Clinical Tips: Skin Anesthesia and Wart Treatment

Tip 1: Consider Plain Lidocaine
When doing erbium full-field resurfacing or even focal dermabrasion, I like to use plain lidocaine (no epinephrine). I can avoid any neighboring vasoconstriction effect and am best able to appreciate my endpoint of pinpoint bleeding. 

Joel L. Cohen, MD 
Denver, CO

Tip 2: DNCB
Dinitrochlorobenzene (2% topical; DNCB) is the best treatment for widespread warts or big plantar warts. Yet, in patients who do not heal with DNCB alone (15%) or who may be immunosuppressed, using a combination of DNCB and imiquimod is great. Sensitize the area with DNCB 2% for 5 days under occlusion, wait another 5 days, and then start with imiquimod 5% under occlusion every night for 2 weeks. Repeat as needed.

Mauricio Goihman, MD
Venezuela

Tips 3 and 4: Adhesive Allergy and Ring Warts
1. Consider preapplication of fluticasone spray to the site of a topical medication patch where allergy to adhesive has developed. This can also work for adhesive allergy to stomal adhesive.

2. Ring warts can occur with cantharidin overuse—it should be banned in the hands of the untrained.

Richard Lewis, MD
Kamloops, BC, Canada