

Multiple plantar warts on the palms of an HIV-positive man. (Reproduced with permission from Richard P. Usatine, MD.)

SYNONYMS

Palmoplantar warts, myrmecia.

EPIDEMIOLOGY

  • Plantar warts affect mostly adolescents and young adults, affecting up to 10% of people in these age groups.1

  • Prevalence studies demonstrate a wide range of values, from 0.84% in the United States,2 to 3.3% to 4.7% in the United Kingdom,3 to 24% in 16- to 18-year-olds ...

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