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Old Corn Treatment: WP

Discussion in 'General Issues and Discussion Forum' started by M Staines, Dec 13, 2007.

  1. M Staines

    M Staines Member


    Members do not see these Ads. Sign Up.
    The NHS has become very restrictive in the agents/medicaments one can use.
    This may largely be due to potential cost....Evidence base...Risk....simplification etc.

    I used Wheatgerm Pyrogallol at University, on a few fibrous corns. It worked. Not curative but with two to three consecutive treatments the corns diminished in size and the degree of pain and recurrence of pain, dropped in over 80% of the patients.

    Does anyone else still use this agent. Any thoughts out there??

    Nothing too rude please
    http://www.podiatry-arena.com/podiatry-forum/images/smilies/confused.gif
    :confused:
    Tripod
     
  2. Daniel Bagnall

    Daniel Bagnall Active Member

    Re: Old Corn Treatment Wp

    Hi Tripod,

    I cant say that I use "Wheatgerm Pyrogallol" or any chemicals for corn tx. I perform good old fashioned scalpel debridement, and enucleate and centre. I still find this to be the most effective and efficient method. However, it took time and patience to confidently master this method.

    Regards,

    Dan
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. Cameron

    Cameron Well-Known Member

    M Stains

    Wheatgerm Pyrogallol still in use??

    I suppose so. The treatment was a combination of a caustic, Pyrogallol (a reducing agent ie takes O2 out of the tissues); and Vit E cream (wheatgerm). Pyro is thought to have a surface analgesic effect and was used in the treatment of neuro-vascular corns. The major drawback (apart for expense) was pyro has an acculmulative effect and can be toxic to the tissues. Hence only two or three applications were advocated. Care is necessasry is masking the surrounding skin when the acid is applied otherwise the paste slips (or trasks) destroying normal skin. The Vit E cream comes from the idea that Vit E is good for fibrous tissue (keloids) and by quasi logic would be useful in the treatment of fibrous corns. However the likely hood a topical applications could penetrate to the level of connective tissue is most unlikely. The thicker paste with Vit E cream would give a buffering median which might offer helpful resistance to sheer across the lesion.

    In the 60s a treatment known as 'pyroblitz' was advocated by many 'experts' and there are several occassional papers on carpet bombing, chronic fibrous corns. Thee are safer alternatives now which carry less conditions. Risk, cost and limited shelf life will probably see pyro relegated not just to the BPC but from most podiatry surgeries.

    toeslayer
     
  5. M Staines

    M Staines Member

    Sorry Daniel, I should have been more detailed.

    The use of WP is in combination with good enucleation followed by the use of WPand the masking of the surrounding skin.

    I would suggest that in 90% of patients with fibrous/NV corns I've used this on (in the past 16 years) they have had a marked improvement in pain relief and a reduced frequency of treatments.

    My thread is really to discover whether any other Pods have any experience that matches this?

    Tripod
     
  6. I used to love that stuff. Swore by it. Then as cameron said it was found to be toxic (i thought it was carcinogenic actually) and pharmacy would not get it any more.

    A shame.

    Oh well.

    Robert
     
  7. zaffie

    zaffie Active Member

    I too used this a great deal about 100 years ago. Found it very effective. I also heard it was carcinogenic. Have not been able to get hold of it for a long time.:(
    Now I sometimes use Emla cream post and pre op on the neuro vasc I see.
     
  8. M Staines

    M Staines Member

    Life is carcinogenic.

    No doubt inhaling for 300,000 years or bathing in it for several years will do the trick.

    Copme on someone send me the COSHH that states it's more carcinogenic than plutonium

    Damn the CIA listening station has pointed all it's satellites and AWACS at me.

    My source is Podiatry Arena.......... Interogate them not me

    Cheers all from a cynical Tripod
     
  9. Denny

    Denny Member

    Dare I admit it , but I still use WP on neurovascular corns with great results. Have never had problems with it burning surrounding skin as I use it minimally to the freshly enucleated area. I bought a small jar (approx. 25gms) 4 years ago in the Uk from the company that took over footmans (sorry the name escapes me).
    I still have more than half left and treasure it as it is not available in NZ.
    Denise
     
  10. :eek:

    Have you looked at the use by?! Its got quite a short shelf life!
     
  11. twirly

    twirly Well-Known Member

    Denny,

    Is it legal to transport that sorta stuff to another country without a carriers licence?

