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Monochloroacetic acid in verruca treatment

Discussion in 'General Issues and Discussion Forum' started by overton, Dec 10, 2012.

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  1. overton

    overton Welcome New Poster


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    Hi

    have a patient that has a very stubborn verruca. We have tried AgNO3, cryo and 60% salacylic acid on it for a number of months and have had only slight improvement.

    i want to try monochloroacetic acid on it but am unsure how to apply it. I have heard conflicting ways of doing it. Shouls I be applying a crystal directly, or with salacylic acid or should it be diluted? How long do u leave it on for and how many applications should be done???

    I know we covered it at uni but I honestly cant remember what was said now :confused:

    Any help would be grately appreciated
     
  2. davidh

    davidh Podiatry Arena Veteran

    Please forget the mono - refer to a Pod Surgeon.

    Mono and it's sister Tri are horrible treatments.
    Podophylum is equally nasty.

    These treatments were all we had in the UK before LA - nowadays we have much better resources available.
     
  3. Maybe a good time to revisit your lecture notes or textbooks.
     
  4. fishpod

    fishpod Well-Known Member

    Think natural resolution leave it alone / poss surgery
     
  5. David Smith

    David Smith Well-Known Member

    Why not try needling followed by debridement under LA. This works very well and all the v.p. bulk is gone immediately. I've attached a paper that might be of interest if you want to persue Monochloroacetic acid treatment but it did'nt do much better than just 10% Formaldehyde in this research trial.

    Regards Dave
     

    Attached Files:

  6. I agree with the Davids.

    You do get some fine destruction with Mono in combination with sal acid. However its extremely hard to gauge exactly how much distruction. Don't be fooled by its innocent appearance and the lack of drama involved in its application, this is a very aggressive treatment and very easy to overdo. You can blow a hole in somebody with astonishing ease using mono.

    My advice would be to find someone who does either Needling or electrodessication and refer it to them.

    If you want to go hardcore these are both (IMO) safer ways with a more controlled level of destruction and a better chance of resolution with lower risk to the patient.
     
  7. blinda

    blinda MVP

    Hi Overton,

    First of all :welcome: to the Arena!

    When you are presenting a case for advice, it is always useful to provide as much information as possible, ie;
    • Age and sex of pt
    • Onset and duration
    • Med Hx
    • Previous tx, etc, etc

    All of the above advice is sound. If the pt is young and the lesion is not painful, I would take fishpods advice and apply a `Tincture of Time` (courtesy of Rob Kidd :drinks).

    However, if intervention is required, I would use mono with caution for the resaons Robert outlined.

    Cheers,
    Bel
     
  8. sspod2001

    sspod2001 Active Member

    Plantars warts can be very frustrating to treat due to the wide variation in success of the various treatments available. As you have tried several methods with little resolution I would try an occlusive hydrocolloid dressing (granuflex, duoderm extra thin or Compeed blister plaster) for a period of 8 weeks changing the dressing every week. Pt to return for vp debridement at the end of the 8 week period.
    This is just another angle for you to try and play to help your patient its also cheap and painless.
    good luck.
     
  9. David Smith

    David Smith Well-Known Member

    CHEAP! I don't like cheap :eek: At least make it cheap and painful but better is expensive and painless. Surely, give him cheap and painless and everyone will want it. :D

    Dave
     
  10. sspod2001

    sspod2001 Active Member

    LOL :) good point Dave.
     
  11. SingaPod

    SingaPod Member

    Hi recent graduate here but my university had huge numbers of VP patients so I have some experience with a range of treatments.

    I would be reluctant to use monochlor myself as I have heard numerous scare stories and seen the aftermath of past treatment gone wrong (none that were treated at my university thankfully).

    I found trichlor to be quite effective and wheatgerm and Pyrogalol (hopefully spelt correctly) to also be quite useful. As long as patients are compliant and they are seen regularly then there seem to be few problems. Obviously a non-compliant or sensory impaired patient should be avoided, or if there is limited flesh under the VP.

    What kind of Cryo are you using, is it the aerosol variety or the more heavy duty liquid nitrogen type? I have never seen any VPs resolve with the aerosol though I have seen some improvement over time.

    If it isn't painful/is only mildly painful you could always offer offloading and simple palliative care, i.e. debridement and Silver Nitrate.
     
  12. rosherville

    rosherville Active Member

    Overton's question prompts me to ask 'what are undergrads taught re. vp treatment' ?

    In the hands of the skilled and experienced monochlor can be quite effective !
     
  13. Admin2

    Admin2 Administrator Staff Member

    The latest newsletter from the Board in Australia has this statement:
    http://www.podiatryboard.gov.au/News/2013-07-15-Communique.aspx
     
  14. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Monochloroacetic Acid Application is an Effective Alternative to Cryotherapy for Common and Plantar Warts in Primary Care: a Randomized Controlled Trial
    Sjoerd C Bruggink, Jacobijn Gussekloo, Paulette F Egberts, Jan Nico Bouwes Bavinck, Margot WM de Waal, Willem JJ Assendelft and Just AH Eekhof
    Journal of Investigative Dermatology accepted article preview 13 January 2015
     
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