The holy grail of effective verruca treatment

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I have always considered that an effective verruca treatment to be the holy grail for the private podiatrist. I was just interested to to hear others views on the subject in regards to private practice.

 

Re: The holy grail

Well then call off the search, because we now have a treatment proven 99.9% effective.

http://www.laser-onychomycosis.co.uk/files/other/Warts_Verrucae_Presentation_2010.pdf

The Laser is actually for OM, but as a little throwaway, they also mention it cures verruca.



Do you expect me to talk?

 

Re: The holy grail

No. I expect to cure you of your genital warts, Mr Bond. After all, you have been with Pussy Galore.


I thank you.

 

I'm quite interested in the Holy Grail and all things Arthurian, both in the romances of Malory and De Troyes etc. and the shadowy historical 'knights'.

Expert opinion is divided. One strong contender is that the grail was the expression of the divine female principle lost with the advent of christianity. However, the more probable explanation is that it was (and is) the inexpressible unobtainable, the mystic 'meaning' for which we all search in one way or another and which none but the perfect knight, Galahad (who was a later - cardboard - interpolation to make the old pagan tales acceptable to the powers that be) could attain.

I suspect that like the knights, you will be rewarded by the quest and the inherent personal challenge, but your Holy Grail will remain as elusive as the original for the very good reason that it does not exist - probably!

Bill Liggins

 

Just wondering if anyone has had any success with the use of Canthrone as a VP treatment?

Cheers.

 

Personally, I would apply a tincture of time - do nothing unless the patient is immuno-supressed.

 

What if it hurts?

 

Easy!!!

You could check to see whether the patient has a 'Rothbart's Foot' and if, so, treat that with a 'Dudley Morton' insole! That might work? igs:

After all, Rothbart's foot seems to be the root cause of many foot-related maladies....and more. It has even been cited as a possible cause of death! :dizzy: Anyway, professor Rothbart seems to think so, and he does have a PhD!

I suddenly feel so enlightened! :deadhorse:

Am I convincing anyone?

 

I would change Rob Kidd's "time" to "patience while treating".

I bring my wart patients in every single week. One week I use Histofreezer plus 60% sal acid dressed under occlusion. The following week I use Histofreezer plus 90% silver nitrate. And so on...

I have great success with this method because each time you use something different on the wart it gets "confused" so it has no time to mutate and cause resistance; thereby narrowing the treatment window of the darn things!

:boxing:

 

An interesting view. Confusion as an antidote to mutation.

When I was at school that method was referred to as "spray and pray" but I guess if it works.

I await Bels view on mutating VPs...

 

Dear All,

I am reassured that our knowledge and skill at t/t a viral infection has not progressed one jot in 15 years or more.

It is a viral infection so topical agents probably hopeless.

The NHS in my area stopped t/t of VP's years ago as it was considered a complete waste of time t/t the damned things.

Evidence supports that no t/t is the only clinically proven modality. 90% resolve in 2 years with no t/t.

As i have said before the only t/t on the horizon is the vaccination for HPV as anecdotal evidence has suggested that VP's resolve after the vaccination.

In my area they are promoting the vaccination for young females, so they still have not realsied that in a few years non vaccinated boys will meet the vaccinated girls.

I understood that it was the intention to vaccinate both boys and girls, obviously this has not happened.:deadhorse:

David

 

Ag cis, Jay

You're not a thousand miles away from what current literature indicates, but won't you first define your interpretation of a mutating vp?

'Darn things' = lekker terminology

Cheers,
Bel

 

mutating vp its abit like a ninja turtle. i wish patients only presented with one vp in a good area bish bosh bit of local electosurgery vp be gone unfortunateley they present with 6 7 20 vps both feet so treating becomes a waste of time both for the pt and the practitioner. i vote robb kid on this one.

 

Yep, I would agree with that. Unless, of course, it is painful and/or the lesion interferes with QOL. Out of interest, Rob, why and how would you treat an immune-suppressed pt?

