Verrucae needling

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Hi,

I have never done verrucae needling but I have a patient that has not responded to any other methods of treatment ( sal acid. silver nitrate, histofreeze, and any combination). The verrucae is actually now forming satellite lesions.

I would like to try needling but do not know the technique.

Does anyone have any advice or direct me to reading I could learn the procedure?

my biggest question is how deep does the needle need to go and can you go too deep?

Thanks

Susan

 

Hi
Some are difficult to get rid of, as you know.
Most techniques are aimed at either destroying the wart or separating it from the host (you)

I have not had much luck with freezing these when they are on the ball of the foot or heel area, in adults.

Excision (curettage actually) is very successful.
The needling technique is also very successful as well as less painful and apparently may immunize the patient against further infections.

Steve

 

Hi, I have been following several threads on this topic with great interest. We have all had the recalcitrant VP, which just doesn't shift with any of the medicamnets and techniques at our disposal. I recently treated a 68 yr old woman with long standing mosaic warts to several fingers, to the apices and subungually. There are satellite VPs to the forefeet which have also recently become painful. She has had aggressive debridement, cryocautery and topical acids, all of which have not resolved the VP. I discussed the needling technique and performed the proceedure on the primary VP to a finger. I look forward to following her progress and resolution of the complaint.
I have also been reluctant to anaesthetise the plantar aspect of the foot, as the LA is as painful as the Tx, so generally I debride and cryocauterise. I feel a Posterior Tibial nerve block would be ideal as the entire plantar surface would be numb and able to be Txed more effectively. What LA techniques do you use?

 

Hi,

I tried the needling technique today.

Pt has mosaic verrucae, the largest being on the hallux periungual which is the one I choose to treat. I was surprised by how difficult it is to pierce the verrucae sufficiently to get a bleeding response. I was also surprised by the way the verrucae tended to split after needling - thus making it difficult to get an even distribution of piercings.

Have others also found this to be the case??

Certainly a learning curve - just hope I did enough damage to get the immune response going.

Susan

 

Hello Susan

There are a number of threads describing needling technique and analgesia and hopefully you can get through these and perhaps seek another colleague to whom you can shadow during a procedure, which should give you enough confidence and skills to undertake this for your own patients. A couple of points - I usually infiltrate plantar lesions with 2% lignocaine and 1:100,000 adrenaline. Good technique and slow infiltration with a 30g needle can usually effect a fairly pain free anaesthesia. Inject slowly! Whilst it is a very successful technique, you may need to repeat the procedure with some patients. I have treated some 183 patients since December 2009 and had complete resolution in 148 patients following one Tx.; 33 patients required two sessions and 2 patients required three Tx.

I would be more cautious with claims of inducing an immune response to further HPV exposure or to eradicate secondary lesions - I have only seen secondary lesion resolution in one patient.

I still use LN2 cryosurgery as well as the more traditional chemotherapeutic agents for some patients where needling wold be contraindicated.

Best wishes

 

We treated a gentleman with longstanding recalcitrant VPs (approvimately 100 if you include the tiny satelite ones) by needling only the 'Mother' VP, as there were so many others.

We reviewed him after 8/52, with no resolution, and being our first guinea pig, we thought, "oh no, it's not worked!" so we re-treated (needled) the lesion.

Another review a further 8/52 down the line and ALL VPs had resolved.

We've since gone on to treat another 15 patients, and review after 12/52, and so far have a 100% success rate, but it's early days.


I think we reviewed the first patient too soon and thought it hadn't worked, whereas possibly if we'd allowed more time, the first tx may have been successful? Who knows. Big learning curve.

 

Got any pics of the needling, before and after.... To prove that you`re not me if nothing else!

I agree, 12 weeks is more likely to show results.

Cheers,
Bel