Mosaic verrucae-help with treatment

Hi all:
Just two small addition to Kevin's post (very well done Kevin).
The ONE and only failure I had was when I used Xylocaine with epinephrine instead of plain xylocaine - perhaps the vasoconstriction decreased the anitigen-antibody reaction by decreasing the amount of blood flow to the area.

Also, needle the area until no resistance is felt.

Glad this tread is back.

Steve

 

Kevin,

Many thanks for the comprehensive instructions for the technique. I do hope to put it to some use although I have one question - if you are penetrating to 8mm, why do you use a 1.5" needle? Could you just use the smaller 5/8" one instead?

Angie

 

Angie:

In this case, size doesn't matter.............a 5/8" needle will suffice.

 

Hi All,

My first posting, and it's just to say how interesting all your replys have been to Poppet's original post, I know where to come should I have any questions, I have been signed up for ages to Podiatry arena and never used the site!!!
Many Thanks

SJR

 

I feel obliged to add one more thought here.

Of all the 'NEW' procedures, instrumentation, medications, healing aids and studies that have come along in my 30+ years of practicing Foot & Ankle surgery, I can't think of any one that has had such an immediate and positive impact on the way I practice as much as this simple needling technique for verrucae has had.

Particularly for those young patients with very large areas covered by mosaic verrucae that I would even occasionally bring to the hospital and put under general anesthesia for extensive debridement.......... these patients are the biggest beneficiaries. We can, now almost painlessly, needle relatively small areas and feel rather optimistic that ALL the lesions will be eradicated.......and no "big ordeals" going through a post operative period waiting for large areas of debrided warts to heal only to have lesions recur.

I'd like to thank Poppet for asking for advice on the original post and especially Dr. Kirby for suggesting the needling technique.

"Needle On"
Steve

 

Steve:

Of course, your photos and clinical reports of your "needled" patients have made this thread an invaluable clinical resource also. Good job everyone!:drinks

 

Hello All,
I am treating a young girl aged 11 with mosaic plantar verucae ov both feet currently with LLLT.
What success have other pods had with this treatment for persistant V/P's in children.
I don't think the needle technique would go down well with this child or her mother.

 

Kelly:

I have no clue what LLLT is (is this similar or different from LLLLLLT?). The needling technique should work exceptionally well on an 11 year old girl or boy, if done correctly. Explaining the level of pain, disability, duration of treatment and success rate of the other techniques for mosaic verrucae treatment should convince any intelligent mother that this technique would be the preferred technique you recommend for this type of problem.

 

LLLT: low level laser Therapy (?)

Interestingly had a 9 year old in Monday who I nearly did the needling technique on. I must stop being a chicken!!!!

Be interested if others have used it on young children.

Ian

 

Thanks Kevin for reply,
LLLT (Low Level Laser Therapy) what is LLLLLLLLT? CURIOUS
Her GP refered her to me for laser treatment as he didn't think cryo was appropriate.
Your needle technique is new to me, and like others would be quite nervous administering this to a young child.
Kelly

 

This is a fascinating thread. I will try this on my next wart patient. The unexplainable "black magic" of surgically removing the mother wart, and sometimes the other warts falling out now has a possible explanation. Perhaps a sloppier, deeper excision pushed some wart cells into the dermis, etc.

With laser ablation the mother wart effect doesn't happen. But even though laser is more precise, limiting scarring, the wound still has to granulate in, and so it's painful for some weeks afterwards.

I wonder how much grief Dr Falknor got when he came up with this crazy idea 40 years ago.

Cheers

Frederick

 

Hello Ian

I tried the needle technique 3 weeks ago on a 7 year girl who had vp lesions on 8 of her toes, some of which were very painful. Her mother had tried Bazuka gel and Wartner over a 3 month period with no resolution.

I explained the technique and the mother was convinced that it was the best thing to do. I did a digital block using 1ml 2% Lidoacine on her right 5th digit and needled the lesion on that toe. The child was very compliant....squeeled a bit with the LA (but most adults do as well!!).

I reviewed her yesterday and EVERY lesion had gone!! Happy child, mother and podiatrist!!

Michael Gillies

 

Hi all,

I am following this thread with added interest and thanks to Kevin for posting the method for needling.

I have taken the plunge and treated 2 people with very different lesions. Once I have a series of photos which show their resolution, I will post them.

However, I have review both this week and the needling area has scabbed over quite nicely. The patients were pleased that they did not have a painful area for a couple of days as with cryo treatment and the one patient, who has warts all over his hands which I am treating, have suddenly got smaller - so there's hope on the horizon

Angie

 

Hello All, I have been following this thread with great interest. It looks like a potentially great treatment for verrucas. But where has everyone gone???!!! Please keep posting!

