The Treatment of Verrucae Pedis Using Falknor’s Needling Method: A Review of 46 Cases

Abstract

Human Papilloma Virus (HPV) related verrucae pedis persist, seemingly evading host immune surveillance, yet sometimes disappear with inflammation. The absence, or reduction, of a cellular immune response may explain why verrucae treatments are not uniformly successful and treatment can be difficult even in immune-competent individuals. Little investigation has been undertaken into the potential benefit and efficacy of needling verrucae, a treatment modality causing HPV infected keratinocyte destruction in addition to inducing an assumed enhanced immune response. A review of clinical practice is presented, reporting the treatment method and results of data collected from a retrospective review of 45 patients. Thirty-one (69%) cases demonstrated complete resolution of verrucae following needling treatment. Three patients demonstrated reduction in size and pain whilst 11 showed no improvement. No adverse events were noted. Needling may have a place in the management of verrucae pedis in an adult population but a large scale study utilising objective measures and a control intervention would provide more detailed efficacy data along with a greater understanding of the effects of this treatment on long term immunity.

The EV erT2 (Effective Verruca Treatments 2) trial: a randomized controlled trial of needling vs. nonsurgical debridement for the treatment of plantar verrucae

“…The clearance rate for the needling group was 65% (11 of 17), which is approximately 4·5 times greater than our corresponding rate of 14% (four of 28). Similarly, Longhurst and Bristow reported a 69% (31 of 45) resolution of verrucae in a retrospective case series analysis. However, our results are similar to the EVerT trial, which reported a 14% cure rate for both salicylic acid treatment and cryotherapy …”

“…Our study followed the same treatment protocols as Longhurst and Cunningham, with the exception that participants in our needling group were given one treatment. Longhurst and Bristow reported a high resolution rate (38 of 45) after one needling treatment. Cunningham et al .…”

“…In the case of large mosaic verrucae, a section of the verruca was needled. This follows the practice reported by Longhurst and Bristow . All participants were asked not to take anti‐inflammatory drugs (such as ibuprofen) for 48 h but were permitted to take paracetamol for pain relief.…”

“…The mechanical trauma to the viral tissue is believed to evoke inflammation and hence enhance the immune response in the area . In a retrospective review of 45 patients who received needling, 31 (69%) experienced clearance of verrucae, three (7%) demonstrated a reduction in size and pain, and 11 (24%) showed no improvement 8 weeks after treatment …”

Needling warts: are we any further forward?

“…On the face of it this latest trial may not appear to be much of step forward; indeed it is not, but there are some lessons to be learned: The bright hope of needling as an effective treatment for plantar warts appears to have been somewhat dashed by this new trial. Two previous studies, a case series and a randomized trial, showed apparently promising results from this type of treatment with clearance rates of 60–70%. Altogether then, the needling story is beginning to look a bit like the duct tape story where a wave of enthusiasm followed the quirky Focht et al .…”