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Mosaic Verruca

Discussion in 'General Issues and Discussion Forum' started by SHudson, Oct 22, 2014.

  1. SHudson

    SHudson Member

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    Hi Everyone,

    I have been seeing a 32 year old female for approximately 6 months duration, she has mosaic plantar verruca present bilaterally for 12 years duration. Most of the lesions are on her heels and plantar B/2nd MTPJ areas. Her medical history includes a miscarriage at 26 weeks duration 12 months ago and she does not consume any vegetables or fruit. She has had further blood tests recently to check on her immune status and despite regularly getting colds, nothing remarkable has come back in her blood work. She has tried various over the counter preparations on and off for the past 12 years including wart off and duofilm with minimal success.
    Over the past 6 months I have tried cryotherapy and 60% salicylic acid which has resulted in reduction of the amount and size of lesions but overall they are still present.

    I have been reviewing some of the threads on verruca treatment on podiatry arena with great interest and I do find the number of available treatments for verruca to be quite overwhelming.
    I work in a remote part of Australia where we have a specialists visit every 3-6 months.
    I was wondering if anyone has had a similar experience to this one and any helpful hints for resolving these lesions will be greatly appreciated by both myself and the patient!!!
  2. simonfeet

    simonfeet Active Member

    Oh the intractable wart is the bain of every podiatrists life. I would've done exactly what you've done. In the British NHS, dermatologists are often reluctant to treat them full stop! How often does one hear the line, 'Oh they'll go in 2 years'. I've sometimes, out of shear desperation, suggested such patients use the onion or banana treatment . And sometimes its worked. Which makes one feel a bit of a fraud after going at the warts hammer & tong with orthodox treatments. Don't ask me how it works, I think the immune system just suddenly kicks in.
  3. Greg Fyfe

    Greg Fyfe Active Member

    I agree , a frustrating problem.

    I had a similar scenario, while working remote. Ultimately the client , who was about 13 yrs at the time,was referred to the nearest regional hospital where the visiting specialists electrodessicated both feet under general anaesthesia.

    6-8 mnths later there was still some thick looking skin around the affected areas so I don't know if the problem was cured, and I've not seen the client since.

    Like your client both feet were affected heels and forefoot, essentially weightbearing areas.

    From the threads falknors needling looks like it may be a possibility worth trying. If you could line up a supportive specialist who was happy to do a tibial block etc and any other support including client buy in :). It could be worth trying, especailly if the client needs to stay local.

    Personally I have not tried the needling , however one of the remote area nurses was prepared to use it on a client, so you may find a visiting specialist who is prepared to. Theres been an article in the Foot and Ankle journal on a case series thats been discussed on Podiatry Arena which you may have read.

    Alternativley referral to a bigger centre +/- dermatology?

    All the best.

    Last edited: Oct 28, 2014
  4. Greg Fyfe

    Greg Fyfe Active Member

  5. blinda

    blinda MVP

    Needling could well stimulate the desired cell-mediated inflammatory response in a patient with HPV-2 (mosaic) as there is less disturbance of cell differentiation throughout the entire thickness of the epidermis than HPV-1 & HPV-4.

    This is because HPV-2 produces limited vacuolization in the spiny and granular layers, leading to a honeycomb-like picture on histology as it proliferates. As the most superficial sub-type, this could explain the higher success rate with most treatment modalities.

  6. SHudson

    SHudson Member

    Thankyou Simon, Greg & Belinda for your posts, links and helpful hints. I think that I will present the dry needling to the patient as an option, particularly as the lesions have been there for 12 years a 6 month wait for a specialist isn't too long really!! There are so many treatment options available and it does seem like you have to keep trying different treatments as we have all seen what works for one patient doesn't necessarily work for the next patient you have for mosaic verruca
  7. Geoff Hull Footman

    Geoff Hull Footman Active Member

    Hi all
    Taking advantage of this post
    I have a new diabetic pt coming in Tuesday who informs me he has vp , he has been to his GP who did not want to treat his vp due to the diabetes. The needling method would be contraindicated and cautious approach needed .Robert Isaacs old dartboard choice of modality also ,as the guy probably won't stand still when I throw the dart :D ( Roberts posts seem to be sadly missing of late:boohoo:).
    Suggestions of suitable approach would be welcome.Should I get the old Glutarol out again?
  8. In a diabetic patient, needling should be a totally safe treatment as long as their arterial inflow is still good.
  9. blinda

    blinda MVP

    It would depend on their glycaemic control. I`ve performed TNA`s on pts with diabetes who have good control without adverse outcomes, which is a far more invasive procedure than needling VP`s.

    That said, any clinical condition which renders a pt `high risk` for delayed healing should be carefully considered for any treatment that creates a wound by tissue destruction; i.e. acids, cryotherapy, laser treatment or needling. In high risk patients, the option of `no treatment` is often most suitable, or utilising conservative care in purely offloading any painful lesion and frequent sharp reduction of overlying callus as the most appropriate treatment plan.

  10. blinda

    blinda MVP

    Same hymn sheet :drinks

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