US2760901A - Method for removing verrucae - Google Patents

Description

United States Patent METHOD FOR REMOVING VERRUCAE Marvin D. Steinberg, Eastchester, N. Y.

No Drawing. Application November 12, 1952, Serial No. 320,116

3 Claims. (Cl. 16758)- This invention relates to the process for the treatment and removal of plantar, subungual and other cutaneous verrucae and to the materials employed for said purpose.

Verrucae are warty growths on the skin and are thought to be of viral original. There are many types of verrucae; common forms are found on the soles of the feet where they are most disabling and generally difiicult to treat and resistant to therapeutic measures. This type is known as plantar verrucae. Another form are the subungual type which causes deformities of the nails of the fingers and toes. Mosaic verrucae are still another form occurring in patches on the skin of the soles of the feet and are characterized by spreading over a large area sometimes the size of a half-dollar. This type is also very resistant to ordinary methods of therapy.

All verrucae and especially those occurring subungually, plantarly and the mosaic group are a therapeutic problem in general medical, dermatological and podiatry practice. These lesions are frequently disfiguring, disabling and many times constitute a source of severe pain and suffering to those afflicted.

The customary treatment of this condition involves a gamut of common measures including psychotherapy, chemical caustics, X-ray exposure and systemic therapy. Many exotic and strange charms and psychotherapeutic measures have been claimed as etficaceous in the removal of verrucae. Obviously none of these measures have been found satisfactory when subjected to clinical investigation.

A common form of treatment has been the local application of caustic chemical agents such as trichloracetic acid, nitric acid, salicylic acid, silver nitrate, pyrogallic acid, etc. The local application of these caustic agents destroy or dissolve the tissues involved in the lesions and many times diffuse into surrounding normal tissue causing severe chemical burns and painful reactions. This type of treatment may be effective in the superficial types of verrucae, however, they cannot be relied upon to remove the more resistant and deep seated forms.

Electrodesiccation or fulguration is used extensively for the removal of verrucous lesions and in skilled hands may be considered the best of the commonly available therapeutic measures. However, there are serious disadvantages to this type of treatment among which are the need for bandaging, the absence of bathing or other contact with water of the healing wound, which in reality is a slow healing third degree burn. When large areas are removed in this manner healing may take from 6 Weeks to 3 or 4 months. Another objection is that a scar remains after such healing. The scar may be disfiguring, annoying or painful especially when on the soles of the feet or finger tips and when the patient tends toward keloid formation.

Radiation by X-ray, radium or other radioactive substances has become a popular mode of therapy despite the serious risks involved. Many authorities on neoplastic diseases state that under no circumstances should X-ray therapy be used for such lesions of the hands or feet. I have seen hundreds of tragic sequelae of radiation therapy ranging anywheres from the production of a local 2,730,901 Patented Aug. 28, 1956 but exquisitely painful radio-dermatitis or radio-ulcer to squamous cell carcinoma of the skin, destruction of deep structures and matting together of the entire post radiation burn to the underlying tendons and bony structures. Such complications following radio-therapy have resulted in amputations of the extremities. It should be borne in mind that that radiation is cumulative, causes mutatious cell changes and in children affects the growth centers of underlying bony structures causing disturbances in size of a limb. Such bad eifects may only be first noticed twenty years after the original therapy.

Use has been made of such agents as arsenic, bismuth,- mercury and various other medicinal agents taken internally or by intra-muscular injection. No consistent favorable results have been obtained for this type of therapy. Such therapy involves considerable risk to the patient as the medicaments employed are usually strongly toxic agents.

It is obvious from the above that there is a vast armamentarium of treatments which have or are being used and which clearly indicates that in the prior art there is no one effective and completely satisfactory treatment for this condition.

I have found a new and satisfactory treatment for all the verrucae above described and especially eflicacious against the highly resistant, recurrent and deep seated forms. This new treatment involves the application of a solution containing a relatively high concentration of Vitamin A into and around the lesion.

The technique which I have used with great success is as follows: (1) Asepticaliy prepare the skin immediately surrounding the lesion, (2) dry the area with sterile gauze and produce a topical anesthesia by spraying with ethyl chloride preliminary to insertion of the hypodermic needle, (3) plunge the needle (25 gage-% inch) of the hypodermic syringe containing the solution of Vitamin A through the edge and into the base of the verruca, (4) carefully adjust the point of the needle so that it is directed at and into the lesion at the deep epidermal level, (5) pull back on the plunger to make certain that the needle is not ina blood vessel, (6) infiltrate the injection solution slowly throughout the lesion, (7) leave needle in place for 30 seconds to prevent back flow and then remove needle and place a sterile, non-medicated band-aid over the puncture site.

The solution of vitamin A which I prefer to use in the hypodermic syringe above mentioned is'an aqueous dispersion of vitamin A of a strength of 5,000 to 50,000 units containing 2% procaine HCl. The dosage used depends on the size and typed verruca but in generalabout 10,000 to 50,000 units per milliliter of injection solution per treatment: is satisfactory.

The above example is a preferred technique of applying the invention but many variations are possible without departing from the scope of the appended claims. For instance, non-aqueous solutions of vitamin A may be employed with good results. When non-aqueous solutions, such as solutions of vitamin A dissolved in a fatty oil, are employed I prefer to inject into the area a preliminary anesthetizing solution 'of procaine HCl before the vitamin A. In order to avoid two needle punctures at the site of the lesion, the needle is left in situ and the first hypodermic syringe is removed and replaced with the syringe containing the vitamin A. Solutions of vitamin A in sesame oil at a level of 25,000 to 50,000 units per milliliter have been found to be about optimum but higher or lower concentrations may be used at the discretion of the operator.

The aqueous dispersions of vitamin A are prepared by the incorporation of a surface active material before dispersion in water. The use of polyoxyethylene sorbitan monolaurate, a product commercially known as Tween is used to prepare a commercially available aqueous vitamin A dispersion.

The use of these aqueous dispersions of vitamin A avoids some of the loca reactions encountered when a fatty oil base is used. I prefer to use the aqueous dispersions in which an anesthetic, such as procaine HCl, is dissolved. Other additions may be made to this aqueous dispersion such as adrenalin to act as a hemostatic agent to slow down absorption of the injected solution or sodium ascorbate which acts as an antioxidant preventing loss of the vitamin A during sterilization or Depending on the size and type of lesion, the a cunt of vitamin A dispersion injected will vary from about 0.05 to 1.0 milliliter of strengths varying from about 1,000 to 100,000 or more units of vitamin A activity. In cases where higher doses are indicated, the pure vitamin P; v be injected; this has an activity of about 1,7 per milliliter. For subungual lesions I have generally found it advisable to limit the volume of the injected solution to 0.1 milliliter.

A variation of the above technique using the aqueous dispersion or the pure vitamin is to divide the treatment into two separate injections. First injecting a solution of a local anesthetic such as procaine HCl and then following with the vitamin A injection after the area is anesthetized. In this way better control over the exact location of the point of the hypodermic needle and the direction and distribution of the vitamin A in the lesion is obtained without discomfort to the patient.

Another variation in the technique is the topical application of vitamin A to the lesion both by itself or combined with the injection treatment. For topical application I have used the pure undiluted vitamin A or its salts such as the palmitate, alone or in combination with a keratolytic agent, such as salicylic acid. To further help in the penetration i also add surface active agents such as Tween or one of the quaternary ammonium derivatives now available as a surface active agent and germicide. By the combined use of the injection treatment with the topical application an increased action is obtained resulting in the lesions undergoing the changes described below at a more rapid rate. Many verrucae are amenable to treatment by the topical application technique by itself. This mode of treatment avoids the discomfort at the time of treatment due to the insertion of the hypodermic needle.

Generally a series of three injections are given at weekly intervals at the dosage levels given above and in accordance with the size of the verruca. However, the number of injections may be reduced or increased by varying the dosage level per injection respectively or in accordance with the response of the lesion to treatment. Following the injections certain changes begin, enumerated they are: (l) a moderate to hardly noticeable inflammatory reaction occurs, (2) coinciding with the subsidence of the inflammatory reaction local itching occurs, (3) lesion involutes by first regressing in size, losing its characteristic rugose surface, diminishing vascularity and desquamation of overlying hyperkeratotic plaques, (4) upon complete regression of the lesion the skin assumes a normal appearance, the papillary lines reappear and no scarring ensues. From studies of the fluorescence of the lesions in ultra violet light it appears that the abnormal tissue comprising these lesions specifically absorbs the vitamin A from the surrounding areas. The high concentrations of absorbed vitamin A probably changes the abnormal metabolism of the verrucous tissue causing it to regress and form normal skin tissue underneath without scarring.

The above disclosure represents the essential features of this invention but many variations are still possible to those skilled in the art without departing from the scope and general idea of the treatment and materials used therein. The term, vitamin A includes the natural or synthetic vitamin or its precursors, derivatives such as the acetate or palmitate, non-aqueous solutions prepared, for instance, with fatty oils such as sesame oil and aqueous dispersions of the vitamin prepared with the aid of suitable surface-active or dispersing agents common to the art.

I claim:

1. In the treatment of verrucae, the step which comprises injecting directly into the veriucae a vitamin A compound of the group consisting of vitamin A and the fatty acid esters thereof.

2. The step in the treatment of verrucae as defined in claim 1 in which the vitamin A compound is injected in the form or an aqueous dispersion.

3. The step in the treatment of verrucae as defined in claim 1 in which the vitamin A compound is vitamin A palmitate.

References Cited in the file of this patent UNITED STATES PATENTS 1,627,963 Fuller May 10, 1927 2,381,830 Lobel Aug. 7, 1945 2,417,299 Freedman Mar. 11, 1947 2,592,149 Jacobson Apr. 8, 1952 OTHER REFERENCES U. S. Dispensatory, 24th ed., J. P. Lippincott, Philadelphia, 1947, pp. 934, 935, 999.

Physicians Bulletin, Sept-Oct. 1951, pp. 117.

l. A. M. A., vol. 139, No. 9, p. 615.

Allington: A. M. A. Archives Dermatology and Syphilology, Sept. 1952, vol. 66, No. 3, pp. 316326.

Ignatoff: J. Nat. Assoc. Chiroprodists, vol. 44, No. 7, pp. 37, 41, 43 (1954).

Branson et al., ibid., pp. -66.

Digest of Treatment, January 1950, pp. -101.

Claims (1)

1. IN THE TREATMENT OF VERRUCAE, THE STEP WHICH COMPRISES INJECTING DIRECTLY INTO THE VERRUCAE A VITAMIN A COMPOUND OF THE GROUP CONSISTING OF VITAMIN A AND THE FATTY ACID ESTERS THEREOF.