Papillomas

A papilloma is a skin lesion caused by a viral infection. Papilloma can be located in any area of ​​the body infecting skin and mucous membranes. When it is located on the foot, it is also known as a plantar wart.

Papilloma sometimes appears covered with calluses, which makes it difficult to diagnose with the naked eye, since it can be confused with a simple callus. It is of variable size, and can be presented as the head of a pin or have the diameter of a 100-ptas coin. Papilloma always begins as a small lesion that is mistaken for a callus or a blister. As the months go by, the papilloma grows, increasing in size and can even infect nearby areas and creating a kind of colony of papillomas .

At first glance it can be seen as a callus of varying size, sometimes surrounded by a ring a little whiter than the rest of the lesion, and small black or brown dots can sometimes be seen through the lesion. These points are hypertrophied capillaries that are located in a certain layer of the skin.

The skin has several layers, the most general classification being that of dividing it into dermis and epidermis. The dermis is the deepest layer and is the layer that the skin itself produces, that is, the cells that make up the skin are born in it. In this layer there is an area called papillary dermis whose morphology is similar to the silhouette of a mountain range. This is the layer that is affected by the papilloma virus.

Papillomas can affect any area of ​​the foot, but it is more normal to find it on the sole, and especially on the heel. This circumstance is purely statistical, since a papilloma can be in any area of ​​the foot: between the toes, in the arch of the foot, under the nail, etc.

Why is it produced?

The virus that causes human papilloma is the papillomavirus. This type of virus has different subtypes, each of which causes a different infection. Fortunately, in most cases the lesions are benign and are only dangerous in certain locations as in the case of genital papilloma.

Papillomaviruses are a genus of the papovavirus family. Papillomaviruses are small viruses 52-54um in diameter. The human papillomavirus comprises a family of more than 70 types of viruses.

Production mechanisms

The papilloma production mechanism is due to the infection process caused by the virus. Heat and humidity are factors that substantially help the infection to occur, since they dilate the pores of the skin, thus facilitating the penetration of the virus.

The onset of the disease begins with the contact of the skin of the person’s foot with the virus. This circumstance is facilitated by the existence of a fissure in the skin that helps inoculation of the virus. Traumatized areas are much more sensitive to these types of infections since there is a greater probability that there is a break in the skin, even if it is microscopic.

Heat and humidity are factors that substantially help the infection to occur, since they dilate the pores of the skin, thus facilitating the penetration of the virus.

On the other hand, the aqueous medium produces maceration in the skin, a fact that contributes to making the skin more vulnerable to the virus. This circumstance explains that papillomas are easily spread in showers, swimming pools, gyms and in general areas where people usually walk barefoot and there is humidity.

Excess sweating is another factor that helps the skin to be more unprotected and to facilitate infection. Once the virus has penetrated the integrity of the skin, it attacks the cells of the dermis and enters them, modifying its genetic information and parasitizing it. This circumstance makes the treatment of these lesions complicated since to kill the virus we will have to kill the cell that contains it or intervene in the process in which the virus passes from one cell to another.

Papilloma has an incubation period that ranges from 6 to 18 months with an average of 9. This condition causes the infection to have occurred prior to the time the wart itself appears. This explains its appearance in the months after the summer holidays or the hottest months when you normally walk barefoot or visit beaches or swimming pools.

After the incubation period, the papilloma appears as a callus of varying size, sometimes surrounded by a ring a little whiter than the rest of the lesion, and sometimes small black or brown dots can be seen through the skin. it covers. These points are hypertrophied capillaries that are located in a certain layer of the skin.

Symptoms of papillomas

The virus infection causes the appearance of a covered lesion surrounded by thicker skin than normal. This circumstance makes it often mistaken for a callus. Around the wart you can distinguish a ring that delimits it from normal skin and that may be a little whiter. Through the skin that covers it, you can see black dots that are thrombosed capillaries.

The size of the wart is variable and the color is close to yellowish-brownish. Often a reddened area may appear.

Papillomas are generally believed to be very painful, but this is not always the case. When the wart is in areas of support or pressure of the foot, they are painful, but if they are located in areas free of pressure they can be painless. Papillomas hurt more if we pinch them than if we press them directly, and this circumstance often differentiates them from a callus.

They can be found in any area of ​​the foot, although it is more common for them to appear in areas of pressure or friction.

Diagnosis

To make an exact diagnosis of the lesion, it is necessary to perform a biopsy of the skin where it is located and refer it to an anatomopathological study, which consists of studying the skin microscopically using various agents that color different areas of it. Apart from the study by biopsy, papilloma can be diagnosed according to the way it presents.

To differentiate it from a callus, what is known as the ring sign is useful. It consists of pinching the wart, and if the pain increases substantially with respect to the pain caused by the pressure, there are possibilities that it is a plantar wart.

It can also be differentiated by observing whether or not blackheads are seen, since papillomas have this appearance due to the thrombosis of the skin capillaries.

The podiatrist can make a diagnosis by cutting the calloused area with a scalpel until these black dots are found, which normally bleed when this level is reached.
Other more specific diagnostic methods include tissue response interpretation tests, protein or antibody detection tests, and viral identification tests.

Treatment for papillomas

There are several treatments to solve foot papillomas. The existence of a wide therapeutic range makes us think that no defined treatment for the solution of the plantar wart has been imposed as indisputable in front of the others.

Commonly used papilloma treatments are:

• Treatments through the use of acidic or callicidal substances, which will normally cause a burn of the skin in order to eliminate the papilloma that is included in it. These treatments are more traditional and have been used for many years. They have several drawbacks: one of them is that they are treatments that take a long time due to the difficulty of controlling the amount of acid that is applied to the wart, another is the discomfort of having to carry a cure that cannot be wet nor wash and it is also important to take into account the possibility of extending the injury due to acid aggression.
• Another treatment consists of the application inside the lesion of a cytostatic drug such as bleomycin. The use of this treatment is subject to complications that may arise from the use of this drug.
• In recent years, the use of cryotherapy has been imposed as the treatment of choice in the resolution of papillomas.
  It consists of the application of cold on the lesion to cause it to freeze, a fact that will cause the destruction of the infected cells. There are various cold-producing agents such as liquid nitrogen, nitrous oxide, carbon dioxide, dimethyl ether propane or liquid hydrogen. In podiatry, liquid nitrogen is used more frequently, which is at a temperature of 196º Celsius below zero. The application of nitrogen is carried out directly on the papilloma by means of a cotton that is immersed in the liquid and which is subsequently held on the area for a few seconds. The application time changes according to the size of the lesion. Larger warts will have to be applied longer, although the application hardly ever exceeds 1 minute.
• Other treatments are papilloma surgery and the use of the electric scalpel, although today they are in disuse due to the associated complications.

How to avoid it?

To prevent the spread of papillomas I should take into account:

• Never walk barefoot on beaches, swimming pools, common showers or gyms.
• Do not exchange shoes or socks with family, friends, or at work.
• Do not get your feet wet in swimming pools or in common showers if you have a wound or abrasion on the foot.
• Wear wool, thread or cotton socks and avoid the use of synthetic fibers.
• Do not wear footwear that prevents proper perspiration of the foot and that keeps the foot wet.
• Use a foot deodorant regularly after daily hygiene.
• Wash your foot every day and if you sweat a lot twice and change your socks every day.
• Dry the foot carefully after bathing or showering to prevent maceration.
• Go to the podiatrist if I have calluses or corns, so that it differentiates them from possible papillomas.