Howto get rid of persistent painful verrucas if you are immunosuppressed (RA)

[ScottOfTheArseAntics]

DH has rheumatoid arthritis and takes methotrexate which suppresses his immune system. His weakened immunity means that he has contracted verrucas on both of his feet - around 8 in total - and they just will not go away in spite of repeated treatment both at home and from the GP verruca clinic. We have also tried the whole duct tape thing without success.

This has been going on for about 9 months now. In that time he has been taking more and more codeine pain killers just for the verruca pain, just when he had managed to cut back on these because his RA was in check. His mobility is limited, he says it is like walking with razor sharp stones in his shoes and his posture has suffered as a result of hobbling around and this is also causing him pain. He has put on weight due to lack of mobility and he is becoming depressed which is not like him. Today he was reduced to tears with the pain and he never cries even when the RA pain is at its worst. In fact, he swears the verruca pain is worse than the RA.

It is becoming intolerable. Has anybody out there got any good news stories about verrucas just disappearing or treatments that actually work? I would be really interested to hear from anybody with RA who may have experienced this. Would coming off the methotrexate for a while help get rid of the verrucas?

Have you tried just shaving them down with something very sharp? eg a razor blade, held almost flat to the foot. You can take quite a lot of the dead hard part off that way, which stops it pressing hard into the sore middle bit. It doesn't actually kill off the verruca but it can reduce the pain quite a lot.

I got rid of a bunch of very long term veruccas last year by using apple cider vinegar - not sure if you can get that in the UK, but if not the closest type of vinegar. Google it and you can read about it. You soak a bit of cotton wool in it, put it over the verucca and cover with a plaster. After 24 hours, take it off and dig out what you can (gross I know), and then put a new one on. One of them went black after a while and I could get it out. With the others, they just got smaller and disappeared. I think the idea is that the vinegar is an irritant and so lets your body know the veruccas are there and your body starts to deal with them as well (if that makes sense!)

Has he requested cryotherapy (getting them frozen off)?

Duct tape over the verucca? File it down a bit, put on tape, then leave for 7 days, remove tape, soak verucca, file down, apply tape & repeat?

Im so sorry he is in such pain.

Thanks for the replies. We have tried cryotherapy - he has had double doses but it hasn't worked as yet. He is due to go for more cryo on 17 Jan. We have also tried the duct tape over a 3 month period.

I do think it might be worth getting them cut down, particularly if that helps the pain. I think I'll try and find a podiatrist or chiropodist as I don't fancy doing a DIY job . Apple cider vinegar is a new one on me in terms of a verruca treatment but we can buy it here so I will give it a go.

Well I also have RA and am on MTX and Humira. About 2 years ago I had endless sinus infections, cuts that wouldn't heal, veruccas that wouldn't go...In the end I had to come off my meds for 8 weeks to clear the sinus infections and ta-da! - the verrucas went as well and the cuts healed up.

Now it could have been coincidence but I think that I was just unable to clear the things because my immune system was so shot down. It might be that coming off the MTX will help but I did that under the supervision of the Doc. (For info I didn't flare up again with RA when In was off the meds.) Hope he gets it sorted - my verruca was so painful I was limping/shuffling so he has my sympathy.

You could try talking to docs about upping his Folic acid intake ... I find that this helps with immune response side effects for me especially ulcers sorry I've never had a verruca but I think the principle is the same.
It may be worth talking about taking a break from the mtx for bit but he should discuss this with docs . I am on mtx & humira and have had to take a break to shake off chest infections & sinus pain hope he gets sorted soon as it's miserable being in pain of any type.

Only successful treatment for persistent vertical I've found us high strength salytic acid. Buy corn treatment plasters with 40% strenth acid, shave or rub down until close to core and use plaster changing every day or two. Then rub off the White skin created.

Salicylic even

Thank you so much for the additional information. It has been very helpful to hear that some of you have come off the MTX (supvervised by doc) to deal with persistent infections. I will mention this to him and ask him to call his Rheumatologist to discuss folic increase and possible break from the MTX. We have discussed this before but he is not being very proactive about dealing with this which is driving me nuts BUT my sympathy is just about holding out.

If you are still around Wonkylegs and Pandsbear, can I ask what Humira is?

Humira is an anti-TNF treatment it's the next stage after DMARDs if they don't work on their own. It is a targeted treatment on a part of your immune system called TNF. It can make you very very vulnerable to infections and has added risks but can be very effective for some patients (like me ) - there are quite strict criteria for who can or can't be prescribed it due to the risks and it's quite an expensive drug I believe, and if you don't show enough improvement some docs will take you off it quite quick. Other downside is you have to inject it but thankfully with humira that's only once a fortnight.

Sorry that sounds a bit negative it's really not meant to as I think it's generally great so far

I have an evil verruca that hasn't reponded to any treatment. The chiropodist was quite suprised. I'm also on MTX.

I don't know if coming off the MTX would help. He could try missing one week. My rheumatology nurse always tells me to skip one week if the mouth ulcers get too much for me to cope with. Has he got a rheum nurse or someone at the clinic he could speak to? Also, how many days a week does he take the folic acid?