    Plus ditto Robert & short shelf life (pyro not Robert he's timeless).


    2nd note to Zaffie,

    Hello :)

    RE: emla cream, do you follow the advice RE: apply 1hour pre-op under an occlusive dressing?

    Seems ineffective otherwise.

    Perhaps I misinterpreted the instructions. (I do that when I cook too, my family eat out a lot) :eek:

    Seasonal cheer to those who bothered to shop. (unlike me) :D
     
  12. We used to get Dave Ashcroft down from "The Society" to give students one of their lectures on medico-legal issues. T'was my understanding from him that pyrogallol was responsible for the most claims against members of the Society. Food for thought.

    I always preferred the marijuana poultice technique for the treatment of corns which I found in an antique text.:santa2:
     
  13. My experience of emla is that it is great on mucous membranes- can I tempt you with a piercing madam? But rubbish on plantar skin- even with occlusion for a couple of hours.
     
  14. zaffie

    zaffie Active Member

    Hi Twirly and Simon
    I have had great success with Emla. Yes it needs occlusion for a couple of hours, but it has enabled me to operate on lesions I could not get any where near without it.
     
  15. twirly

    twirly Well-Known Member

    Thanks for the offer of piercings Simon,

    I have my full quota already ta. (7 to date, my mothers appalled!) ;) I think you'll find its the 17stone rugger players that need the ''there there'' cream pre op :D

    Big boys do so cry :rolleyes:

    Zaffie, I am certain I have read somewhere (can't find article but will keep searching, I think was in Pod mag) a clinician recommended phenol wiped over pre op n/v area as an analgesic.

    Like I say, I cant find the original Ref. but will keep you posted if I do.

    Regards, :drinks
     
  16. Cameron

    Cameron Well-Known Member

    twirly

    Phenol (80%) and an alternative nitric acid were recommended as analgesics on painful corns many years ago. Appear in Reif and Le Rossignol but would be considered too risky these days.

    As to out of date pyro, it will gain in strength and the practitior (end user) is legally responsible for any complications that may result from its application.

    :santa2:
    toeslayer
     
  17. twirly

    twirly Well-Known Member

    Thanks Mr Slayer Sir,

    Thought I had seen it somewhere. Been trawling through ref books here for ages. :bash:

    I secretly think your'e quite smashing ;)

    Regards muchly,
     
  18. zaffie

    zaffie Active Member

    Hi
    Dare i say i have used phenol pre op. Have not found it as effective as Emla. With you Twirly "big boys" always require "special treatment" especially when they faint!!:D
     
  19. Leigh Shaw

    Leigh Shaw Active Member

    I too remember using this and lament its dimise. The last time I got hold of some was 15years ago when a tame chemist made it up for me. Have since used silver nitrate sticks to some effect but not as good as WP.
     
  20. Cameron

    Cameron Well-Known Member

    netizens

    Pharmaceutical companies estimate the shelf life (and then expiration date) of a drug to determine the amount of time the drug is at acceptable potency, colour, etc., levels. The acceptable levels are set by the pharmaceutical company or the Food and Drug Administration. The process in which the shelf life is determined is called a stability analysis. The shelf life of a drug is loosely defined as the length of time a drug can stay on the shelf without degrading to unacceptable levels.
    Pyrogallol by itself in an acidic solution and has a good shelf life but mixed preparations, much less. It is difficult to guestimate but three months would probably be the full limit of shelf life. After that period uncertainty of the preparation's capabilitie would preclude its use despite its apparent success.

    toeslayer
     
  21. Cameron

    Cameron Well-Known Member

    twirly

    >I secretly think your'e quite smashing
    :santa2:

    Your secret is out now and yes, since I have been Elf'd my appeal to both males and females has apparently increased. I along with David Beckham, am metro-sexual, and a bella figure which of course is wasted here in Western Australia since WA men are only in touch with their female side when accompanied by a woman. :boohoo:

    You have exquisite taste twirly. Keep it up

    toesalyer:morning:
     
  22. twirly

    twirly Well-Known Member

    Leigh,

    I have to thank you.

    Am having mental pic of said chemist looking like an extra off Life of Brian, & all other chemists in a safety cage.


    :D
     
  23. Denny

    Denny Member

    Regarding the expiry dates - every time i contact the local pharmacy they assure me it's just a government requirement and acids don't expire - contamination is more of a risk.

