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Multiple puncture technique for verrucae

Discussion in 'Australia' started by mak, Jul 8, 2009.

  1. mak

    mak Welcome New Poster

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    hi guys,
    ive been following a thread in the general discussion forum regarding this particular type of treatment for verrucae. it involves LA and needling of plantar warts to promote an immune response. wondering if anyone in or around Sydney has used it? keen to learn more.
    Last edited by a moderator: Jul 8, 2009
  2. MelbPod

    MelbPod Active Member

    I've used it in Melbourne
  3. naoglesby

    naoglesby Welcome New Poster

    I used it recently in Melb, applying LA to heel caused moderate but short lived discomfort for patient. Procedure went to plan, however I was only able to review with the patient at 1 and 6 weeks post op, so am unclear as to the long term results.
    Simple procedure to perform. Followed step by step guide as per Kirby.
  4. facfsfapwca

    facfsfapwca Active Member

    It was done in US.
    Anesthetize the area and needle the largest wart completely turn it to swiss cheese.
    A scab will form in a few days and all the other warts will start to disappear.
    I have suceeded with this and believe the sal acid method actually does the same thing.

    There is no literature and therefore i CANNOT SIGN MY NAME BUT SOMEONE NEEDS TO DO A STUDY!!!!!
  5. Paul Bowles

    Paul Bowles Well-Known Member

    You are stimulating an immune response - there are plenty of studies on treatments of VP's. Gary Dockery writes a bit about the above technique, and Kevin Kirby discusses it regularly. Personally if you are going to do this, I don't see why you wouldn't sharps excise it and phenolise the base - much easier and efficient. Basically by dong the above technique you are curretting the lesion anyhow.
  6. facfsfapwca

    facfsfapwca Active Member

    Curretting and phenolizing this is a very good and proven technique with supportive studies for singular VP lesions. This wasn't the topic why did you bring it up? But when you have multiple recurrent VPs (e.g. mosaic ) you can't do each one and besides the recurrence factor.
    needling is an interesting way to deal with many recurrent warts but again I have never seen or heard of a double blind study or any research done to cause an immune response. I am sure weekly treatment with strong acids may cause a immune response as recurrence is rare with this method as well. Kirby and Dockery have never done a double blind study on needling. Why did you mention them?
  7. drsarbes

    drsarbes Well-Known Member


    I started using this due to the difficulty in treating patients with recalcitrant multiple lesions; those that were not conducive to excision and quick recovery.

    Although quite skeptical at first, with the "prodding" of Dr. Kirby I have now done quite a few of these ( I haven't counted but at lease twenty) and have only had one that needed a repeat treatment. Most have been a needling of ONE lesion in patients with multiple lesions.

    To say the recurrence in excision/phenolization is rare is an overstatement. Whatever your definition of RARE is I doubt we can categorize the rate as RARE.

    In addition, I have never felt that I was initiating an immune response when I excised a verrucae. I do, however, think that it's quite obvious that the needling technique does.

    It's a very simple treatment that is MUCH less tender than excision (especially considering that not all the lesions are treated) and very successful.

    Visit the HELP WITH MOSAIC VERRUCAE thread.

  8. Paul Bowles

    Paul Bowles Well-Known Member

    I raised it because needling mosaic (or other) verrucae is nothing more than blunt curettage really. You turn the lesion to mush, then curettage it and then potentially phenolise it.

    This causes (hopefully) an immune response - and boom lesions resolved.

    The advice I have always issued this advice to patients (even with those pain in the rear end stubborn returning lesions): to stimulate an immune response any which way possible.
  9. Paul:

    Don't know if I can agree with you that the needling technique is "nothing more than blunt curettage". The needling technique probably works since the virus particle is being driven deep to the dermis, into the subcutaneous fat, stimulating an immune response. Rather, blunt curettage is performed (at least with the podiatrists that I know) by scraping the verrucae out of the foot at the epidermal-dermal junction, and then possibly phenolizing the base. Blunt curettage, if done properly, does not penetrate deep to the dermal-subcutaneous fat boundary. My clinical experience is that blunt curettage of one verrucae plantaris (vp) lesion does not cure vp lesions distant to the treated vp lesion. On the other hand, the needling technique can treat multiple verrucae on the same foot by only treating one vp lesion and can even be used to treat vp lesions on the contralateral foot.

    I would be interested if other clinicians have had the same anecdotal findings as I have had regarding the curettage versus needling techniques.
  10. Paul Bowles

    Paul Bowles Well-Known Member

    No worries Kevin - but an immune response is an immune response, any way you wish to look at it.

  11. Paul:

    How do you know that a verrucae plantaris currettement procedure produces an immune response to the virus?
  12. Paul Bowles

    Paul Bowles Well-Known Member

    The same way you know pushing into the subcutaneous fat does....

  13. Paul:

    So you are saying that when you currette one lesion of a mosaic verrucae, that this will then eliminate all the other warts of the mosaic verrucae within 4-8 weeks? I have never seen this happen, have you??
  14. Heather J Bassett

    Heather J Bassett Well-Known Member

    Thanks Kevin and Steve for looking in the Aussie forums and sharing your expertise.

