The Technology Review Site for Primary Care Providers
Advances in technology have improved healthcare providers' ability to rapidly diagnose patients at the point of care, screen for common conditions, and provide a variety of effective treatment options. Providers need to be aware of what innovations are available - or will become available in the near future. It is the purpose of Medgizmos to educate and inform healthcare providers regarding the latest and greatest technologies.
ScopeAround Wifi Otoscope, new inexpensive digital otoscope!
In this age of “high-tech” devices and innovation, it’s nice to find an inexpensive and low-tech approach to a common problem.
Such is the case with the removal of ticks attached to patients. Traditionally we use a hemostat to pull out an embedded tick and if one is not cautious, the tick may win this tug of war and the head and or mouth pieces left in the skin. If one uses the $5 Ticked Off spoon, you generally can remove the entire tick, painlessly and quickly.
Let me know if you have your own recommendations for accomplishing common medical problems using low cost and low tech solutions!
Cantharidin preparations have long been used for treating warts of various sorts. It is a blistering agent and is available for purchase from a number of Canadian pharmacies as well as several compounding pharmacies in the United States. Cantharidin is available as a single agent liquid consisting of 0.7% of the cantharidin in a film forming vehicle. It is also a component of a more potent mixture commonly used for keratinized and plantar warts – containing 30% salicylic acid, 2% podophylin and 1 % cantharidin. These agents are available from Dormer Laboratories in Canada as Cantharone and Cantharone Plus.
In pediatrics the advantage of cantharidin agents compared to liquid nitrogen is that it is pain free at the time of application. Cantharidin is not recommended for children under 3 years of age, and the more potent mixture is not recommended for children under 12 years of age.
In general cantharidin is applied to the wart, allowed to dry and covered with a non-porous dressing which may be removed in 4-6 hours and replaced with a band aid. A blister usually forms within 24 hours. The patient is then seen in 2-3 weeks for debridement and reapplication.
The cantharidin containing plus mixture is applied as above, but is covered with non-porous tape for 4 to 8 hours and then removed. As above a blister will form in 24 hours and the patient seen 2-3 weeks later for debridement and reapplication if required.
Wart therapy is generally reimbursed at about $200 per visit, and these agents are generally available for less than $100 per bottle, enough to treat dozens of warts.
We have previously presented videos discussing wart removal using liquid nitrogen as well as cantharidin products. Both methods require that patients return to the office every few weeks for debridement and re-application. The entire process from initial treatment to wart resolution may take many applications. This is expensive for the patient, as those with high deductible insurance will pay $200 or more per office visit. Over the past few months my local dermatologists have been advising patients to purchase the $10 WartSTICK to eradicate warts at home, providing instructions in its use. This is particularly appropriate during the COVID-19 pandemic as it minimizes return visits to a medical office. Patients should return only if warts persist after several months of use.
Wart STICK contains 40% salicylic acid, in a wax based medium. It should be applied once daily or every other day, with a band aid cover left in place for 8- 24 hours or until reapplication. For small warts one can use a cotton swab to apply the Wart STICK wax medium to avoid application to healthy tissue. Patients need to debride the wart with a pumice stone or emery board before re-application. As the device looks exactly like a Chap Stick, parents need to be cautioned to keep the Wart STICK out of the reach of children.
By the way, I expect these would work well with molluscum as well.