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Hi all,

Just wondered if anyone has had any success treating verrucae with a hydrocolloid dressing such as granuflex? Would the affect be the same as duct tape?

I have patients who look at me like I’m crazy when I suggest duct tape!! Despite me explaining how and why it works. I suppose that when you’re paying for a service you want a treatment that sounds a bit more ‘medicinal’.

When patients do try the duct tape method they have difficulty keeping the tape on the skin, particularly if they have sweaty feet or have used an emollient.

My thinking is that granuflex, to these patients, is more of a ‘medical treatment’, as opposed to duct tape, which sounds like an old wives tale. It also stays on!!

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I have found Compeed blister plasters a much better alternative. They are adhesive and easy for the patient to purchase. Post cryotherapy treatment they offer cushioning and protection too that I feel possibly reduces the likelihood of a blister reaction, although I usually advise application after the original padding is removed. I explain to patients to put them on a leave them until they fall off adding tape if an edge rises.There are other companies that offer a cheaper alternative too.
:-)

You do know that it's all smoke and mirrors with verruccae anyway , don't you?

[quote=Elizabeth Humble-Thomas;262320]You do know that it's all smoke and mirrors with verruccae anyway , don't you?[/QUOTE

PLease explain

See here; Duct tape does not work for VP`s

Yeah, I`ve seen that look on Steve. Usually when I`ve said something crazy

__________________
Just a rock `n roll refugee.

If...

Yes, I`d appreciate your elaboration on that statement too, please?

__________________
Just a rock `n roll refugee.

If...

There are safer alternatives

"I have patients who look at me like I’m crazy when I suggest duct tape!! Despite me explaining how and why it works. I suppose that when you’re paying for a service you want a treatment that sounds a bit more ‘medicinal’. "

I would have to agree with your patients on this one.

So what do you tell them? (why it "works")

Steve

__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

Hear Hear - how and why does it work?
I'm looking at the screen like you're crazy !!!

Well, I suppose I mean by 'smoke and mirrors' is that treating verruccae is a fairly baffling art. A treatment that works brilliantly on one patient may have no effect in another similar case.
I have used just about every treatment available over the years, except laser and electro-cautery,and I still find it almost impossible to predict the outcome.
I even bought the ultimate smoke and mirror machine, a Biogun! I felt like a snake oil salesman when I used it, but remarkably, it worked on quite a few patients.

I agree. Immunophysiology of verrucae is indeed complex, rendering predictive outcomes difficult to ascertain. However, there has been significant progress in the field of immunology and the humanpapilloma virus, and much work published which indicates that a cell-mediated immune response is required for resolution (see attached article below). Not really "smoke and mirrors" which is a metaphor for a `deceptive, fraudulent or insubstantial explanation or description`, according to Wiki

Hmmm, remarkable indeed. Remember this discussion you and I had not long ago?
Cheers,
Bel

Attached Files

Interaction of HPV with the host immune system - A well evolved relationship (Frazer, 2008).pdf (184.4 KB, 29 views)

__________________
Just a rock `n roll refugee.

If...

I just work at the foot end, trying to get best outcome for patients, not trying to score any points.

Not too sure what you mean by "score points". But, I firmly believe that if we are going to offer a pt a treatment regime then the onus is on us to explain the clinical reasoning, risks and benefits of every procedure. I can understand why you "felt like a snake oil salesman" when using the biogun on a viral infection.

__________________
Just a rock `n roll refugee.

If...

I am going to leave this forum, it is too aggressive for me. I'll just get back to treating my patients. Goodbye.

Het Elizabeth

We've all been at the sharp end of comment back to us when we've said something. Have to say that so far the treatment response you've had seem quite gentle in comparison to others I've seen. Knowing some of the posters on this thread I certainly did not interpret their comments towards your posting (not you personally) in a negative context.

Rather than leave the arena stick around. Pick up how to say the things you want to. Even I dip my toe in now and again.

