More on Veruccas and warts

The Bandolier 31 article on veruccas and warts has been the source of much Bandolier correspondence. There is a wide disparity of views out there, on how big the problem is, to how and when to treat, if at all. Randomised trials show that freezing warts can be effective ( Bandolier 31 ), but Dr Bridger from Bromley and Professor Bantavala from Guy's and St Thomas' do not think treatment is always appropriate. They sent Bandolier a paper on the appropriate management of warts in the community.

The paper is reproduced in full on the Bandolier Internet pages . They give much useful data on prevalence, incidence and natural history, and the main points they make for appropriate management are given below.

Appropriate management

Bridger & Bantavala make the case that;

Cutaneous warts are unsightly but harmless and transient.
Treatment is unnecessary.
When warts cause disability or difficulty in performing tasks, first line treatment is the application of a wart paint at home.
Guidelines should be developed for the management of cutaneous warts in the community and shared with schools and those who advise schools.
Appropriate mechanisms for educating health care professionals on the management of warts should be established.
Funding of cryotherapy treatment of warts should be reduced.

Verrucas and games

A letter from Dr Dudley C Hubbard, Rochester

I read the article with interest as the treatment and control of verrucae has been an area of endeavour with me for many years. Unfortunately I have no controlled or carefully analysed data to present but over 25 years experience as the main treater of these in our practice of over 10,000 patients. Until the advent of liquid nitrogen available to general practitioners, we used an old Hyfrecator to diathermy the ones that didn't respond to topicals and paring, to which many did respond. Between 1972 and 1992 we used the Hyfrecator about 800 times; we keep a record of cases done. The total number seen and treated must have been several thousand on this basis.

At one stage I had conclusive proof of transmission at one particular school. I became aware of a preponderance of the verruca club from one school. When I checked I found that almost half of the then current group came from one school. We have pupils spread across some seven secondary schools close to the surgery. I felt that this was more than chance and investigated further. I discovered that one particular PE mistress did not believe verrucae were important, nor catching, so insisted all pupils did bare foot gym and dancing on polished wood flooring. No precautions were taken whatsoever.
I insisted that this be stopped, encountered resistance, but with the backing of the county council schools PE inspector, had all active cases covered up and parents' rights to insist on PE in gym shoes re-instated. The epidemic disappeared in about 3 months, returning to the usual sporadic case pattern we see in all the schools.

I cannot prove whether the infection was occurring in the changing rooms or in the gym, but as all schools inevitably have bare foot youngsters in changing rooms, I feel the gym floor was almost certainly the source of cross transfer. The risk of minor trauma from the floor would seem to support the theory that skin abrasions are the entry route.

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