  15. No worries!:drinks:drinks:wacko:
  16. drsarbes

    drsarbes Well-Known Member

    Hi Paul:

    When the needling is performed there is no curettage. The lesion is needled (turned to mush as you so aptly put it) and nothing more.

    If you'd like to curette after needling then go ahead, but it's not necessary, adds to the post op discomfort and does not increase the success rate.

    AND let's give Dr. Fraukner his due......it's NEEDLING not multiple puncture.

  17. Paul Bowles

    Paul Bowles Well-Known Member


    When you "needle" a mosaic verrucae are you not trying to stimulate an immune response?

    So if we follow that basic concept, you stimulate a localized immune response with acid, liquid nitrogen, needling, curretting bluntly or with a blade or however you want (banana skin anyone?) you should also resolve the lesions in the immediate vicinity. I am sure many of my colleagues will attest that treating large lesions in isolation often resolved satellite lesions as well who have had no treatment! Why? Immune response...

    Take it a step further and look at some of the research behind oral tagamet (cimetidine) . Sure no one is saying its ground breaking stuff, but it is suggestive of a cell mediated immune response upon taking it.

    Holy hell - so it stops acid reflux and fixes warts - this is the good gear! :D

    I have had multiple complicated mosaic verrucae patients (who could not have localized treatment such as those mentioned above for various reasons) respond well and completely resolve after 8-12 weeks of tagamet 300mg per day. Now those patients may have spontaneously resolved anyhow, but hey we could say that about all VP's we see and treat.

    Why do cheap chemist alternatives such as weak acids, corn pads etc...work? Immune response.

    Why does the cochrane database of reviews suggest one of the best treatments for verrucae pedis according to the literature is zinc oxide sports tape! Agast! Well not really, keep the tissue moist, add friction, it gets red and irritated and whoopee an immune response!

    No arguments from me here Kevin on needling, I had this advice from you almost 10 years ago and have used it since then - works a charm, but in concept every treatment for verrucae is essentially trying to achieve the same overall outcome - immune response.

    An immune response is exactly that - even by any other name!

    Interestingly there is a growing movement in Australian clinical practice to NOT treat verrucae in a healthy patient (especially teenagers) - why? Eventually there
    will be a cell mediated immune response and they will spontaneously resolve anyhow. Same principal as mentioned above! :eek:


  18. Paul:

    I didn't know that the public health services for both England and Australia have now decided to move toward not providing proper treatment for painful verrucae. Is this the case?? In my eyes, to force a teenager, or anyone, to live with such a painful lesion while waiting for the eventual "cell mediated immune response" to occur, is nothing more than a governmental agency trying to save money, all at the expense of the health and well being of their citizens.

    Let's hope that we all can do better than that for our patients.
  19. Paul Bowles

    Paul Bowles Well-Known Member

    Agreed to a large extent, however there are cases of isolated VP's in certain patients if they are non painful and do not appear to be spreading I do not bother treating.

    Thanks for the discussion Kevin - it's been interesting and hopefully it will stimulate some more talk in this thread.
  20. SandraN

    SandraN Welcome New Poster

    I would like to see some more recent research on this method (other than the 1969 Falknor article), any ideas?
  21. edgl

    edgl Welcome New Poster

    I think it all appears to be talk and "ideas" if there is no conclusive researched based evidence for either then nothing can be right or wrong.
  22. Sandra:

    Who is going to take the time to do it? Who is going to fund it? Will you??
  23. SandraN

    SandraN Welcome New Poster

    Edgl and Kevin:
    Thanks for your posts. I've enjoyed reading your input so far Kevin, and had hoped you or others could direct me to publications so that I could read a little more on the subject. As Edgl says, perhaps there's no right or wrong at this stage, but I would enjoy reading further studies if there is any other info out there.
  24. Paul Bowles

    Paul Bowles Well-Known Member

    1: J Am Podiatry Assoc. 1969 Feb;59(2):51-2.Links
    Needling--a new technique in verruca therapy.

    Falknor GW.

    Theres the PUBMED search...and original reference for this discussion.

    Click here for the clinicians version!

    Interesting how Bleomycin gets a fair amount of hits in a search - Kevin have you used this much? In Australia it has not been easy to gets your hands on...although I haven't tried recently.
  25. SandraN

    SandraN Welcome New Poster

    Thanks Paul, will read through the Google hits! :good:
  26. Paul Bowles

    Paul Bowles Well-Known Member

    Don't know if any will help - I was more making a point about how much useless info there is out there, rather than the useful stuff. Makes for a funny read anyhow.