Thanks for that infor on Humira Wonkylegs, I am really glad you are finding it beneficial. MTX seems to be working very well for DH which is why we haven't heard of Humira I guess.

crashdoll Can I ask what the chiropodist does for your verruca. DH and I have a had a row this morning about going to see one. I think he should, he thinks it will be a waste of time and that any treatment from the chiropodist would be cause more pain. He is really resisting doing anything other than sitting around and waiting for the GP to do another cryo treatment. In response to your question I think he takes the folic acid once a week. He does have a rheumatology nurse and when he gets home later this morning I will be making sure he gives her a call. I just which he would do it without me badgering him.

The vinegar is definately worth a try, my friend had great success getting rid of persistent warts with distilled vinegar. Theres alot of information available re how to apply etc if you do a google search. Good luck

Thanks for additional comments. I have just been discussing this thread with DH and he dropped the bombshell that he stopped taking his mtx 3 weeks ago! No discussion with rheumatologist, nurse or gp. I am beyond livid. I know it's his body but GAH! Can you even stop mtx like that do you have to tail it off. I don't know what to say or do.

Yes you can just drop without tailing off - i stopped it to have a baby and you just stop taking it. It takes up to 6mths to get out of your system though.

Thanks wonkylegs. That's good to know. So if it's still in your system for 6 months it might take longer than that for his immune system to come round and start fighting off these verrucas. If that's the case, he's probably been a bit short sighted.

I'm a Health Professions Council registered graduate Podiatrist.

I would be concerned about the amount of cryo he is having, if you over do it the vp (verruca pedis) goes but you can cause scarring to plantar skin (skin on the bottom of the foot) with cryo and when you get scar tissue on a weightbearing area you get corns.

These build up quickly in RhA patients anyway due to thin skin from previous steroid treatment and loss of fatty padding due to toe clawing (the toes move backwards and pull this fatty tissue on the bottom of the foot with it to expose the tender head of the bones).

In the case of scar tissue they can form in 3 weeks, as opposed to 8-10 weeks in non RhA patients. And there is no cure, only management to control the pain. Imagine having stone strapped to the bottom of your foot, that's what a corn feels like.

If a chiropodist/podiatrist did not originally diagnose these lesions as vp I would go to the NHS one to get a diagnosis. I cannot tell you how many referrals we recieve for patients with vp only to find it is corn. I know you would imagine a GP knows the difference but you would be wrong. They often dont. They dont recieve a great deal of training to do with feet.

If it is a vp, and the RhA is active it will be very difficult to get rid of, their immune system is so busy attacking it's own synovial linings it really hasnt got the time to worry about a virus in the skin.

If it is a vp do not self treat with acids, especially with Salycillic acid, as it is not self limiting eg some acids only work for 24 hrs but sal acid just keeps burning, even down to bone. And if he gets an ulcer due to a burn it will be very hard to heal. He will be down at a chiropody clinic every week having it dressed and not able to bathe it at all until it heals which can take 6 months or longer.

Whilst you are waiting for a NHS podiatry appointment ask your gp for Doublebase gel in a 500g pack. Apply it morning and night, you will not need to rub it in you just smooth it over the skin and put socks on and it will still soak in. It does not mark bedding. This will soften the skin and put it in better condition to recieve any treatments.

For shoes he should try trainers. They get a bad press but they are fantastic for cushioning the feet. If they make his feet sweat then spray them with normal anti perspirent before putting socks on.

Shoes with normal soles are just not as good at dealing with the pressures on the foot generated from walking. I wear mine every day for work and never get aching feet. They dont need to be expensive, he's not an olympic runner so he doesnt need any fancy technology just a well cushioned roomy shoe. As long as it fits with room to wiggle the toes and has a lace or velcro fastening, NO SLIP ON styles.

hth.

Hi, DH also suffered horribly with persistent verrucas and tried everything you mentioned without success. In the he had to have them surgically removed but, because they had been there for so long, he needed many operations (13). No scars, but could not walk for 3 days after each op and needed to apply prescription treatment in-between sessions. I would recommend trying to get referral to a dermatologist who understands this sort of thing. PM me if you are in London and want the name of the one we used. Good luck!

OP, as fluffycloudland77 mentioned, my chiropodist treated me with salycillic acid (I had forgotten it's name) several times and it made no difference at all.

I was on folic acid one a week and I'm much better now I'm on in 6 days a week. I'd highly recommend your DH asks for this.

Thank you so much fluffycloud, crash and suiGeneris.

We are in Yorkshire SuiG but thanks for the offer - 13 ops sounds horrendous.

fluffy that is very interesting information particularly about corns versus verruca's. His diagnosis of vp came from the GP and although I have begged DH to see a podiatrist privately he is insisting on doing nothing until he has seen the GP. At least he has agreed to ask the GP for a referral to a podiatrist when he goes next, I will also suggest he asks about seeing a dermatologist.