Tasleem’s water jet sign

Tasleem’s water jet sign
Image Credit: Dr Tasleem Arif
Tasleem’s water jet sign
Image Credit: Dr Tasleem Arif

Dermatology is known by various signs many of which bear clinical importance while many more are being further introduced. Here we mention our observation while working with the management of cutaneous warts and discovered a new sign in dermatology which has been named as “Tasleem’s Water Jet Sign”. While giving local anesthesia to the site of wart, we observed that sometimes the local anesthetic spills out back through the verrucous surface of the wart like a jet of water which was referred referred to as ‘Water Jet Sign’.

When a local anesthetic solution is injected into the base of the wart, the incoming solution of anesthetic doesn’t find a sufficient space in tissues like palms, soles, etc where the skin is tough and less yielding which is also contributed by the dense hyperkeratosis of the wart itself. As a result, the local anesthetic solution is held under a high pressure at the base of the wart which tries to negotiate through any weaker area. When more anesthetic solution is being injected, the pressure at the base of the wart increases as the solution is now held in a tight unyielding space. The dense hyperkeratosis of the wart, tough connective tissue of the palms and soles and the elongated rete ridges which are bent inwards towards the centre of the wart do not allow the anesthetic solution to escape through the bottom and sideways. As a result when more anesthetic solution is injected, intracompartmental pressure increases more and more and draws the solution through the narrow channels present in between the columns of dense papillomatosis away from the base of wart and comes out of it as a jet of water.

The water jet sign is usually seen in the palmoplantar warts where the skin is tough and unyielding and is not seen in verruca plana and at areas with loose skin like axillae, scrotum, neck, eye lids, etc.

The importance of the sign lies in that the dermatologist dealing with warts must be wearing eye protection to avoid chances of getting the jet of local anesthetic into the eyes during procedure. When this sign is present, it augments the diagnosis of warts.

How to cite: Arif T, Amin SS. Tasleem’s water jet sign – A new sign in dermatology. Our Dermatol Online. 2015;6(3):382-383.

Article link: http://www.odermatol.com/issue-in-html/2015-3-36/

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