  27. SandraN

    SandraN Welcome New Poster

    I see what you mean...........:wacko: LOL!
  28. Nina

    Nina Active Member

    When I did my top up degree a few years ago (I originally qualified in '83) I did a retrospective study on the blunt dissection of verrucae done the the School of Podiatry in Plymouth, of the lesions which were successfully erradicated all the untreated lesions resolved within 3 months of the original lesion being excised.
    I have never surgically excised vp's but have been successfully treating them for many years. It seemed to me from the cases I studied for my dissertation that the patients had considerable post operative pain and had a wound which took about 3 weeks to heal.
    I have used the needling technique on only a couple of patients so far but have found post operative pain to be minimal, only the simplest dry dressing is required and only for 24 hrs.
    I am now a huge fan of needling, it's simple, and highly effective.

  29. Paul Bowles

    Paul Bowles Well-Known Member

    I can't agree - I sharps resect and phenolize plantar lesions daily and I see patients reporting 1/10 on a VAS. Does it surprise me - a little, however using sharps we do not really traumatize tissue (such as a blunt curette) and I think this makes a massive difference.

    Its all about technique! There are numerous examples in bone surgery as well where good intra-op technique and dissection lead to less post op pain.
  30. Nina

    Nina Active Member

    Perhaps the cohort I studied had more post operaive pain because the majority were done by students. How long do you phenolise for?
  31. Paul Bowles

    Paul Bowles Well-Known Member

    I think they would have had more pain due to blunt technique...

    Also I apply phenol until cauterization of the lesion is apparent and the surrounding tissue is white due to the caustic nature of the phenol.
  32. perrypod

    perrypod Active Member

    I have joined this late. Firstly, as far as I am aware there is no clinical evidence for any one verrucae cure. Therefore, to date they have not greatly assisted in this particular area. Regarding this technique it is possible on some paients to use very thin acupuncture needles, or small biopuncture needles with little or no L.A. If the needles are sharp and thin, and the acupuncturist is skilled at relaxing and diverting the patient ( mild hypnosis for want of a better term), then a similar effect can be created, often with little or no pain. Sorry, I like Kevin have little time for carrying out clinical trials on the matter, so please feel free to shoot me down in flames!
    Best wishes to you all.
  33. Iain Johnston

    Iain Johnston Active Member

    Hi, Guys,

    Thanks for the insight, Kevin on Needling, I know this post is somewhat belated, but I was spurred to research a comment made by a patient about Duct Tape. She had apparently read about it in a local newspaper and it was claimed to have a 70% success rate!! :bang: Anyhow, I gently explained to her that if this was true, we would all be doing it. :pigs:
    Her case, has been a resilient lesion, which I have removed with the Radiolase, but it came back, then applied Marigold Therapy - a paste serived from marigold flowers for four weekly aplications, then a 2 month homework period with Tincture and Oil derived from the same. Active ingredient - Thuja. But still no response. So having found your thread on Needling, I thought what the hell, the patient was willing, so, lets see how it goes. Will update in a few weeks time.

  34. Paul Bowles

    Paul Bowles Well-Known Member

    Ian I think I recall a Cochrane review citing that ZO Tape was one of the most effective methods of treating VP's. Maybe your patient wasn't so wrong after all!
  35. RussAgg

    RussAgg Active Member

    Hi Paul
    Perhaps the low VAS reporting was due to the analgesic effect of phenol.
    We have done many excisions using electrosurgery with a high proportion of patients taking over 4 weeks to heal and high VAS readings. I must admit, I like the sound of the needling technique!
    Regards, Russ.
  36. Iain Johnston

    Iain Johnston Active Member

    Well, I managed to stick this chap, like a pincushion, possible as a direct result of the frustration I have had in dealing with his case. He presented with a serious case of multiple, long standing common and mosaic verrucae. He has been there and done that. Considering the sheers size and volume of the infestation, I utilised Marigold Therapy, and advised Cellfood, as a nutritional support with the intention of boosting his immune system.
    Well, I guess the only reason he keeps coming back, after six months and two series of marigold application (4x 1 weeks application paste, 8wks tincture and oil = 1 series) is because he has never felt healthier ie Cellfood :D.
    In any case, I had read up about the Needling, and he accepted a go.

    So I'll let you know in due course.

  37. Paul Bowles

    Paul Bowles Well-Known Member

    Yes I have read about that in the literature - however after 12 years I am still at a loss as to how phenol has an analgesic effect.
  38. piede

    piede Welcome New Poster

    I had a large v removed a few years ago.LA in the area not ankle block.The healing process was a little long winded but without complication or much scarring.However,I recently gained a few more on the same foot and the thought of going through that again, only this time with multiple V`s was not a pleasant prospect.I was advised to try needling and underwent the procedure on Monday this week.The only pain was the initial LA after that there was very little pain until later on during the evening but I would grade that more as discomfort than actual pain.I will see the results over the coming weeks I guess.
  39. whols

    whols Member

    For those that have used this tecnqiue in Australia, what item number do you use for private health funds? Is it just a standard consult and do you use a speciality code number? Any replies would be great.
  40. 123-girlfriday

    123-girlfriday Welcome New Poster

    Hi there, I'm currently looking at this subject for my dissertation too. Could you direct me towards any of the studies you used.

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