Verrucae plantaris (plantar warts) are common cutaneous lesions of the plantar aspect of the foot that are caused by the human papillomavirus (HPV). Ubiquitous in our environment, asymptomatic infection with HPV occurs frequently, with most infections controlled or cleared by cellular and humoral immune responses. However, certain populations have been observed to manifest plantar warts at higher rates compared with the general population, placing them at increased risk for wart-induced pain and complications. Plantar warts shed HPV, which can then infect other sites in the plantar region or spread to other people. Although controlling risk factors is useful in preventing infection, the pervasive nature of HPV makes these preventive measures frequently impractical. This literature review outlines the current knowledge regarding the relationship between plantar wart pathophysiology, HPV transmission, and epidemiologic characteristics. Given the high propensity for treatment resistance of plantar warts and no established, practical, and reliable method of prevention, HPV prophylaxis for populations that demonstrate high rates of plantar warts may be of benefit in controlling the spread of lesions.

Objective: Verrucae plantaris (VP) results from environmental exposure to human papillomavirus causing plantar warts of the foot, resistantto treatment, and high recurrence rates. Current treatment paradigms focus on the treatment of lesions as opposed to primary prophylaxis. Wehypothesize that a topical combination of herbal supplement with anti-viral properties and a vitamin derivative* can be used prophylactically todecrease the primary incidence.Methods: We initiated a double-blinded clinical study with participants (n=282) randomization into control (lotion emollient only) (n=120),treatment (herbal and vitamin derivative) (n=110) and no treatment (NT) (n=52). Participants underwent examination of the feet at baseline (0months) to exclude VP lesions and were randomized to receive a bottle containing topical lotion with emollient only, control (C), lotion with an herbaland vitamin derivative, treatment (T), or NT, where participants did not apply anything to their feet. C and T participants applied lotion topically to thefeet once daily and were examined at 3, 6, 9, and 12 months to document the incidence of VP.Results: No incidence of VP occurred in the T group (0/110=0% incidence), two lesions in the C group (2/120=1.7% incidence), and five lesions inthe NT group (5/52=9.6% incidence).Conclusion: Treatments for VP rely on treating lesions after they occur, have high degrees of variability in success, risk of continued transmissionduring treatment, and have high rates of recurrence. Although the study number is relatively low, early indications show decreasing incidence ofVP from 9.6% in participants with NT to 1.7% in participants who used lotion only, suggesting increased health of the plantar epidermis, and 0%incidence in those participants applying topical herbal and vitamin derivative*. Additional study with increased numbers of participants is warranted.