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Experience treating Verrucae pedis with Salycilic Acid and Trichloroacetic acid

Discussion in 'General Issues and Discussion Forum' started by Sarkade, Jan 17, 2012.

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  1. Sarkade

    Sarkade Member


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    I have a basic query I think, but based on my recent discussions with numerous colleagues and some online searching, I can't seem to find a straight forward response. Can anyone please give me some advise on your experience treating Verrucae pedis with Salycilic Acid (60%) and Trichloroacetic acid..

    What % of Trichlor do you use and how do you mask the area? I have been told and found contradictor info..

    All advice welcome.....
     
  2. Catfoot

    Catfoot Well-Known Member

    Hello sarkade,
    The treatment you mention is very aggressive and has rather unpredictable results. In addition the patients need to be selected very carefully.

    Where was it that you leaned about this?

    If you haven't been shown how to mask the area correctly, then I would advise you not use the treatment. I wouldn't use the treatment at all, personally.

    regards

    Catfoot
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Used to use it a lot. Worked well. The ulcer it often created was always easy to heal and the VP was always gone.
    Used 100% trichlor (ie the crystal form!) - the crystals were held in place with the 60% sal acid. Masked the area with TbCo and a hole cut in adhesive tape.
     
  4. Disgruntled pod

    Disgruntled pod Active Member

    Trichlor is one of those treatments in which YOU MUST KNOW WHAT YOU ARE DOING.

    Did you know that VP treatments along with orthotics head the litigation tables?! Fact!
     
  5. LOL!

    Not always. I can remember seeing the VP sat in the middle of a bloody great hole like one of the cliche desert islands. Only missing the palm tree in the middle.

    If you're going to be that aggressive I think other treatments are more predictable and less damaging.
     
  6. cornmerchant

    cornmerchant Well-Known Member

    No one ever seems to mention the scar tissue that can occur following aggressive treatments like this. Ok, so the vp is gone, but the scar tissue can be far more uncomfortable and is there for life.

    Cm
     
  7. Sarkade

    Sarkade Member

    Thanks evveryone for the responses, in particular Craig. As with all VP treatments, there is never one straightforward tx option.

    Sorry, one more - I have found some info in the literature on Beetle Juice - Cantharidin. Again, am keen to hear your experience with this and method of use please... Is the area masked with tape and felt padding?

    We currently have a client with very stubborns VPs. In particular she has a few on her L/1st toe and we are concerned about this fragile area and reluctant to try any treatments that are too aggressive.
     
  8. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Never had a probem with scar tissue, but I never used it on a weightbearing surface.
     
  9. blinda

    blinda MVP

    Cantharone isn`t licensed for podiatric use in the UK, if you are in the UK. You can refer your pt to a dermatologist for it`s application. The red bottle (mixture of cantherone and sal acid) is potent stuff and smarts somewhat, but has reported high success rates.

    I did obtain some a few years back for my own crop of VP`s, but didn`t need it as they self resolved (or was it my conviction that the Canterone would work? ;)) So, I gave it to a dermatologist friend of mine who put it on his wifes` finger which had a wart. It worked, but they are no longer married!

    Cheers,
    Bel
     
  10. Sarkade

    Sarkade Member

    Ha ha... Thanks Bel!

    I'm located in Victoria Australia, so was just curious to know what other Pods experience with Cantharidin was and if anyone is using it where they purchase it from (if we can use it that is!).
     
  11. Gbade

    Gbade Member

    This a very good question, I believe that treating Verrucae has a direct relationship with the patients immune status, and Query the strain of the HPV (Human papilloma virus).
    From my little experience in University and placements I have had good treatment rates, using Sharp Debridement to the level of pinpoint haemorrges, letting the blood ozz for about 60 seconds, this encourages the migration of inflammatory response cells, stimulating immune response in the patient. Salicyclic or Trichloroacetic can then be used as adjucts.
    Its worth trying.

    Gbade


     
  12. Gbade

    Gbade Member

    The concentration of the trichloroacetic is 10 %, this is applied to the lesion using a deflective padding with cavity in which you put the agent, this is secured in place with strappings (Neale's Disorders of the Foot)
    Gbade

     
  13. Kaleidoscope

    Kaleidoscope Active Member

    Blinda

    ...... Perhaps then it is a CURE for MARRIAGE lol! (ops! sorry)

    Where I am an associate, the owner uses just this treatment - to (apparently) very good affect. When reviewing the notes of such patients, I have found no areas of scar tissue post-op? (Perhaps just luck).

    Again, as has been said, it is VERY much the case of picking the RIGHT patients (perhaps?).

    Regards
     
  14. blinda

    blinda MVP

    Hiya,

    There`s only one cure for that......

    Which tx did they use? Sal & tri acid or cantherone?
     
