Verruca are annoying, lets face it. Most of us will have had one at some point in our lives. I've seen verruca most on children's feet, usually kids don't care very much about them and often see their verruca disappear with very little (sometimes no) effort. Adults however seem to have verruca for much longer, they can be persistent, painful and unsightly to say the least.
Over the years there have been many treatments put forward for verruca most with mixed results. Treatments you may encounter include salicylic acid, microwave (Swift), sharp debridement, needling and cryotherapy. The results of these treatments are so varied that the National Health Service (NHS) has stopped treating verruca (in most places I believe). The thinking behind this is, that generally most verruca aren't painful, get better on their own and therefore do not need professional treatment. BUT (and it's a big but), what if someone has a painful, large verruca that they are desperate to get rid of? This blog post looks at a few different treatment options and some of the evidence for each.
Swift - Microwave therapy for cutaneous human papilloma virus infection
Swift microwaves your skin! The thinking behind this treatment is that verruca can withstand cryotherapy, laser and radiotherapy but microwaves are able to pass through thickened skin to deliver energy and essentially heat up the tissue/skin in a controlled and painless way. One study by Swift with Bristow et al. (2017) found that 75% of verruca's in 32 participants resolved, on average it took 80 days for the verruca to disappear. Treatments were given by a podiatrist at one week, one month, three months, and 12 months.
My Thoughts: This does sound pretty good, especially because success rates of podiatry treatments using acid and cryotherapy (freezing the skin) are thought to be between 23-33%. However, the study was only a pilot and was also funded by Swift, which increases the chances of bias. The evidence would have been far stronger had the authors conducted a randomised controlled trial, comparing the outcomes of participants having treatment with those who did not. Swift is pricey but might be worth a try if you're really desperate to get rid of that verruca, I'm not 100% convinced just yet.
Treatments Applied to the Skin - Including Cryotherapy, Salicylic Acid and even Duct Tape
There was a huge systematic review of these podiatry treatments in 2012 that has been published in the Cochrane Library, (a trusted and well respected resource). This study was needed because most of the treatments included were being used frequently and not really working (sneaking my opinion in there). The authors (Kwok et al. 2012) compared 85 randomised controlled trials (the strongest type of research model) involving a total of 8815 participants. The study was inconclusive, the results couldn't tell us that one treatment was better than any of the others tested. It also stated that resolution might be only slightly better when using Cryotherapy or Salicylic acid on your verruca than doing nothing at all!
My Thoughts: Don't spend a fortune on regular (weekly or fortnightly) treatments with your podiatrist if they suggest acid or freezing. Use salicylic acid or bazuka at home and save the money.
Needling - Breaks down the verruca creating a controlled inflammatory response
This treatment first came about in the 1960's, and is known as Falknor's needling technique, named after its creator. Treatment involves having an injection of local anaesthetic to numb the foot before your podiatrist inserts a needle into the verruca multiple times, just deep enough to cause bleeding and inflammation. The thinking behind verruca needling is that your body will respond to the inflammation created, and get to work starting an immune response to fight the Human Papilloma Virus (HPV) that causes verruca, which may have gone undetected (by your immune system) up to that point.
Supporting evidence for needling has mixed results, the strongest evidence that I'm aware of comes from Hashmi et al. (2017) who performed a randomised controlled trial comparing verruca needling with basic callus removal (from the verruca) using a scalpel. The authors concluded that needling did not resolve verruca any quicker but it did achieve a significant reduction in pain compared to callus removal alone.
My Thoughts: Verruca needling is the treatment of choice at Find Your Stride, so I am a little biased. I've stuck with needling for the last few years because of the results I've seen in clinic, the number of treatments required and the evidence mentioned above re: pain reduction.
Summary
Essentially there is no treatment that can 100% guarantee the resolution of a verruca, however research does suggest that podiatrists can reduce pain, improve function and help get people with painful verruca active again. Get in touch if you have any questions.
Find Your Stride!