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.

Keywords: HPV; foot; infection; plantar; verrucae; virus; wart.

Figure 1

Demonstrating the needling technique.

Figure 2

Wart. Immediately post-operatively after undergoing needling.

Figure 3

(a) Lateral plantar lesion before treatment; (b) Same lateral plantar lesion during treatment; (c) Same lateral plantar lesion resolved, one month after treatment.