Favorite Wart Treatments

[shadesofgrey]

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For a panacos procedure we charge $700, and it's generally a one and done thing. It's a 30 minute appointment, but I generally block the patient and then see another patient while the MA preps the room/foot. Then takes me another 10-15 minutes to do my part. I feel the reimbursement is fair. I'm not selling anything which is plus. It's low risk. Don't have to deal with insurance. Works well. If it's much higher than I feel guilty.

For Swift I believe we charge $250 per visit. I just don't like the swift because it could be a single visit or it could be 10 visits, and each time you have to numb up the areas you are going to treat. The peds patients end up with PTSD. Having said that the practice paid off the machine in less than a year. As I alluded to before, we get a ton of wart referrals from the local dermatology groups.

 

[Feli]

Is it $700/visit or $700 for the full course of treatment? Do the 10x pts end up paying $7k?

I described Swift as a dubious investment because it depends heavily on how many patients have cash/hsa funds, but also on what else you can be doing with your time. You could get a lot done in 30 min without owning a swift machine.

Not trying to be critical, the way you describe it it's a good fit for you, but I know it wouldn't work in my practice.

Leave it to DPMs to come up with massively complex and expensive solutions to simple problems...

Neuromas, warts, nail fungus, heel pain, and everything else... nothing is safe. "We can do this the easy way or the hard + expensive way!" 🤠

 

[shadesofgrey]

Leave it to DPMs to come up with massively complex and expensive solutions to simple problems...

Neuromas, warts, nail fungus, heel pain, and everything else... nothing is safe. "We can do this the easy way or the hard + expensive way!" 🤠

Honestly curious, how would you propose treating recalcitrant multi cluster warts on b/l foot or hands? Are you solely using sal acid or canthacur? How many visits to resolution?

Generally if I'm trying a cash pay treatment it's on someone that has had warts for years or even decades. Also not just podiatry, have had many patients that have spent significant amount of money at derm.

 

[Feli]

Honestly curious, how would you propose treating recalcitrant multi cluster warts on b/l foot or hands? Are you solely using sal acid or canthacur? How many visits to resolution?

You do basic common sense care (proper office debride + sal and maybe sometimes canth, consider cimetidine also), if pt agreement and little or no progress (might be 4,8,12+ tx, depending on pt and case)...

...to OR for scalpel around, big curette to basement membrane (phenol or laser or bovie afterwards optional), rinse, silvadene... 30mins. I tell them aim will be not to violate basement membrane and cause scarring, but it's definitely possible.

I have only seen a few that ever needed OR if proper debride is done. Everyone does it their own way, though.

 

[shadesofgrey]

You do basic common sense care (proper office debride + sal and maybe sometimes canth, consider cimetidine also), if pt agreement and little or no progress (might be 4,8,12+ tx, depending on pt and case)...

...to OR for scalpel around, big curette to basement membrane (phenol or laser or bovie afterwards optional), rinse, silvadene... 30mins. I tell them aim will be not to violate basement membrane and cause scarring, but it's definitely possible.

I have only seen a few that ever needed OR if proper debride is done. Everyone does it their own way, though.

Ok, well I really don't think we are that far apart in our treatment algorithm. I would just rather offer, a hopefully one time, in office surgical procedure and be done with the damn thing in situations where someone would require multiple and repeated locally destructive procedures.

 

[wakaflocka88]

Including residency and my years in current practice, I’ve had >90% success with compound W and duct tape for 6 weeks daily. I debride down to bleeding skin first visit. Usually on the 6 week follow up, their wart is resolved.

 

[NatCh]

Including residency and my years in current practice, I’ve had >90% success with compound W and duct tape for 6 weeks daily. I debride down to bleeding skin first visit. Usually on the 6 week follow up, their wart is resolved.

Haven't most of your patients tried sal acid and duct tape already by the time they're sitting in front of you?

 

[dtrack22]

Haven't most of your patients tried sal acid and duct tape already by the time they're sitting in front of you?

I’ve found that patients have tried some of those things, sporadically, for an inadequate length of time.

Kind of like a plantar fasciitis patient who has “tried inserts and stretching.” But they mean Dr. Scholl’s and their “stretching” is just actively dorsiflexing the foot while seated, as if the anterior compartment alone is going to overpower and “stretch” the gastrosoleal complex. All I do for most of them is recommend better inserts and teach them how to stretch and give them a few references, then tell them they need to do it daily for the next 1-2 months. Patients generally think they have tried some sort of treatment, and my job is to tell them why they haven’t, and how they can do it better.

 

[wakaflocka88]

Surprisingly, only a few do but for a week and that’s it. Rarely do I need to do a second debridement but I still have them do another 4 weeks of sal acid and duct tape.

 

[NatCh]

Pssst... Cantharone Plus is now available again.

 

[dtrack22]

Pssst... Cantharone Plus is now available again.

you should have posted this 3 days ago…

just don’t run your mouth to those IPED Neanderthals on Facebook

 

[NatCh]

you should have posted this 3 days ago…

just don’t run your mouth to those IPED Neanderthals on Facebook

I had to get mine first!

I'm not in that group so no worries there.

 

[dtrack22]

I had to get mine first!

I'm not in that group so no worries there.

I just assumed this was a late April Fools joke

 

[NatCh]

I just assumed this was a late April Fools joke

Dormer sent us a letter (dated March 29) saying that they’re filling existing orders that were already in place, then supplies should return to normal. Price has gone up though.

 

[ExperiencedDPM]

Dormer sent us a letter (dated March 29) saying that they’re filling existing orders that were already in place, then supplies should return to normal. Price has gone up though.

Of course the price went up. I had to squeeze that beetle juice into all those small bottles myself. Good help is hard to find.

 

[NatCh]

I'm not saying a THING. Peep! 🤫

 

[dtrack22]

I'm not saying a THING. Peep! 🤫

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[NatCh]