Multiple Puncture/Dry Needling

Multiple Puncture



This form of treatment is indicated for multiple verrucae (image 1), large surface area verrucae (images 2&3) and mosaic verrucae, all of which present the most difficult of challenges to clear. The procedure involves repeatedly ‘stabbing’ the verruca(e) with a needle.  The area is numbed first with a local anaesthetic (either a Digital Nerve Block which numbs the digits for verrucae on toes, or a Tibial Nerve Block that numbs the weight-bearing areas for verrucae on the sole). For multiple verrucae it is the ‘mother’ lesion that is targeted as this is likely to be the longest standing and most difficult area to clear, however if ‘satellites’ in close proximity to the ‘mother’ lesion are also numb then we will undertake the procedure on ‘satellite’ lesions at the same time.

The body’s own mechanism to produce antibodies (cell mediated immunity) is initiated from white blood cells. These cells circulate around the body but rarely penetrate the very outer layers of the skin.  Since the Human Papilloma Virus that causes verrucae is active in the outer layers of the skin (the Epidermis) it can therefore be considered that the viruses that cause verrucae infections predominantly sit beyond the reach of the immune system.

This fact explains why verrucae can persist for many years and can prove resistant to a wide range of treatments. Multiple Puncture is a treatment which aims to impregnate microscopic epidermal skin debris (that is infected with Human Papilloma Virus) into the deeper layers of the skin (Dermis). Here in the Dermis the virus can be exposed to the body’s own defence system i.e. white blood cells. Once white blood cells come into contact with the virus they may then be prompted to produce antibodies to eradicate the virus that cause the verrucae.

Repeatedly ‘stabbing’ a verruca may sound like a bizarre and unpleasant treatment but the technique has been used for many years and is quite painless. The area is needled repeatedly to depths of between 3-12mm (depending on the site of verrucae).

When completed the area will resemble a raw beef burger! (Image 4), a plaster is then applied and patients are advised to avoid prolonged/intensive weight bearing activity for the remainder of the day. When the numbing effect of the local anaesthesia wears off (after a couple of hours) patients will experience nothing more than modest discomfort. The plaster needs to be kept in place and dry for 48 hours.

As with all the specialised treatments we undertake (Partial Nail Avulsions, Total Nail Avulsions, Steroid Injections, Electro-surgical Hyfrecation, Laser, etc) and in accordance with best practice, we review the outcomes in order to assess rates of efficacy (how effective the treatment has been), thus the lesions are reviewed after 4 and 8 weeks.

Some practitioners claim to have achieved cure rates of up to 80%, but in the absence of any reliable published research this is not open to scrutiny. However despite undertaking the procedure in a variety of different ways we have been unable to offer such rates of cure. At the time of this publication we were achieving cure rates of 52%.

 Although a cure rate of 52% may appear to be unremarkable, consideration should be made to the lack of credible alternatives (apart from Laser) for the treatment of multiple/mosaic/large surface area verrucae infections. Additionally it is relevant to add that we undertake this treatment predominantly on verrucae that have proved resistant to an array of other treatments and in many cases by an array of different clinicians.

With the exception of a Nd YAG class 4 medical laser, Multiple Puncture/Needling provides the only credible and practical alternative for these kinds of symptomatic verrucae.

Since Multiple Puncture/Needling is painless and does not cause large and penetrating areas of tissue destruction it is recommended particularly for symptomatic ( cause discomfort) multiple verrucae, mosaic verrucae, and large surface area verrucae.

There are a multitude of ‘old wives tales’, over the counter preparations, and bizarre lotions & potions that profess to cure verrucae, however for large, multiple, long standing, resistant verrucae these will provide as much chance of obtaining a cure as it would be to fly to the moon and back !

There is no ‘one off’ simple, painless, and guaranteed cure for verrucae (Nd YAG 1064nm Lasers come very close to offering this!). For smaller and less significant verrucae & warts Multiple Puncture would not normally be indicated. Other treatments would instead be considered, i.e. :-

1. Cryotherapy

2. Caustics/Acids

3. Electro-surgical Hyfrecation

4. Laser treatment (Nd YAG 1064nm)

5. Curetage (normally undertaken with Laser)    


Although all of these three treatment regimes provide higher rates of cure than we can offer with Multiple Puncture/Needling, they will all produce post operative discomfort and tissue destruction of varying degrees, and therefore their use is not indicated for larger or multiple irregular shaped verrucae (except Laser).

With the exception of a Nd YAG 1064nm Laser, the only credible alternative treatment for symptomatic, multiple, large surface area verrucae infections, is Multiple Puncture/Needling.

Many Practitioners do not offer this treatment due to a lack of familiarity and a scope of practice that does not extend to regional block anaesthesia. This is unfortunate, since this procedure DOES offer patients a choice between the chance of obtaining a cure with a painless and credible treatment, or doing nothing except wait for spontaneous regression of their symptomatic, multiple, mosaic, or large surface area verrucae.

Our wart and verrucae specialist is Mark Hollinshead. Mark has been treating resistant warts & verrucae for over 26 years and his experience in this is area considerable. Mark was one of the first practitioners to introduce Multiple Puncture/Needling to the UK.

We regard this treatment, together with the acquisition of a Nd YAG 1064nm Class 4 medical Laser, as complimenting our extensive scope of practice in the treatment of  ‘difficult to clear’ warts & verrucae. We are only one of a handful of Practices in the UK who are able to offer these treatments.

If you are affected by warts & verrucae then call us today and make an appointment with an expert, we will provide the very best advice and treatment that the profession has to offer.