Surgical pearl: Topical thermo-sclero-cautery for shaved palmoplantar viral wart
How to cite this article: Mukhtar M, Mukhtar N. Surgical pearl: Topical thermo-sclero-cautery for shaved palmoplantar viral wart. CosmoDerma 2023;3:9.
Topical treatment is often ineffective in treating hyperkeratotic palmoplantar viral warts, and it offers a therapeutic challenge for dermatologists. The feeding capillaries of the wart are its major source of blood supply and survival. The thrombosis and sclerosis of these capillaries are the basis of the treating warts. These feeding capillaries can be topically cauterized and sclerosed using chemical and sclerosing agents.[1,2] The author has suggested a simple method for treating viral warts based on these therapeutic concepts.
To improve the effectiveness of the topical chemical cautery, the exophytic surface of the palmoplantar wart is shaved with a blade without local anaesthesia to expose the feeding vessels of the warts. Following that, hemostasis is achieved by applying pressure with a cotton ball soaked in saturated hypertonic saline, which has vascular sclerosis, thrombosis, intracellular hypertonicity such as cryogens and antiseptic properties). Then, 100% of trichloroacetic acid (TCA) is applied topically for cauterizing the exposed part of the lesions after shaving. After that, the patient is told to use 2–3 times the warm, saturated hypertonic saline at home for 4–6 weeks to take care of the remnant lesions of warts using thermosclerotherapy. The patient was seen once a week for the following 6 weeks. The warts disappeared after 3–4 weeks [Figure 1a-c]. There have been no adverse effects or recurrences of the lesions at the treated site. Thus, thermo-sclero-cautery therapy using warm, saturated, and hypertonic saline, TCA with shaving can be an effective and simple treatment option for resistant and chronic palmoplantar viral warts.
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Patient’s consent not required as patient’s identity is not disclosed or compromised.
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