Anatomical Detection of Inflammatory Changes Associated with Plantar Warts by Ultrasound

Abstract

Background: Plantar warts are common and pain is one of the main symptoms. The anatomical alterations associated with the primary lesion are unclear. Moreover, an adequate separation between the lesion and the surrounding tissue abnormalities could help to better manage this pathology and enable the provision of comprehensive information to physicians and patients. Methods: A color Doppler ultrasound examination was performed on 29 recurrent plantar warts and 10 healthy controls. The morphology and extension of the warts and surrounding soft tissue abnormalities are described. The diagnosis of a plantar wart was correlated with a standard histology in all cases. Statistical analysis was performed by the Student t test. Results: On ultrasound, all warts were recognizable, and sonographic signs of soft tissue inflammation were detected that were associated with the warts: in 79% (23/29) of the cases there was an increase in sublesional arterial blood flow in the dermis, 54% (16/29) had a plantar bursitis, and 52% (15/29) had a focal decrease in subcutaneous echogenicity. No signs of inflammation were seen in the unaffected controls. Conclusion: Ultrasound can provide detailed anatomical data on warts and their inflammatory changes in the surrounding tissues. This noninvasive imaging technique may help to manage difficult cases.

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Position Statement on Dermatologic Ultrasound

“…Ultrasound can be used to assess the extent of plantar warts and to monitor treatment response in human papillomavirus infections [42]. Ultrasound assessment of abscesses has also become widespread in emergency departments in the United States.…”

Common Applications of Dermatologic Sonography

“…Plantar warts may be associated with other inflammatory signs in the surrounding tissues such as plantar bursitis. Thus, sonography allows noninvasive support of the diagnosis and also monitoring of therapeutic responses, especially in recurrent and difficult cases with persistent symptoms 45 , 46 …”

Assessment of Tumor Thickness in Melanocytic Skin Lesions: Comparison of Optical Coherence Tomography, 20-MHz Ultrasound and Histopathology

“…In clinical practice, images would be needed from several sites of a skin lesion in order to build a three-dimensional reconstruction of a skin tumor [10]. In this context, a recent study by Wortsman et al [24] focusing on the anatomical detection of inflammatory changes associated with plantar warts should be mentioned. The authors could provide detailed anatomical data on inflammatory changes using high-frequency color Doppler ultrasound [24], and it might be interesting to test this method for estimation of the lymphocytic infiltrate in melanocytic lesions.…”

“…In this context, a recent study by Wortsman et al [24] focusing on the anatomical detection of inflammatory changes associated with plantar warts should be mentioned. The authors could provide detailed anatomical data on inflammatory changes using high-frequency color Doppler ultrasound [24], and it might be interesting to test this method for estimation of the lymphocytic infiltrate in melanocytic lesions. Focusing on OCT imaging, there are several factors influencing the accuracy of skin tumor depiction and measurement, such as blurring of OCT images due to infiltrative analgesia, hydration, and erythema and pigmentation due to UV light [14].…”