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Hi all,

I have just seen the most unusual thing... and was wondering if anyone else has seen the same, as I have never seen it before...

Patient this afternoon was a 12 year old girl with a small verruca on the medial aspect of the IPJ on the left hallux, 3mm in diameter, which had been present for around 12 months with no previous treatment (self or other). The patient reports it is painful with shoe pressure, and would like treatment... The girl is in good health, taking no medications, etc etc, and there were 5 capillaries visible from the surface of the lesion...

Anyway, on debridement of approximately the top half thickness of the verrucae (which I didn't feel was normally "aggressive" enough, as the wart was still raised from the skin), one of the extravasating blood vessels began to bleed, and took around 5 minutes to stop! It was quite unusual in that the bleed was faster than what I would normally expect with a wart, normally I see the capillaries "bead" a tiny amount and they don't bleed much at all... The patient reports no pain during or post treatment, and once the bleed stopped I used trichloracetic acid crystals on the lesion...

Has anyone else seen this? Am I missing something here?

Regards

Donna :)

Of course I wouldnt want to scare the parents, but any hints of previous cuts bleeding profusely, or parents likewise? Am thinking inherited protein missing from clotting, unless it was an unusually large vessel or corollary of one??

Hi Unitas,

No there is no history of bleeding or slow clotting in this girl or her family...or not that they know of anyway... It just seems very bizarre that it bled for so long from such a small vessel... I would have thought a clotting disorder would have been apparent well before 12 years of age... hmmm... and the patient is on no medications whatsoever, I even questioned recent use of NSAIDs but nothing!

I am stumped... I see the girl again next week so will have to keep you posted...

Regards

Donna

Normal whole blood bleeding time is from 2 to 9 minutes...

Toes, and verrucae, are very vascular at the best of times.

I would not read too much into it...drop the GP a line if you really feel she needs some coagulation screening.

LL

Hi LL,

Thanks for that advice... I guess it just freaked me out a little as I hadn't seen a wart that bled that much before... Especially since I had only taken part of the thickness away, I didn't expect that much blood!

I'll keep you posted with what happens with this patient...

Regards

Donna :)

Hi all,

This girl returned this evening for follow up treatment, she reports minimal pain since her initial treatment.

I debrided the lesion which had a small amount of coagulated blood and eschar from last week, and had no bleed after applying the trichloracetic acid crystals... :)

I debrided the lesion a second time to remove the "jelly" (I was feeling daring) and had a very small extravasation bleed, then applied the trichlor a second time and no post-treatment bleed...

The verruca appears to be responding to treatment, so perhaps the rogue blood vessel was a result of the verruca being such a long standing problem? Grr I hate verrucae...

Thanks for your help Unitas and LL...

Regards

Donna :)