  15. Kaleidoscope

    Kaleidoscope Active Member

    Hi Bel

    Sorry the Tri and Sal Acid. They debride as usual, and then apply through tiny plaster aperture the 60% Sal acid and then in the middle of this they put the tiniest grain of Triclor and cover.

    Cheers
     
  16. blinda

    blinda MVP

    Righto. Yeah, it can be quite effective. But, as Disgruntled pointed out, use of this combo has resulted in rather a lot of insurance claims against SCP members for inducing big `oles in feet, according to one Mr Potter. I`ll see if I can get any stats from him, be interesting to see.

    Cheers All,
    Bel
     
  17. cornmerchant

    cornmerchant Well-Known Member

    With respect to anyone successfully carrying out these treatments, the patients that have scar tissue as a result do not go back to the pod who did the treatment!!

    Craig- interested to hear that you dont use on weightbearing areas- this must rule out a large percentage of patients? The worst scar tissue I have come across has been on weight bearing areas, but I have had patients who have scar tissue on non weight bearing areas, and this can become very uncomfortable regardless.

    CM
     
  18. Kaleidoscope

    Kaleidoscope Active Member

    Cornmerchant

    You are of course right! Unless we are litigated against how could we possibly know? Unhappy (but not enough to complain) patients do not return....... Although we HAVE had them recommend others to us BECAUSE we have 'cured' their problem AND yet not return because they are 'cured'! Two sides of a coin.

    All I would say is that they are regulars - who have tried all other 'soft' options like cryo (although even this has problems!) and OTC remedies, debridement and gaffa tape etc. and Im (reasonably) sure that those we have treated thus HAVE been back for further treatment - for other lesions/nails etc. I certainly believe one should choose their patients carefully and weight up that other more permanent solutions may themselves bring scar tissue to bear (like electrotherapy etc.). Indeed many come already with scar tissue from other remedies.

    Most patients (seem to) understand that VPs are a virus and they do not 'go gently into the dark night... but rage rage against the dying of the light....'

    Others..? well perhaps it is a risk we sometimes take on-board when we work in PP as most Trusts do not treat VPs and patients come for treatment and are given options and (hopefully) full advice on the pros and cons before making an informed decision.

    Incidentally, if I wasnt working in other's practices perhaps I would not use anything but dry-needling - as I think the results I have witnessed so far are amazing and (appear) not to result in scarring.......mais c'est la vie!

    Regards
     
  19. blinda

    blinda MVP

    Needling. Brilliant!

    Yep. Not a single case of scarring, thus far. And perfectly acceptable to perform on W/B areas, but nothing is guaranteed. Immune systems are funny ol' things. Had a 71 year old pt in today presenting with a HPV type 1 VP of 30 plus years duration! And, yes it definately is a VP. Wasn't requesting tx (she wanted 'those metal things for fallen arches', of course) she said she would miss it if it were to leave her now! Folk, eh?
     
  20. Bethy

    Bethy Member

    My colleagues & I use Monochlor crystals in combination with 75% AgNO3.

    At the first treatment debride HK, mask area with sports tape, find appropriate sized crystal for VP, wet scalpel blade with saline & pick up crystal with that (not too much else crystal will dissolve!) then place in centre of VP. Cover with plaster (e.g. Cutiplast) and then offload with felt. Leave in place 2 days, then pt removes it.

    R/V 7/7 - blood blister should have formed, debride HK & blister roof. Then apply 75%AgNO3. If not too sore the following week & nil ulcer, can use another Monochlor crystal & repeat the cycle until VP cleared.

    Again must definitely pick your appropriate patient! Make sure not over bony prominence, adequate blood flow...etc.. but keep in mind that it can be (and most likely will be) painful as well!

    Beth
     
  21. Kcoley

    Kcoley Welcome New Poster

    Would anyone be able to tell me how I can buy 60-70% salicylic acid? I recently graduated from residency and my director used this all the time and it really seemed to work (even on my own wart...ewww, I know lol).
     
  22. Sarkade

    Sarkade Member

    I purchase it from a local chemist that knows us well and we have a good rapport with them.
     
  23. rosherville

    rosherville Active Member

    Bethy

    'My colleagues & I use Monochlor crystals in combination with 75% AgNO3'.

    Alarm bells rang when I first read this, 'in combination with AgNO3', as the layered technique was always restricted to Trichloracetic Acid. In combination with Monochlor would lessen the chance of the abcess bursting and increase the pain.

    Then I read further and saw that that you used the AgNO3 to astringe the ulcer, not in 'combination' but seperately at a later date.

    Have made this point as I`ve seen catastrophic results where AgNO3 was used in combination with Monochlor, the clinician believing that it was weaker than Trichlor !
     
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