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A 35-year-old patient of mine with rheumatoid arthritis (treated with methotrexate and steroids) has multiple VPs on both feet PMA and heel areas. In the PMA area there are about 10 on each foot and in the heel they have 'merged' together to form a thick mosaic-like crust. She has had cryotherapy treatment, to which she turned out to be allergic, and various caustic treatments which, she feels, have made them worse. What else would you suggest, considering their number and her suppressed immunity? Leave well alone (they don't cause much discomfort but seem to be spreading). Many thanks.

Mifiros

 

Well, I'm having some success managing patinets with stubborn VPs using heavy dbridement and phenol. Debride the lesions (to bleeding is best, but judge your patinet carefully), then apply phenol with a cotton tpped applicatior for 30 seconds, flush with alcohol, repeat 2-3x. You will need to see them weekly for a while but they should reduce. It's also useful for kids with mosaic warts all over their toes where cryotherapy is just impactical. See how that goes?

-Adrian

 

Welcome mifros.

Consider LILT. There is some evidence that it works better than placebo and anecdotally i have found it effective in a few resistant lesions (which have sat and smiled at everything else we have thrown at them). Its not a destructive treatment so there should be fewer concerns re healing.

Regards
Robert

 

Thank you all for your views- much appreciated. Robert, does the LILT have to be of a specific flavour, or will orange do? I'm finishing a can right now... ;p (only kidding)

 

You may laugh. (really, its ok.);)

But the number of statistically significant double blinded studies showing lilt (the totally tropical taste) to be effective for the tx of VPs (the totally irritating lesions) is probably the same as the number carried out for .......insert-name-of-homeopathic/oldwivestales-remedy-here.

IE none. :craig:

The "flavour" of LILT i use depends on how deep / large the lesion is. Your choice is red or very red. They don't do an orange and ultra violet would probably be carcinogenic. :rolleyes:

Regards
Robert

 

That certainly clarifies things and I will ask our manager if we can stock up on the 100% organic, additive-free LILT and start using it on VP patients. I look forward to the results! On a serious note, thank you all for the tips; I believe that clinical observation is sometimes more valuable than the most extensive form of research.

Regards,
Mifiros