A study to compare two different pedal wart treatments.

The needling treatment involves breaking up the infected skin cells with a hypodermic needle. This, in theory, creates an immune response which will kill the virus. This process is called cell mediated immunity. We believe the Cell Mediated Immune Response, as a result of needling, to be created by 1) migration of immune cells to the local area due to an inflammatory response to injury, 2) manual lysing of infected epidermal cells to release the contained human papillomavirus (thereby exposing them to the immune cells), 3) translocating the virus in closer proximity to the papillary skin layer where there is a higher concentration of resident T-lymphocytes and, 4) sensitising the immune system to human papillomavirus antigen resulting in a CMIR against the human papillomavirus. Needling treatment protocol 1. Local anaesthetic is administered; either local infiltration or block technique depending on the location and size of the wart. 2. Alcohol wipes are used as a disinfectant to clean the surface of the largest pedal wart and surrounding skin to be treated. 3. The wart is then debrided using a scalpel until pin-point bleeding is present. 4. Using a sterile 25-gauge needle the wart is punctured perpendicular to the surface through the spongy stroma and the base of the capsule into the subcutaneous fat. 5. This needling method is repeated, starting at the periphery and working circularly towards the centre of the wart until all of the papillae have been destroyed. 6. The wound is dressed with the Cutiplast. The Participant is supplied with adequate spare dressings. Injectable Lignocaine or Lidocaine hydrochloride delivered by 25 gauge syringe. Frequency: Prior to procedure, as required. Maximum dose: 3mg/kg (up to 200mg) i.e 50kg adult may have 150mg of Lignocaine/Lidocaine. Preparation: 1 or 2% Typically in these procedures we would use up to 10ml of 1% lignocaine to achieve local anaesthesia. In 10ml of 1% lignocaine preparation there is 100 mg of Lignocaine. The maximum recommended dose for a 50kg adult is 150mg. This shows there is a large window between the doses to be delivered in this procedure and the maximum dose. Uncommon adverse events associated with the use of local anesthetics include hypotension, bradycardia, arrhythmias, cardiac arrest, muscle twitching, seizures, coma and/or respiratory depression. Australian Standard Infection Control policies will be in place to reduce any risk of bacterial or fungal infection, however, a certain degree of risk will always be present. Other possible complications such as bleeding, blistering, hindrances of daily activities, stress, and pain will be minimised. - Bleeding will be controlled by an absorbent padded dressing applied under tension which will apply pressure to the wound and provide comfort for the patient. - The wound will be monitored closely every two weeks for signs of infection and the Participant managed appropriately if such an event occurs.