Mosaic verrucae-help with treatment

If lesion is under met heads, insert long needle into interdigital web (few nerve endings) and aim for lesion to create 'window' of LA either under or near lesion. Once you have window in plantar surface, you can inject into plantar surface with no pain. If on heel, insert long needle above striated skin say 5cm up from plantar surface and again aim for lesion. If lesion is in centre of large heel, you will have to create window of LA and go into that possibly more than once to'leapfrog' to the lesion.
With nervous patient, use EMLA cream 30mins prior to LA for totally painfree experience.

 

Exactly how I do it!!!

 

Martin & Steve,

Yep, tried the ID method for met head VPs, works very well indeed:drinks. However, I can`t quite picture how you perform infiltration on the calc area without going directly through plantar skin. Sorry to be dense

Bel

 

UP THE SIDE LATERAL OR MEDIAL WHERE THE SKIN IS THINNER - GO IN - SMALL BLEB THEN DOWN AT AN APPROPRIATE ANGLE TOWARDS THE PLANTAR SKIN DROP SOME THERE TO CREATE A WINDOW WHICH SHOULD THEN ALLOW YOU TO GO THROUGHT THE PLANTAR SKIN
THE LEAPFROGGING TECHNIQUE (FOR WANT OF A BETTER DESCRIPTION) CAN CAUSE SOME DISCOMFORT AFTERWARDS IF YOUVE HAD TO DO SEVERAL LONG NEEDLE TRACKS - ALSO HAD ONE RECENTLY THAT CAME BACK WARM AND IT DID CONCERN ME THAT YOU ARE CROSSING A FEW FASCIAL PLANES USING THIS METHOD SO INFECTION COULD POTENTIALLY BE A PROBLEM
SUGGESTED ABs BUT PT DIDNT BOTHER SEEMD TO HAVE SETTLED NOW

 

OK........NO NEED TO SHOUT!!!!!

 

hi,

i used this 'multiple puncture technique' on a verucae on my wifes thumb. shes had it for years and wont stop whinging! nothing else would work. anyway, its totally killed it! and she thinks i'm a genius!

a doctor friend of mine said it could cause it to spread around the body and show up in multiple sites. i think he just was cranky that i (a podiatrist) was sticking LA into a thumb!

cant wait to tell him.

phil

 

One of my patients who is into ancient Egyptology tells me that they used to puncture warts with a thorn and then watch it die off after a month or two........nothing new under the sun!

 

Hi Denny,
Don't be despondent. It can take 5-6 months to kick the immune system into action and see a result. Just get them back every 2 months for debridement.

 

thanks Martin i haven't given up - saw that same woman again and we've decided to needle another of those massive verrucae and see what happens- mind you this time I'm doing it free of charge so that's a great incentive for her.
Have also just needled another woman with similar size and amount of verrucae, similar duration of approx 7 yrs. she has had very expensive, and painful laser treatment from her dermatologist to no avail so finger crossed.

 

Pot permananate (Condy's crystals) was routinely used as a foot bath in the tropical armed services and prior to entry to change rooms at public swimming pools in Qld . It is still very usefully as a foot soak for mixed bacterial and fungal infections on the foot. It has been restricted for sale since Sep 9/11 as it is a component for home made explosives. You may be able to purchase very small amounts through a pharmacy.
Robyn Hoodigs:

 

Hi All
regarding the postassium permanganate I still use it for chronic tinea pedis if its over a large area - with strict warning that they could end up with brown toenails if they make the solution too strong.
I wouldn't use it on chronic leg ulcers though- there are inadine or silver dressings for this pur[pose.
I buy the crystals from a gardening supplier, I think I found them on the internet and they just delivered a huge jar of the stuff - will probably last me for the next 20years. If the Nz podiatrist (can't find your post- it's school holidays and the kids are going wild) wanted some give us a shout I'm in Auckland.
Denise Lewins

 

We haven't heard from anyone recently on their results of treating multiple verrucae with the needling procedure which I described early in this very popular thread. Anyone want to share their results with the procedure.....good or bad??

