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Mosaic verrucae-help with treatment

Discussion in 'General Issues and Discussion Forum' started by poppet, Feb 27, 2009.

  1. blinda

    blinda MVP

    No worries, Del and Linda,

    My reputation was sullied long ago....enough fluff for now, normal service should now commence.

    Still researching immunology in relation to HPV and cell mediated immune response, fascinating stuff...but don`t expect anything concrete for some time.

    Cheers,
    Bel
     
  2. rachel.liminton

    rachel.liminton Active Member

    Am in the same boat with a young lad , 15 yrs old...tried everything, just read a recent article from Podiatry Now re 5% imiquimod cream...any other views on this?
     
  3. Bel:

    Have you all made any progress toward that paper on the needling technique? I think a paper on this subject would be a very valuable addition to the worldwide medical literature.
     
  4. blinda

    blinda MVP

    Hi Kevin,

    As you know, we were going to write up case studies on the needling technique, but then decided to take it a step further and began investigating the possibility of undertaking a trial. This has proved to be quite challenging, particularly with restrictions for research in private practice in the UK. However, I remain optimistic. It`s going to be a long haul!

    Cheers,
    Bel
     
  5. Sounds like it will be a long haul. Unfortunately, there is little to no money in studying simple treatments....the money only comes when studying the expensive treatments.

    This is one of the unfortunate realities for the population of our small planet: simple and inexpensive treatments are much less likely to have good research projects done on their efficacy. These treatments then can never be "evidence-based" without research. Therefore, patients and physicians are not necessarily getting the best treatments when they do use "evidence-based medicine", they are only getting the treatments that have been studied by good scientific research....which are few and far in between within the treatments used in the world of podiatric medicine.
     
  6. blinda

    blinda MVP

    Indeed. I am acutely aware that this research will not attract the sponsorship of pharmaceutical companies, nor afford me the life style I`d like to become accustomed to. In reality, it will cost me dearly in time and energy. But, I will give it my best shot.
     
  7. Bel:

    I am rooting for you 100%!!:drinks
     
  8. betafeet

    betafeet Active Member

    Hello All, At the Buckinghamshire Branch SCP we recently had an excellent demonstration of 'Dry Needling' from Richard Thomas Lecturer via Northampton University.

    I would also like to share that I have adapted this technique using an acupuncture needle, puncturing the VP 4 or 5 times. No anaesthetic used so treatment can be used in normal podiatry appointment and clients that you would not want to use anaesthetic on.

    It is a little painful but treatment is quick and proving to be effective after 2 – 3 treatment used with and without cryo and silver nitrate.

    This technique in my opinion works in much the same way, pushing the virus into the next derma layer to stimulate an immune response. If any of you have any time I think this would make an interesting research project.

    Judith
     
  9. scalikeet

    scalikeet Member

    Hi poppet , I agree with your drastic ... when I first heard about it - and even now still sounds barbaric. But we use it in our clinic with great results . The hardest part is trying to make it all sound roses so that patient agrees to let you needle their wart till it looks like as quoted earlier " hamburger meat " great description I might add ! Gail
     
  10. Denny

    Denny Member

    hi all i'm after a podiatrist in perth that does this needling technique for a gentleman with a 1.5cm diameter mosaic verrucae on the plantar surface of his hallux - so a very easy spot to inject!
    unfortunately he turned up at my clinic the night before he was due to fly out so i was reluctant to treat the verrucae as it already was sore from his gp freezing it a couple of days prior and he was starting his new job on arrival. I've had great success with this treatment and it is my 1st line treatment with mosaic vp so would like to refer him on - looking forward to hearing from you and will pass your details to him.
     
  11. DTT

    DTT Well-Known Member

    sorry miss read post:
    Cheers
    D;)
     
  12. medisrch

    medisrch Active Member

    Gluterol painted on is very effective. Not sure pot.permangante would be effective but all worth a try.
     
  13. medisrch

    medisrch Active Member

    No experience with the thuja tablets but it sounds a good idea. I have had success with Thuja tincture applied twice weekly.

    Do remember though thuja is an irritant.
     