 

Hi MelbPod....
I have tried Thuja on a few VP patients as per a homeopath. It has never worked for me. Just my 5 cents worth. Regards, Vernon Lever

 

Hi Kevin, i am newly qualified and read you post with interest. As a newly qualified pod our training into LA is only a digital nerve block and although we are told about an ankle block, we have to go on to attend a course to obtain a certificate to do this. I was wondering if on the plantar surface of the foot an ankle block would be the only option and if you could recomend conservative treatment for multiple VP's. The practice i work in currently uses a variety of caustics but where multiple lesions occur the patient can leave with several dressings on each foot and have to attend for frequent treatment, any advice would be helpfull :bang: Joanna.

 

Hello Everyone
I work in the NHS in Brighton and I am putting together a proposal to introduce this method on a trial basis in our department. The evidence appears very compelling. I am hopeful that all those who have used this method will post their results. Please keep them coming!
Many thanks
Yvonne

:dizzy:

 

Hello Everyone,
Just lost the thread there, so my comments might pop up again. Sorry.
Anyway, I work for the NHS in Brighton and I am putting together a proposal to trial this treament in our depatment. The evidence so far looks very compelling. I would be interested to hear from anyone using this technique, successful or not! Please keep posting comments, photos etc.
Many thanks
Yvonne

 

Yes I have used THUJA-- In Liquid form It was a "new " treatment when I worked in a clinic in the UK.
We advised the patients to also take Vitamin C supplements and I had several surprisingly good results when all else had failed.

 

Joanna:

I would suggest learning how to inject anywhere on the foot if you want to be the most effective podiatrist for your patient. It is not that difficult. I rarely give posterior tibial nerve blocks for verrucae treatment. I use ethyl chloride spray and plantar injections much more commonly. I prefer the needling technique for multiple verrucae, but I am sure there are many others that work also. You may want to thoroughly read this whole thread so you can have more of your questions answered.

Good luck........and.........never stop learning!

 

I have been following this thread with great interest as have a couple of patients with long-standing multiple mosaic verrucae.
So decided to give it a go, photos attached (hopefully)- all photos of one patient, one foot.
Patient couldn't remember original initial so we picked one she felt could have been just proximal to webbing. Used a 19g and needled area till looked like raw meat. But unfortunately 6 weeks down the track no change.
Patient happy to have treatment repeated so what should I change this time?
Would appreciate any help.
Regards Denny

 

sorry so caught up making sure my photos attached, never checked my text -
was suppose to read " patient couldn't remember the original verruca so we picked one of the longer standing ones that was easy to inject."
I haven't got a recent photo as she has been on holiday in the UK but it is 6 weeks since needling and I talked to her today and she has noted no change.
Denny

 

I am new to podiatry arena and this is my first post. I work for the NHS and still treat Verrucas (lots of them) and have been reading this post with great interest. My current treatments include salicylic acid, cryotherapy and marigold therapy all with limited success. I am fortunate to have worked with a podiatric surgeon for a couple of years and consequently have experience administering L.A.

I am hoping to try this technique but need to convince my boss first and will use this thread to help me - I may have to condense it a bit

I would love to know if there are any other NHS podiatrists who are using this technique and if you have a protocol in place.

Tracey Wilkins

 

Hello Tracey
I am in the same position as you. My manager will not agree to a trial until I have presented a proposal for his governance group. In this respect I feel Pods in private practice can be a step ahead. But, we see more at risk patients, so the potential problems can be greater, so I suppose erring on the side of caution is prudent, (and frustrating)! Having said that, a lot of young healthy individuals are still being referred to us for help when nothing else has worked!I am glad that there is such a lot of good evidence on this site.
I hope that all those who have used the treatment keep posting their results and pictures so that NHS Managers can take the step to at least do a trial.
Good luck
Yvonne

 

I forgot to say on the subject of photography that when having trouble getting the verruca in focus I have found it helpful to take the photograph through the magnifying lens of the trolley light.

Tracey W

 

Dont like the suggestion that Us "Pods in Private Practice" can't determine where and when we can or cannot apply this extremely useful technique - I am just as qualified to make those decisions as colleagues working for the NHS - I am just not shackled by the same laborious procedures as you are!! - Choose your words more carefully - I see some very high risk patients (although not as many I grant you). This does not affect my clinical judgement.
in my opinion if the local anaesthetic is used safely and effectively the technique is preferable to caustics and surgical procedures - and the choice of those procedures would come under the same assessment for high risk patients

 

Hi,
I decided to give this a whirl, as I have a couple of cases that have not responded to just about everthing I could throw at them ie: Marigold therapy, Electrosurgery, Cryotherapy, Supplements. So Needling sounded sexy.