 

Having good results...in fact it's my first line treatment option for verrucae of any sort. The only time I don't use this method is if patient has needle phobia.
I give them the treatment the day they come for the consultation, then issue them with a foot file and a bottle of 10% formalin to apply twice a week (to make them feel like they are doing something), then have the patient return in 2 months for debridement and assessment.
I had one 21yr old lady who was over the moon when she found her hand warts had gone one month after just one of her verrucae was 'multiple punctured'.
It has not worked for all the patients, but I am optimistic it will given time. It can take 6+ months in some cases. Even the first signs that they are in recession is an awesome feeling, when all else has failed.

 

Hi Kevin:

My results have been SO GOOD and SO PREDICTABLE that I consider needling routine now.
As a result, I haven't taken many pictures. Sorry.

Steve

 

So far only done 2 people, one adult one child. Only four weeks since the adult was done and on review last week (wk 3) no change. Early days I suppose.
Ian

 

As a student, I do only 1 day a week in clinic. I have 3 beautiful plantar warts, with the promise of more from a large family, a large barefoot family, sigh....I wanted to needle them, the patients were willing...but my tutor wasn't. I had to histo-freeze them. Sob....
One year to go!

 

I now have a preference for using Electrosurgery for all sizes and types of VP, for larger VP's I use LA to numb the area and for smaller VP's I now apply Elma cream which is apllied 1 hour before treatment.
I use Elma cream for children as this procedure is over quickly and painless without any affter effects and it provides a high success rate. I find this method simple and effective.

 

Hi Joseph:

Just one comment;

If you have a young child who has multiple verrucae the needling method allows you to treat just ONE lesion. This is quite an advantage in children with multiple and bilateral VP.

It really is amazing how this works and the patient doesn't have too smell themselves cooking!!!!

Steve

 

Hi Steve
With small children all Vp's need Emla cream applied for 1 hour before procedure, there can be multiple Vp's.
As long as the child does not feel heat or pain, ALL vp's can be treated.

When heat is applied the Vp's melt as the skin burns, if possible apply heat to the healthy skin edges around the Vp's, as I believe that Vp cells could be present if not treated in the same way, thereby reducing the return of any Vp's returning.

Patient should return in 3 weeks, if any sign of Vp's returning, then same treatment is applied again, it is better to get them when small.

Yes I know that it is a virus and no cure at the present, but I do find that this method does work.

Joseph

 

Hi Joseph:

I think "melt" is an inaccurate description of what electrocautery does to soft tissue.

I'm familiar with electrosurgery and various ways of anesthetizing children and the multitude of treatments for warts.

The point I was making was that with the needling technique you don't have to treat ALL the lesions.

Less pain, less time - better results ......... and it may just enhance the immune system to fight future infections.

Steve

 

Hi all,
Just wondering how often you use the technique? Is it a once off Treatment or do you review and treat again at 1-2-3-4 weekly intervals? I realise that if done correctly the autoimmune response should occur after one treatment but we all know how stubborn these can be.
Sam

 

Sam:

I just did a needling procedure today. I will see the patient at 2 weeks post-op, and then at 6 weeks post-op. If it is not showing good clearing by 6 weeks, I'll see the patient again at 10 weeks post-op. Most needling procedures show excellent clearing of the verrucae plantaris lesion by 8 weeks.

Hope this helps.

 

I have undertaken needling on six patients so far who have presented with various types of VP, and initially after a 4 week review I found the the response to be very good with healthy tissue visible at VP site. However, further follow-ups have been disappointing with the VP's on all patients returning. I am seeing one chap today who had needling to his VP in June and because this has returned I may offer him the option of needling again or adopt a more conventional treatment. I do not believe my technique is at fault as I penetrate the subcutaneous tissue to a depth of 5mm and the VP looks like a mashed burger by the time I am finished. I am very disappointed. See attached photos of VPs following needling.

 

I would use Electrosurgery and surgical remove the Vp in Fig 1, For the others again I using Electrosurgery this time wihtout surgical removal until such a time that they are reduced in size. It is up to you whether any chemicals are applied.
Joseph

 

e
I review at 3 weekly intervals, of course the smaller that they are treated the better the results. So far results seem to indicate that larger Vp's do tend to reappear but smaller in size. Single larger Vp's can be surgical removed and the area Cauterized to prevent bleeding and second to destroy any remaining Vp cells.
Joseph

 

Hi,

Just reading through this post, know it is an older post so hope you get this question..

