Refractory Periungual Warts Treated with Filiform Fire Needle Combined with Warming-Yang and Collateral-Dredging Chinese Medicine Soak: A Two-Case Report.

Rationale: Periungual warts, caused by Human Papillomavirus (HPV) infection, are a therapeutic challenge due to their proximity to the nail matrix and poor drug penetration. Conventional treatments, such as cryotherapy and laser, carry a high risk of nail damage and recurrence, highlighting the need for safer and more effective alternatives. Patients Concerns: Two patients with refractory periungual warts were included, who had failed multiple previous traditional treatments. One was a 38-year-old male with a 2-year history of periungual warts on the right great toe, and the other was a 60-year-old female with a 1-year history of periungual warts on the right middle finger. Both patients showed no improvement after repeated cryotherapy, topical antiviral drugs, or oral medication. Diagnoses: The diagnosis of refractory periungual warts was confirmed clinically based on the characteristic verrucous lesions adjacent to and partially embedded under the nail plate, coupled with a history of treatment failure. Interventions: Based on the "Wen Tong Qu Shi Du" (warming dredging to dispel dampness and toxin) theory, a combined therapy was adopted: filiform fire needle (0.30 mm × 40 mm, heated to incandescence with an alcohol lamp) puncturing the core of the wart every 2 weeks, combined with daily soaking in warming-yang and collateral-dredging TCM decoction (10 g Ramulus Cinnamomi, 6 g Rhizoma Zingiberis, 15 g Poria Cocos, 20 g Coix Seed, 12 g Radix Angelicae Sinensis, 9 g Flos Carthami, 15 g Radix Isatidis, 15 g Folium Isatidis; decocted to 200 mL, soaked at 40-45°C for 20 minutes each time). Outcomes: The 38-year-old male patient achieved complete wart shedding after 3 treatments (6 weeks), and the 60-year-old female patient achieved complete wart shedding after 4 treatments (8 weeks). No adverse reactions such as nail matrix damage or local infection occurred in either patient during treatment. During the 6-month follow-up, there was no recurrence, and the nail bed was smooth with normal nail plate growth. Lessons: The combination of filiform fire needle and warming-yang and collateral-dredging TCM soak shows significant efficacy in treating refractory periungual warts. The filiform fire needle directly destroys wart tissue and activates the local immune microenvironment based on the "resolving fire stagnation" principle, while the TCM soak improves the "dampness-stasis-toxin accumulation" pathological state through "warming yang to resolve dampness + dredging collaterals to dissipate stagnation", achieving both symptom and root cause treatment. This therapy avoids the risk of nail matrix damage from traditional physical treatments and overcomes the limitations of poor drug penetration in antiviral therapy, providing a safe and effective TCM external treatment option for clinical practice.