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What is the likelihood of this procedure having a good outcome with a pt that also suffers from chronic urticaria of (as usual) unknown etiology.
Their immune response is confused already- could this focus the response to overcome their issues?
And love the pics in this thread- I am a visual person!!!
Suck it and see!!
If you have a pt that has a suitable VP why not give it a go and let us know what happens.
Saw my patient today (see March 4 post) - approx. 4 weeks post needling.
This is amazing!
I'll post one of the pre-op pictures and one from today.
I apologize for the quality of todays picture, but take my word for this, they look
great. The larger lesion that was needled is gone, the remaining
lesions are ALL disappearing.
I'll see him one more time in 4 weeks.
I did another one yesterday on a young girl with LOTS of mosaics and solitary lesions. I'll see her next week and take some after photos and post them together.
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
The Following 9 Users Say Thank You to drsarbes For This Useful Post:
Saw my patient today (see March 4 post) - approx. 4 weeks post needling.
This is amazing!
I'll post one of the pre-op pictures and one from today.
I apologize for the quality of todays picture, but take my word for this, they look
great. The larger lesion that was needled is gone, the remaining
lesions are ALL disappearing.
I'll see him one more time in 4 weeks.
I did another one yesterday on a young girl with LOTS of mosaics and solitary lesions. I'll see her next week and take some after photos and post them together.
Saw my patient today (see March 4 post) - approx. 4 weeks post needling.
This is amazing!
I'll post one of the pre-op pictures and one from today.
I apologize for the quality of todays picture, but take my word for this, they look
great. The larger lesion that was needled is gone, the remaining
lesions are ALL disappearing.
I'll see him one more time in 4 weeks.
I did another one yesterday on a young girl with LOTS of mosaics and solitary lesions. I'll see her next week and take some after photos and post them together.
Good job Steve. Now you know I'm not totally crazy.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Next time you see this patient, could you get some better lighting on the plantar foot as you did on the first set of photos. I am having a difficult time seeing the lesions with the dimly lit plantar foot.
Improved photos would make it much more helpful when demonstrating the change in lesion morphology to the many others following along. Maybe some close up photos of specific lesions over time would also be helpful in order to document the skin changes better.
Thanks for doing this for all of us.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Hi All
I was very interested in the `needling` discussion on VP's. I have never heard of this before but I'm keen to try. I am increasingly convinced that much of what we do to VP's has little or no effect and sometimes seems to make matters worse eg. acids etc.
Pot.permanganate can be used to make explosives but it is still available in the UK if you can proved you are a healthcare professional when purchasing it.
Regards
Deborah
I've been following this thread with interest- needling to stimulate the immune response makes so much sense thinking about it. Can think of a few patients who may want to try it so I'll join in the picture show if they agree
I have occasionally treated patients who have very widespread mosaic vps because they are immunocompromised. The needling obviously cannot be expected to work in this group.
Does anyone have any suggestions for treatment/management in this case?
Ian
The Following User Says Thank You to Ian Drakard For This Useful Post:
I never thought you were "totally" crazy, just a little bit!
I realized too late that the photos were not up to our standards, the patient had already left the office when I downloaded the pictures.
Sorry.
I'm not sure what happened, the assistant that took them is normally very good at it.
I'll make sure the next ones are up to snuff.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
The Following User Says Thank You to drsarbes For This Useful Post:
I have occasionally treated patients who have very widespread mosaic vps because they are immunocompromised. The needling obviously cannot be expected to work in this group.
Does anyone have any suggestions for treatment/management in this case?
I've been following this thread with interest- needling to stimulate the immune response makes so much sense thinking about it. Can think of a few patients who may want to try it so I'll join in the picture show if they agree
I have occasionally treated patients who have very widespread mosaic vps because they are immunocompromised. The needling obviously cannot be expected to work in this group.
Does anyone have any suggestions for treatment/management in this case?
Ian
Yes - I was thinking about this too - I have a pt on Azothiaprine for chronic colitis. I treat her regularly , often getting rid of the VPs but only to see new ones appear - she has a healthy foot so caustics aren't a problem but i do sometimes wonder if I am chasing rainbows.