Having studied in the UK we only learnt basic blocks for nail surgery and didn't have training for administering post tibial nerve blocks.

Do you know if there is any training specifically for this anywhere? I am in Cairns so know I will have to travel!

Thanks

 

Just thought I'd share another data point...

Lady with a vp about 14 mm diameter, >10 years duration. Needled pretty aggressively with a 30 guage needle. On 6 week review after debridement the verrucoid tissue was still very much present and active, though far less clearly demarked and organized. Decided on masterly inactivity for a further month. Next appointment healthy skin clearly growing through.

I've tended to find that the small ones are coming off pretty quickly and obviously resolved in 6 weeks. The bigger ones ARE resolving, but are taking longer!

Regards

 

JMD

Good pictures- how and what camera were you using? My pictures have been ok on macro but yours are fab!

Cornmerchant

 

Hi Cornmerchant,

The camera I use is the Canon IXUS 860 15, 8.0 mega pixels, 28mm stabilizer

JMD

 

Hi Kirkintilloch

I have the same camera!!

Did you use auto or program? flash on or off? I am sure it would be macro.

thanks
Cornmerchant

 

Hi Cornmerchant,

The photographs are taken in digital macro auto with overhead workstation light. Hope this helps

 

Many thanks- I have some good ones, but I think I need to increase the lighting.

Cornmerchant

 

Hi all

Well, 10 needling ops, all on mosaic vps and only 2 have gone.....!

I know in the first 2 I probably didn't go deep enough and have now been digging for victory (so to speak). I have even re-needled those 2 patients and still no success. 2 of my colleagues have also been needling and have had similar results. We are using 25g needles and puncturing like mad.

Infact several patients complain of the pain for days afterwards....

What are we doing doing wrong? Useful feedback would be very much appreciated.

Julian

 

Hi , i have heard of a treatment called cantherone used by dermatologists to treatment VPS etc...
it has sal acid in it but also an activate ingredient froma a beetle. dont know too much about it but apparently works very well. does any one know much about it.

it is a once treatment that blisters post tx after 1-2 hours
please inform or investigate

regards

paul

 

footsteps2,

firstly you do tend to cover ankle block anaesthesia at undergrad but to my dismay hardly ever get to perform any / see any unless you rotate in a Podiatric Surgery unit.

Try visiting your local nhs pod surgery department, they will perform countless ankle / popliteal blocks for you to see. Courses wise, try Mr Ian Reilly & Mr Stuart Metcalfe's company @ www.elitece.co.uk

 

hi all,

i have been watching this thread since my original post with keen interest. i would like to thank all those who have contributed, commented and posted pics and words of advice. i myself have only managed to attempt this treatment on 2 pts. the first didnt work but, having seen that others have seen results after 5-6 months i will wait and see on that one. the second time, i felt i 'went for it' a bit more and am hopeful of the outcome. i will keep you posted. i dont have pictures at the mo as my camera died in the summer and cant quite afford a new one yet...but santa might be kind to me...if not ...january sales here i come

thanks again for all your posts.

poppet

 

Where's the follow up photos? It's killing me. Did it work?

 

I've had fantastic results with this on my pt with her 7yr plus multiple mosaic vp. I originally posted photos saying I'd had no results so we decided to have another go on a different vp and 4 wks later the needled vp was gone, a month later she returned for reneedling to the large vp on heel but when I debrided the overlying callus it was practically gone. She still has more vp (this girls both feet are covered in mosaic vps) so we are hoping these will go with no further treatment. I tried to post the photos but they load as large practically full page photos- how can I make them smaller?
Help appreciated Denise

 

right click and then click "save as" and then down the bottom it will give you options of "full size, 75%, 50%, best for email etc so just click on the email or internet one and it will make them much smaller. Can't believe I'm giving technical computer advice. I'm almost IT illiterate but do write a recipe column for a newspaper now so am used to sending photos by email etc. Hope it works. Sorry the late reply

 

Very interesting thread. Could I ask, what do UK private pods charge for this service. I am hoping to start using this in clininc but have no idea of a price comparison? I hope some brave fellow can offer me some idea! regards Clair