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Good day to all!

I wonder if you experienced and esteemed folks could shed light on a recent dispute:

Clinic 1: uses monochlor acid crystals with 60% salicylic acid paste for treatment of VPs. Both are applied with a dressing, patients are booked in 24 hours later for removal. A big deal is made of the fact that it is a strong treatment, and a 'caustics consent' form is signed by the patient before application.

Clinic 2: same application, but patients are advised to keep the dressing on for 3-5 days. No form is signed.

Clinic 2 is somewhat shocked that Clinic 1 is only putting on the caustic for 24 hours...Clinic 1 thinks Clinic 2 is on fast track to being sued. I happen to work for both, and am confused.

Who is correct?

 

I was always under the impression that monochlor was pretty powerful stuff and was rarely used. I use Trichlor + 60% sal through aperture padding, dressing changed after 3-4 days and kept dry, with written instructions on removal if painful etc and to call me if queries or problems. But I only use this on healthy compliant pts and wouldn't use it as a first tx on a new pt. (Some pts are freaked out with using Duofilm for the first time!) Is there much debris to remove after 24 hours with monochlor and sal? Is there much difference (pain wise) for the patient between leaving it for 24hrs and 3-5 days?

 

I always asumed it was an issue of tissue destruction rather than pain per se...that monochlor isn't self-limiting, and simply carries on working, the longer you leave it on. This is what I have been taught, but it appears I am wrong.

I wondered if this disagreement is linked to the length of time in practice: I only qualified 3 years ago, and these other folk have been working for 25+ years. They seemed a little non-plussed when I asked them about the evidence base for their practice.

 

I know this is an old post but can others expand on their treatment of warts? And secondly, on the use of monochlor which has been my mainstay of treatment. But hwo do you use it. I receive the monochlor as crystals. Some somehow make this into a solution but I am not sure how. Can someone expand on this procedure. And further, do you apply crystals directly to the wart - what amount?

 

Guys go to the thread titled 'Verruca treatment - KOH?' in The general issues for discussion forum. Have a read of that thread as there are a few good ideas on Tx.

Trent

 

netizesn

The two (very) old text which deal with this type of thing are:

Read PJ 1972 An introduction to therapeutics for chiropodists London Actinic Press

and

Le Rossignol JN & Holliday CB 1971 A pharmacopoeia for chiropodists London Faber and Faber

You can also try the BNF because the treatment is rather old ( but no less effective).

Monochlorocetic acid hydrolises proteins and has a strong penetrative action. It can cause considerable pain so should be applied with caution. Salicylic acid is keratolytic which softens keratin causing it to exfoliate.

Read recommends a return date of between 5-7 days when combined treatment is used.

>how do you apply crystals directly to the wart - what amount?

One small to medium size crystal is placed on the sal ointment (skin side). Usually the ointment is housed in a cavity within the padding. Mask the healthy tissues by ringing the wart. Hold the final padding with occlusive strapping. Change every 5-7days until breakdown.

If you are using a crystal alone (exercise care for the bigger ones are brittle) use forcepts to hold under running water , carefully dry excess water from crystal with cotton wool , then direct crystal to the skin surface and rub area with vigour. Not a technique that I would recommend.

toeslayer

 

Hi all,

I've used monochlor in many different ways over the years. I often paint a saturated solution over verrucae after debridement then covering with a hypo allergenic strapping. The destruction can be nothing much to a nice blistered breakdown. It is less dramatic then the nuclear option of using mono xtals and more ammenable to the patient. I always book a return appt for 7 days with the proviso that the patient is not in intolerable discomfort. If they are they need to return sooner. This method seems to work OK but is never guaranteed to work on everyone. Occasionally I use a mono xtal and sometimes silver nitrate. Will there ever be a verrucae treatment that works for everyone?

 

How do you produce your saturated solution? Do you make it yourself from crystals (if so, how) or purchase it already made up?

 

markleigh

You buy the crystals and make a saturated soln by disolving them in water until some crystals are visible (saturated soln). I would imagine it is volatile mixture and hence you would need to make up fresh solutions each time. The alterative is as I suggested (below) ie wet a crysal and rub the soln on the skin surface.

toeslayer