__________________
Ian Linane

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Podia-Clinic
Southwick
England
www.podia-clinic.com

Elizabeth,

I apologise if you read my postings as aggressive. That was not my intention, at all.

I`m sure you`ll agree that we all want to offer our patients the highest standard of treatment and care, based on scientific evidence and clinical experience. It is the former that requires us to keep up to date with current evidence and this is where Podiatry Arena is an invaluable source for links and references to peer reviewed published work, in addition to providing a network for our professional community offering advice and support for each other.

There is a wealth of knowledge and experience here that we all benefit from and I would include you in that as you have had many years of valuable experience and, therefore, have much to offer our community.

So, please accept my apology and I hope you will continue to engage here and make use of this fantastic resource.


Cheers,
Bel

__________________
Just a rock `n roll refugee.

If...

"I have patients who look at me like I’m crazy when I suggest duct tape!! Despite me explaining how and why it works. I suppose that when you’re paying for a service you want a treatment that sounds a bit more ‘medicinal’. "

I would have to agree with your patients on this one.

So what do you tell them? (why it "works")
=================================

THE ABOVE COMMENTS WERE DIRECTED AT "MissB" THE ORIGINAL POST.

I THINK WE ARE ALL STILL WAITING FOR THE EXPLANATION OF HOW DUCT TAPE WORKS AND WHY SHE HAS CHOSEN THIS Tx ABOVE ALL OTHERS.



Steve

__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

Sorry for keeping you all waiting. I've just come back from Egypt! Yes i had a lovely time :-)

You guys have all given me something to think about! Thank you Blinda for the duct tape VP link - very informative.

First things first...I'm not crazy! Honest.

I had been under the impression that duct tape worked by irritating the skin - initiating an immune response, and this is what I told my patients. A lecturer of mine, as well as a few other pods had told me this, and I myself have actually had good results with the duct tape method??

I have learnt a valuable lesson here. DON'T take what someone tells you as gospel!!

PS.

I'd like to add that I DON'T choose the duct tape method above all other treatments for VP, not at all. I only suggest duct tape if other treatment options have failed, or if for some reason they are unable to use corstics. In these situations I recommend needling (if appropriate). However, if the patient does not opt for needling or is not suitable then I suggest duct tape almost as a last resort.

Thanks,

MissB

Hi Miss B

Thanks for the response.

I guess using Duct Tape when all other treatments, even CORSTICS (sic) have failed, might be appropriate.

Can I ask when is needling not appropriate if you have a difficult case?

Also, do you think Duct Tape is more irritating to the skin then, say, canthrone or SalAcid or other caustics (or needling?)


===================

One other thing..."I have learnt a valuable lesson here. DON'T take what someone tells you as gospel!!"

May I ask .............never mind. This thread has all ready had one victim of "aggressive behavior"..... let's just move on.

Duct tape away.....

Steve

__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA

Hi Steve,

As a new graduate I have only had a few instances where a patient didn’t want needling. This was because they were needle phobic. Patients such as these are therefore unsuitable for needling.

No I do not think that duct tape is more irritating to the skin than other CORSTICS (apologies for my spelling error). But caustics can burn the skin and duct tape doesn’t. Please understand that I (wrongly, it would seem) had been under the impression that duct tape was a credible treatment option – this is what I was taught.

I don’t think you’re being aggressive, perhaps a bit ‘nit-picking’, but I don’t mind that

I joined this forum to learn. You all have so much more knowledge and experience than I do and I admire you all. I’m sorry if my comments or questions seem stupid.

Steve, if you have any papers that you think I might find useful on the whole treatment of VP’s I will happily read them. As I said…I am here to learn.

Many thanks,

MissB

Hi Miss B
There is no such thing as a stupid question. Stupid answers maybe! hahaha

Interesting that they taught you to use Duct Tape as a treatment option. No comment.

Ask on....... warts.......they come and they go, frequently whatever a patient is using at the time gets credit.

I have found that needling is a very successful and quick healing treatment option.

Steve

__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA