Treatment of verruca vulgaris using the ultrasonic surgical aspirator

ARTICLE

Auteur(s) : Sumiyuki MII¹, Shiro NIIYAMA¹ sniiyama@aol.com, Chihoko NAKAHARA¹, Yoshinori ITO², Noriyoshi SUMIYA², Kensei KATSUOKA²

¹ Department of Dermatology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374 Japan

² Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-0043 Japan

The ultrasonic surgical aspirator has been used in renal surgery, neurosurgery and cardiac surgery. We have already used it to treat several skin diseases [1-3]. We report the treatment of verruca vulgaris using an ultrasonic surgical aspirator.

The ultrasonic surgical aspirator used for this treatment was Sonopet UST-2001 (Miwatec, Kawasaki, Japan). The aspirator is composed of a main unit (figure 1A) and a hand piece (figure 1B). The tip of the hand piece oscillates at a frequency of 25 kHz and at an amplitude of 300 μm. The operator can adjust the level of oscillation between 0 and 100. The area around the tip is irrigated with physiological saline, which is suctioned away through the tip itself. After administration of local anesthesia, the ultrasonic surgical aspirator was set up. The power was set at 60% (for lesions on the hands, fingers and paraungual areas) or at 60-80% (for lesions on the soles of the feet), and the rate of saline irrigation was set at 30 ml/min. Holding the hand piece like a pen, the operator lightly presses the tip onto the wart and moves it in a continuous, circular, brush-like motion. When sites that are allowed to come into contact become white and swell up with fluid, the epidermis is grasped and peeled back with forceps, and then cut away with scissors, since it detaches from the dermis. The center often becomes hard, like a clavus, and that portion is always completely scraped away. After electrocauterization of any bleeding, an antibiotic ointment is applied and the wound covered with gauze.

The patient was a 63-year-old male who presented with a 1-year history of a recalcitrant wart on the bottom of the right toe, approximately 15 mm in diameter (figure 1C). Previous treatment with liquid nitrogen cryotherapy had not been effective. The lesion was removed with the ultrasonic surgical aspirator and there was no evidence of recurrence on follow-up at 3 months (figure 1D).

There is currently no cure for human papillomavirus (HPV) infection and treatment for verruca vulgaris is through the ablation of infected tissue using a variety of techniques. These include salicylic acid, podophyllin, bleomycin, cryotherapy, laser therapy and surgery [4, 5]. Salicylic acid may cause local irritation and desquamation; bleomycin may have potential side-effects; cryotherapy is painful; above all, it takes a long time to complete recovery. Laser therapy may lead to scarring; surgical removal of extensive warts on the finger and toe may require a local flap reconstruction. Recently, immunomodulators have been used against HPV, but there are ineffective cases, especially for those on the palmar and plantar surfaces.

The ultrasound-assisted wart aspiration method was introduced by Tsukamoto and colleagues [6]. The ultrasonic energy causes fragmentation of high fluid content tissues such as the epidermis, enabling its removal by suction. However, at the same energy level, adjacent structures such as the dermis and blood vessels which have a low aqueous content, are minimally affected. The properties of this device allow the effective removal of verruca vulgaris with less scaring and bleeding. The first choice of treatment method is cryotherapy, but the therapy is changed to the ultrasonic surgical aspirator when patients have not improved even with long-term cryotherapy, or patients complain of pain every time they receive the therapy. We have experienced about 20 cases, in which the recurrence rate was about 20%. The same therapy is performed again for recurrent cases if the wart is small. No recurrence has been observed in any of the cases.

Disclosure

Acknowledgements: The authors gratefully thank Dr. S Aiba and Mr. S Kohira for their critical cooperation in preparing this paper. Financial support: none. Conflict of interest: none.

References

1 Y Ito, S Kondo, N Sumiya, M Yoshii, K Otani, M. Wako Dermabrasion using an ultrasonic surgical aspirator Plast Reconstr Surg 1996; 97: 1034-1039.

2 K Otani, Y Ito, N Sumiya, S Kondo, S. Ieba Treatment of Bowen disease using the ultrasonic surgical aspirator Plast Reconstr Surg 2001; 108: 68-72.

3 S Niiyama, S Aiba, K Katsuoka, Y Ito, N. Sumiya Treatment of osmidrosis using the ultrasonic surgical aspirator Acta Derm Venereol 2006; 86: 238-240.

4 A Rivera, S.K. Tyring Therapy of cutaneous human papillomavirus infections Dermatol Ther 2004; 17: 441-448.

5 E. Haneke Dermatological surgery Eur J Dermatol 2009; 19: 418-419.

6 K Tsukamoto, M Kanzaki, N Deguchi, A Miyahara, T Okamoto, A. Osada Successful treatment of refractory warts by ultrasonic surgical aspirator Clinical Dermatology 2005; 59: 107-110 (in Japanese).