That's it! Here i am in Australia intrigued by this forum and that's it! Come on guys its 04/04/09 and no results. No pictures.Please give me more. By the way Kevin -have been to a number of your conferences here in Aus. Refer to your publications regularly. Thanks
That's it! Here i am in Australia intrigued by this forum and that's it! Come on guys its 04/04/09 and no results. No pictures.Please give me more. By the way Kevin -have been to a number of your conferences here in Aus. Refer to your publications regularly. Thanks
Patience!! - will be posting some pics at review in the next 2 weeks - look through the thread again and you will see some pics already posted
The original pics of the treatment were great but i have no other pics available for viewing. May be my browser? I will sit quietly and wait in anticipation. These treatments are unheard of in this country so i am very interested. That's one of the many benefits of podiatry arena. Thanks!
The original pics of the treatment were great but i have no other pics available for viewing. May be my browser? I will sit quietly and wait in anticipation. These treatments are unheard of in this country so i am very interested. That's one of the many benefits of podiatry arena. Thanks!
Thanks for providing this article to us. I am not sure if this article is the one I first read about this technique back during my surgical residency in 1983-1984 at the Veteran's Medical Center in Palo Alto.
My co-resident during my residency, David Arkin, DPM (now practicing in Big Flats, New York) and I, would take turns driving the 45 miles from our homes in San Francisco to Palo Alto every morning during our residency. Whoever was the passenger that day would bring some journal articles along and read the highlights to the driver. Then we would discuss the article and how it might apply to our patients.
I remember reading the article to Dave on the way to work one morning and we both thought it might be worth trying some day. I thought I remembered something about an electric toothbrush that had been modified with a needle holder to make the multiple punctures in the skin being mentioned within the paper. Therefore, there may be another paper from before 1984 that also mentions this needling technique in one of the podiatry journals. My memory is a little foggy on this since it was 25 years ago.
Glad to hear that this reintroduction of such a simple technique is proving so interesting to others.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Thanks heaps everybody! I have a lecture on verrucae on Weds pm. This was not mentioned. Now how can I send this thread to my (receptive, open-minded) professor.?
I too have been following this thread with keen interest. To finally be able to provide a 'proven' treatment with reasonable outcomes would be a real breakthrough.
I feel sure we all become a little frustrated at bombarding VPs with cryo', caustics, acids & in Robert Issaacs case dead cats!
This technique appears to have sparked interest for many on Podiatry Arena.
Quote:
Originally Posted by Kevin Kirby
I thought I remembered something about an electric toothbrush that had been modified with a needle holder to make the multiple punctures in the skin being mentioned within the paper. .
This also interests me. I remember prior to undergoing an immunisation at secondary school age 11 a 'Schick' test was administered initially to all individuals to ascertain if immunity was already active. http://en.wikipedia.org/wiki/Schick_test
This has me wondering about the device which was used to administer the test. A multiple needle which in one application innoculated an area the size of a new 5 pence piece.
However, I have searched endlessly online to no avail to find the name of this apparatus. Can anyone remember the having test & perhaps throw a little more light?
Many thanks,
Caractacus Potts.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
With regard to immunocompromised pts, I would consider some of these as ideal candidates for the needling technique (obviously after considering any other pathology/systemic conditions and ascertaining vascular, neurological status). These pts are more susceptible to infection as a result of suppressed immunity. So to perform, what I would consider, a less invasive procedure that does not create blistering, ulceration or necrosis (as is the case with Sal Acid, cryotherapy, cantharidin, etc) would surely be reducing the risk of infection?
The idea that the virus is implanted into subcutaneous tissue should also increase the likelihood of stimulating the desired immune response as HPV is considered to be in the basal layer of the epidermis; therefore cell mediated immune response is not facilitated. Whilst Parton & Somerville (1994) suggested abrading the surface of the VP to cause capillary bleeding to promote cell mediated immunity, I think implanting the virus below the dermis takes this premise further and agree with Ian in that this technique makes so much sense.
I have a healthy 48 year old pt taking low dose methotrexate, for psoriasis, with a hx of recurring VPs. He has had cryotherapy repeatedly to remove the VPs only to have new VPs appearing elsewhere on both feet.