My armamentarium consists of; Sal A, currettage, needling and no treatment.

This is an excerpt from a presentation that I am working on;

It`s important to reassure pts that HPV`s are benign tumours. Some types can undergo malignant change BUT NOT PLANTAR WARTS! Only specific genital warts (HPV 16 & 18) have been linked to cervical and penile cancers.

Hope that`s useful.

Cheers,
Bel

NB: We briefly discussed how HPV evades the immune system here

 

Point entirely taken - have always said that. Last time I treated a wart was 1979 - and then it was either nothing, or electro desiccation under LA

 

Viruses mutate; even our little wart friends! I have just found that it is more difficult for me to treat a wart that many other practitioners have been unable to erradicate before... That's why I love the "virgin" warts, which have not been touched by any treatment modality, because then I can clear it much quicker than if it had treatment before.

...So that's what I mean by "mutate" in my previous post.

In response to David; my exoerience is that patients want me to treat the wart regardless of me telling them that it should resolve by itself. They feel "dirty" and want it "out"!

 

JaY,

I love your quirky terminology!

But, I don`t think the word `mutate` is correct in this context. Not all viruses mutate.

Verrucae are benign tumours, caused by infection of keratinocytes by the double stranded DNA Human Papilloma Virus. DNA viruses do not mutate (*see below). I think the recalcitrant warts you are observing is due to the virus cleverly evading the host immune system. It is the virus` job to do this, create more copies of itself and spread to other hosts. The characteristics that help a virus to replicate tend to be kept from one generation to another. Characteristics that make it difficult for the virus to spread to another host tend to be lost. This is where adaptation, rather than mutation, comes into play as shown in the attached article by Frazer.

Most research and treatments of HPV are aimed at creating an enhanced systemic immune response to eradicate the virus (or reduce viral load), specifically a cell-mediated response, which is neither predictable or 100% successful for every pt, yet.

Cheers,
Bel



Loosely taken from this website;

 

A good reference here guys. Thank-you very much for the information. I have a fascination with Virology. This is simply feeding the habit - Shame on you!

 

Am rightly and deeply ashamed `all right for kicks... you found out that it's a habit that sticks` - Buzzcocks.

Just to update my previous posts; the Quadrivalent Human Papillomavirus vaccine which is now being offered to both pre-teen boys `n gals is the way to go. Whilst this tx is sub-type specific (HPV-16, HPV-18, HPV-6 & HPV-11 only) the same technology will hopefully be utilised to vaccinate specifically against the benign HPV sub-types that we see on the hands & feet, that is predominatley HPV-1, HPV-2 & HPV-4.

Cheers,
9 fingered Bel:drinks

 

Re: The holy grail

Wow Simon that was truly one of the best responses every! Hahahaha!
Thank you sincerely for that!
:drinks
Bruce

 

Re: The holy grail

I use Cryo in office every 2 weeks, 27.5% sal acid applied by the patient daily along with Effudex 1% applied daily as well. That has a pretty good coverage and cure rate. When that fails I will attempt Aldara cream for a short time if outpatient treatment is not an option. When outpatient sx is an option we will usually use pulsed-dye laser as it has little scar risk. If none of that works I will use CO2 laser excision with topical aldara cream q3-4 days. That last treatment probably works best but has delayed healing times due to the use of the Aldara and risk for scaring due to the CO2 laser.
Finally, don't forget moisture management by getting the patients out of cotton socks and into wool or polyester socks instead. This makes a huge difference as well imho.
cheers
Bruce

 

Re: The holy grail

Hi Bruce,

Unfortunately, neither Efudex nor Aldara is licensed for podiatric use in the UK, we have a relatively small armamentarium in comparison to you guys :bang:

But, I am interested in your thinking on the moisture management of HPV. Why would you recommend a moist environment? Not disagreeing with you, just intrigued.

Cheers,
Bel