Surgical curettage and electrodessication, under local anesthesia, is potentially the most effective treatment we have for plantar warts—but as you might imagine, piercing the sole of a young child’s foot with a 30-gauge needle is rarely our first choice. It’s the method we used before liquid nitrogen was widely available, and it was a nightmare for all involved. Three outcomes were possible, two quite negative: Serious post-procedure pain and scarring were almost certain. But worst of all, the wart could easily return despite all that. The only time I use this is when the plantar wart is totally resistant to treatment and so large as to interfere with walking.
TAKE-AWAY LEARNING POINTS
• The reason there are 20 or more treatments for warts is that none are remotely perfect.
• Plantar warts are a special problem because they develop on weight-bearing portions of the sole, growing inward (endophytic) in a thick skin layer that allows the virus to avoid detection by the immune system. Plantar warts often cause pain, which treatment can worsen.
• Parents/patients need to understand all of this prior to selecting an appropriate treatment choice.
• They also need to understand that warts do not have to be treated. Most will resolve on their own, eventually.
• Terrorizing children is to be avoided if at all possible. Parents may want their child’s warts to be “taken care of,” but they need to understand this may not be possible.
• Consider referral of problematic plantar warts to dermatology.