Emblation who manufacture the new Swift microwave technology for verruca and wart eradication have changed their protocols for treatment times from having a treatment every couple of weeks to 4 weeks. Further research has shown that the stress proteins which are generated by the Swift’s microwave energy are active for weeks after treatment. It is these stress proteins which initiate an immune response. One session of Swift is like receiving a ‘therapeutic dose’ of low level laser or a drug which needs a window of 4 weeks to achieve it maximum potential. Having additional sessions of microwave energy before then to ‘top-up’ does not increase efficacy of the treatment.
This is great news for patients who find the treatment uncomfortable or have logistical issues in travelling to clinic, but it does present with problems in managing patient’s and dare I say it podiatrist’s expectations. Everybody is looking for quick tangible results. How often have podiatrists heard: “I can’t see any change, when is it going to go, how many more treatments will I need?” Patience is seems, is the key to a successfully received and delivered Swift treatment programme. This can be hard for an eager podiatrist when they first receive their new singing and dancing device. Podiatrists want to ascertain quickly that the treatment is effective, to confidently convey this to their patients. It will be a few months or so before they realise their first success stories.
When I first received my Swift I was hoping to see dramatic results akin to using my thermal Nd:YAG laser, but you don’t observe dramatic haematomas. The Swift works in a totally different way. Yes, thermal heat is created, but it is more controlled with it’s main principle of action being to mediate an immune response as opposed to direct tissue destruction. I always seem to get the most difficult cases in clinic, those patients with multiple treatment recalcitrant verrucae who are desperate for an effective treatment ‘solution’ once and for all after everything else has failed.
One of my first Swift patients was one such case. She had tried so many different verruca treatments to nil effect, so therefore was putting so much hope on the Swift to succeed. She found her first treatment quite painful and nearly did not rebook for the next, but subsequently noted that the verrucae were shrinking inward so agreed to proceed to a second session. To reduce pain levels, we offered her the application of a Zimmer Cooler to use in conjunction with the Swift. This really does make the treatment so much more comfortable. With the treatment made more comfortable I was able to increase microwave delivery time from 2 seconds to 3-4. I consulted Emblation to check cooling would not counteract the effect of the microwave generated heat and they advised as long as no additional water content was added to the treated area it would not reduce efficacy.
After 4 treatments, an application of 70% salicylic acid and home-topicals, the verrucae at 3 months had all resolved. The reason I advised the use of keratolytics was to keep my patient focused and positive that we were doing all we could to tackle her verrucae, as there were times when we both were not sure the treatment was working? I questioned myself whether she had an immune issue and therefore nothing would work, but patience and perseverance won out in the end. My lady was thrilled to be finally verruca free.
I always work very hard as a podiatrist to get results, but there are times when nothing works due to immune issues. Even my ‘top-gun’ laser can fail. It is sometimes hard to know if a patient has an underlying immune issue and will never develop antibodies to fight the HPV. With all verruca treatments it is about managing both patient and podiatrist expectations; having the belief it will work and this certainly applies to the Swift.
I feel there is nothing wrong in having a combination treatment approach to help break down old scar tissue and reduce callous formation. Never be kind to verrucae. Would the Swift treatment for my patient have worked equally as well with no other intervention? I can’t answer that one as there is no way in clinic I can check what the immune system is up to, but many singular verrucae and warts can resolve after just 1 – 2 Swift treatments without a combined approach. Treating verrucae can be challenging, but the Swift does offer a real treatment solution. A great tool to have in our box of tricks.