    As to transporting substances, well no one asked so what was to tell.
    I did get picked up at customs by having a scaple in my hand bag. Unbeknown to me a scapel handle has fallen thru the linning but once they realised it was bladeless they couldn't have cared less. My partner wasn't impressed though!
     
  24. I must admit i did find you eeriely attractive in green tights and a bobble hat. :eek:

    Hey there good lookin'

    Love and kisses
    Robert
     
  25. Leigh Shaw

    Leigh Shaw Active Member

    Very apt as it happens, complete with malphasic gait!!
     
  26. twirly

    twirly Well-Known Member

    Medicament of choice?

    I have been browsing the verruca threads for inspiration. Happened upon this one & decided to revisit in hope of others views.

    I have within my arsenal of medicaments:
    Monochloroacetic acid
    Pryogallol (40% w/w) Wheatgerm oil (25% w/w) in Wool alcohols.
    Sal' acid 70% & 60%

    Pt. Male aged 45. In good health no underlying medical history of note. Non smoker. Excellant peripheral circulation. Active lifestyle. Jogging, walking regularly etc.

    Presented with verruca (single lesion) plantar 1st met' Left foot.
    Lesion is non painful & I initially advised if non problematic that in time the lesion should resolve without intervention. I also advised that some vp treatments may create more problems potentially than the initial lesion.

    I have previously (at the patients request for treatment) debrided the area, masked the lesion & applied 70% Sal' acid then further debrided 5-7 days later requesting the pt. keeps the area dry.

    4 treatments later & no change. I am open to suggestions/thoughts on if to encourage the patient to allow his immunity to eventually respond to the virus or bring in the 'BIG GUNS' eg. Pyrogallol or similar.

    I welcome your thoughts.

    Many thanks,

    Mandy.
     
  27. Cameron

    Cameron Well-Known Member

    Twirly

    Not everyone responds to keratolytics and even when you apply reducing agents this too may have no apparent effect. The therapeutic object is to create a dermal epidermal blister which cradles the wart and susequent removal and debridgement takes the infected section away. In a healthy individual such as you describe the inclusion of a monochloracetic acid crystal into sla paste may accelerate breakdown but often this adds to the general discomfort. I have always found cryotherapy to be at least a plausible alternative and certainly have never failed with herbal treatments of kalanchoe.

    It is possible if the lesion is not actually a wart then treatments will appear to be ineffectual. Sometimes it pays dividends to suspend caustics to be able to closely inspect the striations of the skin. That way you may be able to do a differential diagnoses based on the presentce of a cricumscribed lesion.

    cheers
    toeslayer
     
  28. DAVOhorn

    DAVOhorn Well-Known Member

    Dear Twirly,

    How about CRYO.

    I use cryo almost exclusively for last 20 odd years.

    Can be persuaded to occassionally use 95% AgNO3.

    As with all chemical t/t i have ALWAYS found the primary problem is the DAMNED PATIENT with compliance and the following advice given.:bash:

    DO NOT GET FEET WET!!!!:deadhorse:

    usually results in i ONLY HAD A QUICK SHOWER.:butcher:

    Also do not remove dressing as the acid will smear.

    Guess what they love to peel the dressing back to have a look and get the acid used all over the foot and their hands etc etc.:bang:

    A FAIL SAFE is to consider all patients IMBECILES that way you get few adverse outcomes and you are occassionally you are surprised that patient listened to whhat one said to them.

    Stick to CRYO.:drinks

    regards david

    ps I seem to remember you pledged your troth to me last year
     
  29. twirly

    twirly Well-Known Member

    Hi DAVO, :D

    Have you a particular cryo device you would recommend? So many to choose from & you know how girls are so bad at making a decision....:rolleyes:

    Also sweety,

    I do that a lot! Gets me into all sorts of bother. :empathy:

    In truth my troth is all over the place. Last seen setting sail in search of a Mini Cooper <S> :sinking:

    Fondest regards,

    Mand'
     
  30. DAVOhorn

    DAVOhorn Well-Known Member

    Dear Twirly,

    I am Bereft.:sinking:

    Anyway in my NHS job in UK we used Liquid Nitrogen which is still my choice.

    But here in Aus we use Histofreeze which is not as cold so application is longer.

    A MINI COOPER S ?????

    Here in Aus i want a FORD FPV F6R 305kw and it is about 65k$ here in aus which is not much more than a MINI here. But in will out run some serious competition.:drinks

    David

    from the Antipodes
     
  31. pgcarter

    pgcarter Well-Known Member

    Along this line of aged chemical magic, can any one offer me any feed back on a mixture of "spirits of camphor" added to baking soda to make a paste, which is then rubbed into the dry "glassy" areas of tissue most prone to develop multiple corn nuclei? I have seen one case of use, with what appears to be a genuinely miraculous change in the nature of the skin of the area. This is used along with normal enucleation of already existing corns. Cameron, you seem to know just about everything about everything......
    regards Phill Carter
     
  32. Trevor Hudson

    Trevor Hudson Member

    Hi Denny
    The Co. that took over from Footman is Mobilis healthcare group, Tele:44 (0) 1616780233, fax 44 (0) 1616274401, E-mail info@mobilishealthcare.com
     
  33. Cameron

    Cameron Well-Known Member

    Phill et al

    To the best of my knowledge Rectified Camphor Oil BPC 1959 (Essential Oil of Camphor) was used with equal quantity of a vegetable oil as a counter irritant and mild analgesic. It was also used in the form of camphorated oil (20% camphor). When applied to the skin the preparation acted as a surface analgesic. The bicarbonate of soda might stiffen the application and does have amphoteric properties which would react with any acids and bases, present. Sodium bicarbonate would also have the potential to affect the pH of the skin, otherwise it’s fairly innoculious. Certainly is cited as useful on corns (http://www.meridianinstitute.com/echerb/Files/1camphor.html) but I would think it would be a post op analgesia rather than corn cure per se.

    toeslayer
     
  34. bob

    bob Active Member

    It's not painful, so why not get him to try the usual 'off the shelf' stuff himself? Last thing you want to do is cause the guy some pain. Having said that, how long has he had it? Is it definitely a verruca? How big is it? Has it changed in size or shape? No lumps or bumps anywhere else on his body?

    Best of luck :santa::santa::santa::santa::santa::santa:
     
  35. twirly

    twirly Well-Known Member

    Hi Bob (in a house) :D


    Lesion > 2 years duration.
    He has previously used over the counter remedies to little/no effect.
    Although non-painful he is very keen to try another remedy (even if causes discomfort) to induce (hopefully)resolution.

    IMO yes 100% verruca. Interrupted striations at lesions edge.(no rolled edges indicating anything more sinister) etc.

    I have (in last 3 weeks) applied pryogallol in wheatgerm to the lesion after debriding & masking the area. Pt. has returned for final of 3 applications for final debridement & I have advised him to basically wait for immunity to have an effect. I am hoping this will occur following t/x as there is inflammation present locally.

    I am also following Kevin Kirby's 'needling' discussion for updates from Steve Arbes recent v/p needling for his outcomes. I would be keen to offer this as an alternative (& hopefully more reliable t/x) to previous treatment methods. However this pt. is needle shy so would prefer to avoid an ankle block if the pryo' can provide the desired outcome.

    As for other 'lumps & bumps' I have thoroughly scrutinised his lower legs & feet & nothing untoward evident. I drew the line at a full body search & was happy to just ask the chap if any other skin lesions were present under his clothes. ;)
     
  36. bob

    bob Active Member

    Have you or admin got a link to these posts?

    How big is the lesion on your patient?

    :santa::santa2::santa::santa2::santa::santa2:
     
  37. twirly

    twirly Well-Known Member

  38. bob

    bob Active Member

    Hmm, fair enough. I was thinking about more sinister differential diagnoses, but it does sound very verrucaey.

    Interesting thread on the multiple stab approach. My only concern would be seeding malignancies if the verruca did turn out to be a more sinister lesion!

    Wooooooo!

    ;):D:empathy::eek::cool::good:
     
  39. twirly

    twirly Well-Known Member

    verrucaey. added this to my clinical description. Right beside verrucaesque. ;)

    Please stop you are scaring the children!

    :drinks :dizzy: :butcher:
     
  40. bob

    bob Active Member

    I know, been in some medico-legal trust rubbish bored fall asleep lecture thing so I'm looking to the darkside.

    :cool::cool::cool::cool::cool::cool:
     
    Last edited: Mar 18, 2009
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