Sequential Use of CO2 Laser Prior to Nd:YAG and Dye Laser in the Management of Non-Facial Warts: A Retrospective Study.

Luigi Bennardo,Federica Tamburi,Elena Zappia,Gaia Fasano,Steven Paul Nisticò,Francesco Rizzuto,Giovanni Cannarozzo

doi:10.3390/medicina58010115

Luigi Bennardo, Federica Tamburi + Show 5 more

Open Access

https://doi.org/10.3390/medicina58010115

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Abstract

Background and Objectives: Warts are benign lesions of viral etiology characterized by a hyperkeratotic appearance tending to spread across the skin surface. Various treatments have been proposed to manage this condition, such as acids, imiquimod, photodynamic therapy, cryotherapy, and various lasers. Materials and Methods: In this paper, we describe a combination protocol using CO2 laser prior to Nd:YAG laser for lesions interesting the palmoplantar areas or dye laser for lesions on other skin surfaces in the management of non-facial warts resistant to traditional therapies. In total, 34 patients with 103 warts suffering from wart infection resistant to traditional therapies treated from 1 January 2019 to 1 June 2020 were retrospectively enrolled at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). Two dermatologists measured clinical results, classifying lesions with complete resolution, partial resolution, or non-responding. Patients at four months follow-up were asked to evaluate their degree of satisfaction with a visual analog scale (VAS). Results: Almost all patients reported the complete resolution of lesions, with no patient reporting scarring. Five patients reported hypopigmentation in the treated areas. The mean satisfaction level was high. Only three patients experienced a relapse of the condition. Conclusions: Using a vascular laser following a CO2 superficial ablation of warts may help reduce the risk of scarring and decrease the incidence of relapses for lesions resistant to traditional therapies. Therefore, more extensive studies will be necessary to confirm the obtained results.

Highlights

Warts are benign lesions caused by several types of human papillomavirus (HPV), a DNA virus from the Papillomaviridae family, which affects about 10% of the population with a high prevalence in school-aged children
We propose that CO2 laser may be used to substitute keratolytic therapies to expose superficial dermis, and vascular lasers, according to the interested area, may be used to isolate the area, reduce the blood flow, and lower the risk of relapses
This article proposed a combined treatment using a first pass of CO2 laser to expose the viral lesions, followed by a second pass of vascular laser to reduce the vascular afflux to the area, necrotize viral warts, and reduce the relapse rate

Summary

Introduction

Warts (verrucae vulgaris) are benign lesions caused by several types of human papillomavirus (HPV), a DNA virus from the Papillomaviridae family, which affects about 10% of the population with a high prevalence in school-aged children. Different types of laser therapy can be used, such as carbon dioxide (CO2) laser, neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, pulsed dye laser (PDL), or a combination of them These devices have been proposed alternatively and before surgery when all other local treatments failed [7,8]. Materials and Methods: In this paper, we describe a combination protocol using CO2 laser prior to Nd:YAG laser for lesions interesting the palmoplantar areas or dye laser for lesions on other skin surfaces in the management of non-facial warts resistant to traditional therapies. Conclusions: Using a vascular laser following a CO2 superficial ablation of warts may help reduce the risk of scarring and decrease the incidence of relapses for lesions resistant to traditional therapies. More extensive studies will be necessary to confirm the obtained results

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