Needling for the Treatment of Warts

Needling is a technique for the treatment of warts that is widely unknown and underused within dermatology. Gordon Falknor, a podiatrist, first introduced the technique of needling for the treatment plantar warts in 1969. He reported only two recurrences in 126 patients treated with his technique. Falknor's technique involves using a hollow needle to repeatedly penetrate the base of a wart, into the subcutaneous tissue, until there is no longer resistance to puncturing. Needling causes extensive destruction of keratinocytes and the release of high levels of viral protein into the surrounding tissue. Deep penetration of this viral protein into the subcutaneous tissue increases the likelihood of developing a systemic immune response against the virus, which often results in the resolution of both satellite and distant warts in addition to the treated primary wart. Since Falknor's original study, there have been few studies on needling for warts. Despite the paucity of literature, needling appears to be a low-risk, inexpensive, and effective treatment for warts, especially in patients with extensive or refractory disease on the hands and feet.