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Dear Colleagues

Please find below a recent case of interest. I have been following the growing enthusiasm in Falknor's needling technique for over a decade. Having had mixed results in the past, I was grateful to see the growing evidence base in recent times. Because of the location of these two clusters of common warts (verruca vulgaris - usually HPV types 2 and 4) on the posterior aspect of the calcaneus and overlying the tendo Achilles, I chose to apply this technique over more aggressive methods. I hadn't seen much discussion on the use of this method for common wart phenotypes, rather than plantar warts - so my patient was kind enough to consent to me sharing these images.

This 63yo female has hypothyroidism and depression, and takes thyroxine and an SSRI. No other significant medical or surgical history of relevance. She had developed these lesions about 2 years ago, which had improved temporarily with her GP providing electrocautery/hyfrecation, but had since redeveloped and spread further - with a new cluster developing more inferiorly overlying the tendo Achilles insertion. At the time of procedure, I debulked the majority of the lesions due to associated problems with footwear irritation - but made no attempt to fully curettage any of the wart tissue. Needling was done with a combination of both 27 and 18g bevelled needles.

At week 4 there is still some slight epidermal thickening and mild erythema, but no gross evidence of verruca tissue. It may be that that this technique might have broader applications to other wart phenotypes beyond plantar warts (usually HPV Type 1). Will advise if any recurrences occur over next 6-12 months.