The use of any electrical equipment in
epileptics is virtually contraindicated due to the risk of inducing fits.
However, I see a very large number of epileptics at St Elizabeth's Home in
Hertfordshire, and apart from verruca pedis, there were a number of patients
with multiple hand warts. I had a very long discussion with Dr Thompson, the
Chief Medical Officer of The National Epileptic Centre in Buckinghamshire, and
it was decided that as the current used by the Biogun is so minute, and the
application being topical and so far from the brain, it should be safe to use.
After all, much higher currents are required direct to the brain to induce
epileptiform seizures. Since that decision was taken I have treated eleven
patients, one with multiple hand warts (36), successfully with the Biogun with
no discomfort or side-effects at all. I would emphasise that all these
treatments are carried out under clinical conditions with a trained nurse from
St Elizabeth's in attendance. However, I do believe that this is not only the
most effective method of treating these patients, but also the safest and
least traumatic.
Influencing factors
a) Conscientiousness
of patients
b) Correct
diagnosis
c) Early
treatment
d) Pain!
a) The
conscientiousness of patients in abrading, and applying the keratolytic on a
daily basis is vital to aid the eradication of any hard skin etc.
b) Correct
diagnosis seems obvious, but even in the last year I have had three patients
referred to me from GPs where verrucae were diagnosed as corns or callosities.
c) Early
treatment. - The sooner verrucae are recognised and treated the better the
Prognosis. I tell all my patients that having had one verruca they must
consider themselves a suitable host for the virus and that regular inspection
of their feet is essential. At the first sign of a new verruca, start applying
the Duofilm etc immediately and telephone me for an appointment to confirm.
This early treatment is often all that is required and I do not have to resort
to the Biogun. I find that children are brilliant at examining their own feet
and discovering new lesions. On the subject of children, who are predominantly
our verruca patients, do make their treatment fun! Make their trip to your
surgery a visit to look forward to. I keep two squeaky glove puppets that
inspect and help treat children, and although I do not use the 'bleep' counter
on the Biogun for timing purposes, I find it a great distraction for the
children to count 20-30 bleeps to time their length of treatment.
d) Pain!
This initially was my main bone of contention with the Biogun. It is not
always a painless procedure, particularly when the probe passes over a nerve
ending, or if the patient is hypersensitive to pain. However, as soon as the
probe either moves on, or away from the sensitive site the pain ceases with no
after effects. I usually operate to within 1/2-1cm from the surface. If it is
necessary because of any discomfort to move the emitter further away from the
site, then I usually double the treatment time.
Finally, I would like to return to the subject of correct diagnosis. I
first qualified as a chiropodist in 1957, and since then there have been a
number of occasions when I have been confronted with what appeared to be a
'burnt-out' plantar verruca. These were usually in older patients and had been
there for anything up to twenty years. The lesion is usually vascular and
paring produces minute capillary bleeding. Treatment with potential
cautery, paring, abrading, cryosurgery,
homeopathy, voodoo or witchcraft over the years makes new forms of treatment
difficult to find. Since I have been using the Biogun, that is three years, I
have had two such cases, which I believe is possibly the condition known as:
Porokeratosis - This is a skin condition characterised by
hypertrophy of the stratum corneum, usually around sweat glands, and is
followed by progressive and centrifugal atrophy. It could be that the
porokeratosis could be triggered off by the verruca site not regenerating
properly or, it is not porokeratosis and my hypothesis should be relegated to
the waste paper basket! Most importantly, both cases responded to the Biogun,
albeit after several sessions each at about four weeks apart.
So what has been the success rate?
Briefly
-
207 patients
approximately 50/50 male-female split
3 patients did not complete treatment
204 cured - 100%
Which is why, after using every form of treatment for verrucae over the last
38 years, the Biogun is my first and only choice for treating these
troublesome lesions.
The
SMAE Journal, Winter 1995
