Atypical Verruca Pedis

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All of a sudden I have noticed more and more patients presenting with atypical plantar warts that resemble drops of candlewax!

2 of these patients have diabetes. And the other 2 are as fit as fiddles!

I notice that they are often in mosaic clusters, and seem to spread quicker than the usual plantar warts I am used to treating. These warts also don't show any petechiae.

I have attached a photo for you to give me some differentials if you don't think it is an HPV infection. (I hope it's attached because I have never attached something to my threads before!)

I have been advised from fellow pods to either needle 4-5 of the bigger warts, or to ask the patient to apply a 5% formaldehyde solution onto the lesions daily for 10 minutes and they come back monthly for debridement.

I believe that this atypical presentation is very difficult to treat too.

 

Perhaps this atypical presentation has something to do with living here in KwaZulu Natal, South Africa which is very humid??