Under local anaesthesia, I multiple punctured the largest verrucae, turning it into a mushy red, cheese grated area, with a 18 gauge needle.

So far I have done 5 cases, three have reported back after 5 weeks. I am sad to say their verrucae are alive and well. :bang:

The cases vary, from large single lesions to multiple mosaic combined with single lesions.

Any Ideas?

Cheers
Iain

 

got any pics? my first two or three were unsucessful too until i listened to Steve Arbes - puncture until you feel virtually no resistance from the tissues.
do the patients have any immune system issues - particularly stress?

 

I had an interesting week of V/P's 3 patients
Patient 1. 3 in total
Patient 2. 2 in total
Patient 3 gave up counting at 100 on the left foot.

Patient 1&2 - they were single unit V/P's and I used 66% salicylic acid and 100 Monochloroacetic acid applied for 1 week. All removed 1.5cm diameter 1cm deep. Healed within 2 day of removal

Patient 3 - I treated the largest single unit as above and taped the rest with non porous dressings.
1 week later - today I removed the single unit and simply debrided the other 99 the redressed with non porous tapes - Leukoflex and then Leukoplast to cover will assess again on Monday

Be very careful when needling and do not cross contaminate healthy skin. I have seen the mess made by G.P's when they stick a needle into the centre of a wart and the proceed to inject six more time into healthy skin - it took awhile for me to repair the mess.


I also us a 20 Watt Laser under L.A. to remove Mosaic Verrucae (Burn Baby Burn)

Warts are very able to adapt to the environment and can remain active for up to 4 years in specimen jars. I have many samples.

Don Scott

 

Hello Steve
If it were not for private pods like yourself, I would not even be considering doing this procedure. I apologise if you felt that my comments were a slight on your professional integrity. I just think that pods in the NHS are sometimes held up by red tape. We all have to make clinical judgements according to our knowledge and experience. Some people have more than others! That's why I am watching this thread with great interest.
Regards
yvonne

 

thanks yvonne - you are not that far from me - if you ever want to see this first hand we can arrange it - your boss can come too!! - send me a PM if you are interested in seeing them
regards

Steve

 

Hi Yvonne
I spent time with Steve on this. Worth taking the offer up.
Ian

 

Hello Steve
Thanks for the offer. I will definately take you up on it. Will let get back to you.
Regards
Yvonne

 

Belinda, you little beauty, thanks a bunch i've been trying to get this paper for weeks with no luck... cheers hun.:drinks

 

No problem, DP. Can`t tell you what I had to do to obtain it...`twas tricky indeed!

Just click your thanks under the post. It will make me feel bettter after loosing the thanks I received when the thread was temporarily lost



Cheers,
Bel

 

Should we not be considering Dr Ian Frazer's work (Qld) in developing the vaccine against cervical cancer and the human papilloma virus (which is implicated in triggering this cancer) ?

Robyn Hood igs:

 

I was chatting to a local dermatologist recently who mentioned she would be interested to study the incidence of VPs in teenage girls post vaccination so i know they are considering its implications

 

Hi JMD,
I was working in Australia last year, and had a patient bring up use of Potassium Permanganate for long standing leg ulcers. He remembered using it many years ago (he was a GP). I did look around (out of interest) and was told the same thing about it being out of circulation. This year, on my return to NZ I have since seen two bottles of it, both in the homes of people I know, and they use it sor something in the garden. Apparently you can source it through garden stores?! I would be interested to know if anyone else has seen it about!!

 

About 10 years ago, I attended a course on Podiatric Acupuncture in London. My first question to the lecturer was how do I treat verrucae? His reply? Insert several acupuncture needles directly through the lesion into the dermis. This will trigger the body to activate an immune response. I have used it on numerous occasions....(not all patients are keen!) but all cases have been successful. It can take up to 6 months to clear, but can work in one month sometimes. I do now offer a dorsal approach local anaesthetic injection prior to needling, for plantar lesions incidentally. Also, I have the patient attend every 8 weeks for assessment and debridement.
I agree with the viewpoint of only treating one lesion, as all the others will be affected at the same time, including hand warts.

 

Hi Martin
Can you clarify your dorsal approach with LA please? Whats the advantages and how you do it/
thanks
cornmerchant