The Plantar Verruca Research Empire

Date of Birth

February 2026

Date of Death

July 2026

It started with the little bastards refusing to die

I have treated hundreds of plantar verrucae.

Some disappear.

Some respond beautifully to treatment.

Some presumably get bored and leave of their own accord.

And then there are the little bastards.

The ancient ones.

Ten years plus.

Large mosaics spreading across weight-bearing areas. Patients who have already tried acids, cryotherapy, Swift, needling and assorted other attempts to persuade the bloody things to leave.

You treat them.

Something happens.

A little inflammation. Perhaps some improvement.

Then everything settles down and there it still is.

At some point I stopped asking:

What else can I do to destroy this wart?

And started wondering:

Why isn’t the immune system clearing it?

This turned out to be a dangerous question.

Perhaps we’re treating very different things as though they’re the same

One thing that increasingly bothered me about the verruca literature was the population being studied.

A recently acquired common wart on someone’s hand is not necessarily biologically equivalent to a large plantar mosaic that’s been sitting under someone’s foot for twelve years and has already survived several treatments.

Yet results can get averaged together and presented as though warts are warts.

From clinical experience, that didn’t feel convincing.

What I actually wanted to know was:

What works on adult plantar verrucae that have been present for years and have already failed multiple treatments?

That dramatically reduces the amount of reassuring evidence available.

Which, naturally, made me more interested rather than less.

Then we got interested in immunity

Needling is supposed to do something cleverer than simply damage tissue.

The idea is that pushing verruca tissue into the dermis exposes viral antigens to the immune system and encourages a cell-mediated response.

Lovely.

Except I’d needled some extremely persistent lesions and watched them produce a brief inflammatory response which simply… fizzled out.

The patient healed.

The verruca remained.

So perhaps exposure isn’t always enough.

Maybe some chronic lesions are effectively immunologically quiet — infected tissue persisting without generating the sustained response required for clearance.

And if that’s true, endlessly applying different destructive treatments may be attacking the wrong part of the problem.

Things escalated

First came the idea of immune priming plus antiviral suppression.

Needle the lesion.

Allow it to heal fully.

Then, several weeks later, target residual active foci with an antiviral such as intralesional cidofovir.

The reasoning was appealing: instead of asking one treatment to do everything, attack two potential mechanisms separately.

Try to provoke recognition.

Then reduce the remaining infected-cell reservoir.

I became sufficiently interested that we started sketching out what a prospective pilot might actually look like.

Eligibility criteria.

Lesion measurement.

Photography.

Follow-up periods.

Safety monitoring.

Comparator groups.

Recurrence.

This had stopped being idle curiosity.

Then came CANDIN

The more I thought about lesions that simply seemed uninterested in mounting an adequate immune response, the more intriguing intralesional immunotherapy became.

Candida antigen — CANDIN — was particularly interesting.

Rather than simply burning, freezing or otherwise assaulting the wart itself, the aim is to provoke a broader cell-mediated immune response.

That raised exactly the question I cared about:

Could you wake the immune system up?

And if so, which patients respond?

Because by then I was becoming increasingly convinced that the useful question wasn’t:

Which verruca treatment works best?

It was:

Which treatment works for which kind of verruca in which kind of patient?

Oh dear. I may have found my PhD.

That led to phenotype.

Chronicity.

Mosaic versus discrete lesions.

Weight-bearing location.

Treatment history.

Inflammatory response.

Smoking and metabolic factors.

Possible immune characteristics.

HPV genotype.

I became particularly interested in whether different plantar HPV types might behave differently enough that averaging them together was concealing clinically important subgroups.

So obviously what this situation required was a registry.

Thus appeared the Plantar Verruca Phenotype & Immune Response Registry.

There was a scoring system.

WISS.

There were proposed follow-up outcomes.

There were plans to document treatment response rather than merely record whether somebody had “a verruca”.

At some point I looked at the sprawling collection of hypotheses, phenotype work, immunotherapy questions and treatment-stratification ideas we’d accumulated and realised:

Oh shit.

There was enough here to keep somebody occupied for years.

Possibly enough for doctoral research.

For a brief and alarming period, this seemed like an excellent idea.

Then reality intervened

By this point, intralesional Candida antigen had become particularly interesting.

And gratifyingly, researchers were already producing evidence suggesting that Candida-antigen immunotherapy could achieve substantial clearance rates in recalcitrant plantar verrucae.

Excellent.

There was just one small problem.

I couldn’t bloody use it.

In UK practice, CANDIN wasn’t sitting in the podiatry cupboard waiting for me to draw it up. Using Candida antigen as intralesional wart immunotherapy is an off-label/unlicensed specialist proposition, and access in my clinical world meant dermatology rather than me simply deciding that a suitable patient ought to have it.

So I’d spent months becoming increasingly interested in a treatment that might address exactly the clinical problem I’d been wrestling with…

…while working in the wrong bloody profession to administer it.

And then I remembered the other important detail.

I don’t actually want to be a podiatrist anymore.

Cause of death

A combination of professional jurisdiction and principal investigator remembering she was trying to escape feet.

Legacy

An alarming amount of research.

A prospective pilot concept.

Immune-plus-antiviral treatment ideas.

A phenotype registry.

A scoring system.

A lasting suspicion that “verruca” is far too broad a category for some of the treatment literature built around it.

And considerable irritation that one of the more interesting treatments was sitting on the other side of a professional boundary.

Prognosis

Dead.

The research questions remain interesting. CANDIN remains interesting. And I still want to know why some ancient plantar mosaics respond while others apparently intend to remain attached to their host until cremation.

But I’m increasingly content for somebody else to answer that.

Preferably a dermatologist.

They can prescribe the bloody stuff.