02/16/2018    David Secord, DPM

RE: Treatment of Verruca in Patient Taking Blood Thinners

I've used the Bleomycin treatment for verrucae
for about 15 years now and think of it as my
primary treatment course for adults with normal
immune systems. With this treatment, I've seen an
approximately 98% success rate with the added
benefit that if the person has multiple verrucae,
treating just the one lesion will allow
resolution of all of them in the course of 5-6
weeks.

The procedure entails using the body’s own immune
system to kill the wart and follows the path of
driving some of the warty material into the
dermis, where the body will identify it and raise
killer T-cells to the HPV (I, II, IV). As these
circulate throughout the body, any place with a
wart will be affected and the lesions will shrink
and disappear.

For those who fail the Bleomycin, I use Aldara
cream with the modified protocol of QD 8º
application under occlusion with duct tape with
every week debridement of the hyperkeratotic
tissue at the lesion to allow penetration of the
Aldara. Between Bleomycin and Aldara, I very
infrequently have failure of treatment. In those
rare instances, I do a primary excision of the
lesion.

In children, I start with Tagamet and have seen
very good results. I seem to see a magic age of
12 as the cutoff for some reason. In my hands,
Tagamet works very well in the 12 and under crowd
and no response in the over 12 age group for
reasons I can't explain.

For mosaic warts, I use the Panacos graft and
have seen 100% to date (43 cases). Hope this
helps.

David Secord, DPM, Corpus Christi, TX

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