Having explained to him that his immune system is suppressed by his medication he is now considering the idea of `needling`. My concern is that the painful VP, which he wants me to needle, is quite close to the Achilles tendon insertion into the calc. The last thing I want to do is damage the tendon so would I be correct in rather wanting to needle another VP site inferior to this, fibular aspect of the calc?
Cheers,
Bel
Ref; Parton AM, Sommerville RG. The treatment of plantar verrucae by triggering cell-mediated immunity Brit J Pod Med 1994; 49:205.
BTW Mand`, I don`t remember the 'Schick' test, being that much younger than you , but oddly enough my ageing hubby also remarked on the similarity of this method!
BTW Mand`, I don`t remember the 'Schick' test, being that much younger than you , but oddly enough my ageing hubby also remarked on the similarity of this method!
Ah those halcyon days of childhood. Fair takes me back to wiping my chalk answers off my slate board & waiting patiently for the gruel to be served.
...................... you can go off a person y'know.
Kind regards,
Mid life crisis. Doncaster.
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
Dear all, Yes, I had the 'Shick' test....circa 1980... to see if I had ever been exposed to TB. Or is this the Manussus test...multiple needles on a little disc pressed on my wrist.
I was thinking about this Mosaic Verucca needling technique, correct me please in my thinking, I am just a 2nd year student....the reason the body does not produce antibodies to the MV is because it does not know it is there. The MV is hiding in the dead layer of the glabraous skin, making no connection to blood or living tissue....so we punch a little thru to the blood, saying 'here it is' and the body recognizes the 'enemy' and sends out antibodies...
the man with psoriasis is interesting....psoriasis is dead cells turning over too fast...I would love to do a punch test on psoriasis....see where I'm going?
Please put up a flag so we know where you are from!
the reason the body does not produce antibodies to the MV is because it does not know it is there. The MV is hiding in the dead layer of the glabraous skin, making no connection to blood or living tissue....so we punch a little thru to the blood, saying 'here it is' and the body recognizes the 'enemy' and sends out antibodies...
This is one theory of how the HPV evades the immune system; ie it sits below the radar in the basal layer of the avascular epidermis. Another theory is the postulated ability of HPV to locally activate T suppressor cells....plus many others.
Just a 2nd year student? JUST A 2nd YEAR STUDENT?!!Well you are braver than I was. I was just a tad scared of being `mashed into a pulp`by posting on PodA as a student....
I`m afraid I don`t subscribe to flags, (But `Winchester (UK) Podiatry` could give you a clue as to my whereabouts ) as i am not of the nationalistic sort. However, IF I was pushed to decide it would be this one. Did you spot it in the video?
Hi Carol:
Perhaps you can describe how the majority of verrucae are successfully eradicated by our immune system while others are not and how this fits into your theory of warts "hiding" from the host.
Also, when large mosaics, particularly on the plantar aspect, develop fissures through the now hyperkeratotic skin, why are these not eventually eradicated as well via the immune system. Some of these fissures are to the depth that they cause bleeding; certainly there must be viral introduction in these wounds.
Or why can patients give a history of repeated verrucae that have spontaneous "cures" only to have subsequent warts that are persistent? Or a patient with several warts at the same time and some went away and some did not?
I do like the "hiding" idea............
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Any more post-needling clinical photos of your patients? We can't wait to see the results.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Just for you Kevin (I'm sure I'll run late all morning now!!!!!!!!! lol)
Here's a 16 year old I did about 3 weeks ago, I have pre and one week post.
She had these for over a year with poor results from repeated chemodestruction/debridement/OTC/etc......
I needled a section of the Mother Mosaic. I did absolutely nothing to the remaining lesions so any changes you see between the initial series and the one week post op is all attributed to possible immune system resolution.
Steve
The Following 5 Users Say Thank You to drsarbes For This Useful Post:
Re: Mosaic verrucae-help with treatment
Re: Mosaic verrucae-help with treatment
Thank you to Steve, Steve and Kevin, I now feel confident to try this on pts myself.
Re: Mosaic verrucae-help with treatment
Re: Mosaic verrucae-help with treatment
Re: Mosaic verrucae-help with treatment
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