  14. medisrch

    medisrch Active Member

    Thuja tinctue is effective. Can be irritant though
     
  15. DTT

    DTT Well-Known Member

    Hi again Poppet

    I think the area covered by the VP would be very difficult to Tx with any chemical application effectively and BTW potassium permanganate will stain the feet brown which can be a problem for those patients that " get their feet out"

    I have had several similar patients to that you describe and one in particular after one needling Tx every VP on his hands ears face both plantar aspects covered, all went .:drinks

    I would suggest you contact a pod that carries out this Tx and refer your patient there.

    Perhaps if you let us know the area of the country you are in a suitable pod may pick up on it ??

    Hope that helps

    Cheers
    D;)
     
    Last edited: Oct 19, 2011
  16. betafeet

    betafeet Active Member

    They do this procedure at Northampton University Podiatry Department, you can refer patients to this clinic.

    Judith
     
  17. Ian Drakard

    Ian Drakard Active Member

    Thought this was quite a nice one to put up.

    Fifty something year old man with vp present for over 5 years. Long history of previous treatments to no effect.

    Took a few needling procedures but the after pic was about 5 weeks from the last one- no hard skin, and only slight discolouration of skin which looked like it was healing through.

    I do have a beautiful picture of a completely clear hallux from an 11 year old girl (who has also had a clearance of other plantar vps and warts on fingers), but just realised I forgot to take a 'before' pic :eek:
     

    Attached Files:

  18. blinda

    blinda MVP

    Nice one Ian :drinks

    I`m also finding that those large, singular VP`s are the most resistant. However, even if they don`t resolve completely at first, you can see how they have reduced in size and subsequent discomfort.

    Cheers,
    Bel
     
  19. Jose Antonio Teatino

    Jose Antonio Teatino Well-Known Member

  20. Innes

    Innes Active Member

    The person who comes up with a successful treatment for VPs will go down in history ! I just havent found a single treatment that gives me confidence in treating these lesions and believe me when I say we've tried most of them. We ran a trial on multiple puncture technique but didnt find it any more successful than any other form of intervention we implemented (including multiple topicals). Interestingly there was a UK program on TV last night called embarrassing bodies where a young girl around 6-7yrs old presented with massive VP formation (Id say around quarter of her foot). Following investigation she had a rare condition affecting her overall immunity - Im sure you could find it on TV on demand on the internet if you googled it.
     
  21. Innes

    Innes Active Member

    . . . oh . . . and they bathed the feet in some kind of formaldehyde soak that apparently improved the lesion somewhat - not sure of the details. (was kinda half watching it)
     
  22. stevewells

    stevewells Active Member

    care to share the details of the trial???
     
  23. dgroberts

    dgroberts Active Member

    Interesting thread, thanks for all the pictures and links to literature.

    Can anyone advise of someone that offers the needling technique in or near Leeds?

    I saw a 50odd yr old otherwise fit and healthy diabetic chap yesterday with multiple focal VP's who has been having them frozen, agno3'd for 2 years with no effect. It's something I'd like to try myself but the NHS trust have a blanket "No VP Rx" policy at the moment.

    I note that Northampton uni is cited as offering this but it's a bit of a trek.

    Any recommendations are welcome.
     
  24. Julian Head

    Julian Head Active Member

    Hi there

    Great pics....am I correct in thinking you used a 25g needle on this patient rather than an 18g needle?

    Julian
     
  25. Julian Head

    Julian Head Active Member

    Hi Ian

    I do quite a lot of needling, mostly use tibial nerve blocks and disrect subcut infiltration. Getting pretty good results....

    Julian
     
  26. DTT

    DTT Well-Known Member



    Hi Ian
    Robert and I do a needling clinic also using tibial blocks every 3 weeks on a Friday ( at the moment fully booked for the forseeable future but arranging a secondry list)
    Also practicing" pain free podiatry" at my clinic.;)
    Hope that helps
    Cheers

    D;)
     
  27. I just noted that my first posting that described the needling technique of Falknor was made three years ago, on February 27, 2009. In that time, this thread now has had over 500 posts, has generated much discussion from multiple contributors and, even possibly, will stimulate someone to write up this technique in a peer-reviewed journal.

    I would be interested in knowing how many of you who have now tried this procedure, after having read about it first here on Podiatry Arena, are still using the needling technique for verrucae plantaris and find it a useful part of your clinical practice? What type of results are you now getting and do you have any good clinical case stories or pearls to share?
     
  28. Griff

    Griff Moderator

    Thanks chaps. There's nothing like a prompt response to a question, and given that I asked that 20 months ago (post #230 back on page 8) then I guess this is quite literally nothing like a prompt response to a question :rolleyes:
     
  29. DTT

    DTT Well-Known Member

    :D Sorry Griff, you know me , never miss an opportunity!!!!
    I remember you asking me now but you found a more local pod in central London ??
    See the memory aint that bad for an oldun :D
    Cheers Fella
    D;)
     
  30. Julian Head

    Julian Head Active Member

    :p

    always happy to be of assistance...........

    :)
     
  31. petermac

    petermac Member

    I read about the "puncture technique" from Kevin about 7months or so ago. I now use it on all warts small or large, single or mosaic. 100% success and counting. Its easy, virtually painless and very quick. Definately worth doing. I have found that needling any of the lesions works - doesnt matter which 1 came first - just go to town on a couple and watch the magic happen.

    - Peter
     
  32. cjhopper1

    cjhopper1 Active Member

    Hi,
    I am a final year student at Northampton university, and we have been told of this technique and seen demonstrations, it is a technique we can use once qualified apparently.

    The university run CPD days on various subjects for qualified practitioners and i understand it is also included in the 'injection therapies module' as part of the MSc in Podiatry.


    Colin :)
     
  33. Mark Dave Smith

    Mark Dave Smith Active Member

    Afternoon all and hello from sunny Christchurch, New Zealand. Like many of the posters before me, I've spent an afternoon avidly reading this thread and I'm very interested to learn the technique. Does anybody locally currently perform this procedure and could I come and watch?
    Like a lot of UK qualified pods (qualified 2003) I havn't done any local infiltration LA only lots of digital blocks.
    I've got a great bottle of Cuban rum for any willing mentors out there!
     
  34. Suzannethefoot

    Suzannethefoot Active Member

    Does anyone know of any local anaesthesia courses being run in the south? All the ones I can find are too far away from me to be practical.
     
  35. Tim VS

    Tim VS Active Member

    Hi all,

    I have done a few of these now and, although it took me a while to get to grips with the ankle block procedure, (Thanks Rob and Caroline!) I'm getting generally consistent and good results so far.

    Many thanks to Kevin and others for the useful information in this thread and for bringing this excellent treatment to my attention!

    Regards,

    Tim
     
  36. DTT

    DTT Well-Known Member

    I Believe Marin Harvey is running one in Tamworth in the not to distant future ??

    May be worth sending him a PM on here to get the details?

    Hope that helps
    Cheers
    D;)
     
  37. cornmerchant

    cornmerchant Well-Known Member

    Call me thick, but can anyone explain why an ankle block would be indicated?
    All my needlings have been done with local infiltration using approx 0.5 to 1ml scandonest 3%.

    regards
    CM
     
  38. DTT

    DTT Well-Known Member

    OK your thick :D;)

    Do your patients scream a lot when you do a direct infiltration into the plantar surface???:eek:

    The idea of the ankle block is to make the procedure......painless .
    Hope that helps
    Cheers
    D;)
     
  39. I never use an ankle block with the needling procedure. Ethyl chloride spray is used always with plantar, or dorsal injections. Posterior tibial nerve blocks, to me, seem like overkill when only an area of skin 1.5 cm in diameter is necessary to be anesthetized for the procedure.
     
  40. DTT

    DTT Well-Known Member

    Kevin,
    every time I have witnessed a plantar infiltration it has been extremely painful for the patient and is well documented as being so.

    IMHO ANY procedure that makes a Painless procedure is the way to go overkill or not.

    Having had many years ago a procedure done with only the use of Ethyl chloride I can personaly state is is as effective as a chocolate teapot :bang:

    Having a doctor tell me "it wasent hurting" and carrying on was to say the least sadistic and unnessasary but that was then so perhaps things have changed without my knowledge.

    I have suffered much pain and suffering from dentists in my time because I am a difficult patient to "numb up". 8 years ago I met a dentist who told me "the age of painless dentistry is here".

    He never caused me ANY pain in all the Tx he gave me from fillings to root canal work.

    I believe that is where we should be heading, to remove the fear of Tx from the nervous patient.

    So Yep when your over let me stick a needle through the plantar surface of one foot and then do a PT block on the other see which you prefer ;).

    Cheers
    Derek;)
     
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