Huge Recalcitrant Warts Treated with Pulse Dye Laser after Conventional Therapies and Others Destructive Physical Modalities Failed

Nuno Menezes, Paulo Varela, Rita Guedes, Inês Leite, Armando Baptista

.

DOI: 10.4236/jcdsa.2011.13008                

Abstract

Cutaneous infections with the human papilloma virus, despite being almost always asymptomatic, can induce slow-growing lesions knowed as warts that can remain subclinical for long periods of time. There are several therapeutical options namely keratolytics, retinoids, imiquimod, cryotherapy, electrosurgery, lasers and classic surgery, but none has antiviral effects. We describe the case of a patient with large warts located on the dorsal surface of the right hand, treated with cryotherapy, CO₂ laser and topical imiquimod having either no clinical response or quick relapse. Treatment with PDL was started and after 13 sessions, the patient was without lesions, with a good cosmetic result and so far without relapse. This case report is relevant to us and deserves to be published because of the size of the lesions and the great response to PDL despite all the failures with the other treatments.

Keywords

Pulse Dye laser, Recalcitrant Warts

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. W. Cobb, “Human Papillomavirus Infection,” Journal of the American Academy of Dermatology, Vol. 22, No. 4, 1990, pp. 547-566. doi:10.1016/0190-9622(90)70073-Q
[2]	B. Berman and A. Weinstein, “Treatment of Warts,” Dermatologic Therapy, Vol. 13, No. 3, 2000, pp. 290-304. doi:10.1046/j.1529-8019.2000.00031.x
[3]	A. Torrelom “What’s New in the Treatment of Viral Warts in Children,” Pediatric Dermatology, Vol. 19, No. 3, 2002, pp. 191-199. doi:10.1046/j.1525-1470.2002.00081.x
[4]	E. Lukasiewicz, J. Martel, J. C. Roujeau and A. Flahault, “La Dermatologie Lebérale en France Métropolitaine en 2000,”Annales de Dermatologie et de Vénéréologie, Vol. 129, No. 11, 2002, pp. 1261-1265
[5]	O. T. Tan, R. M. Hurwitz and T. J. Stafford, “Pulsed Dye Laser Treatment of Recalcitrant Verrucae: A Preliminary Report,” Lasers in Surgery and Medicine, Vol. 13, No. 1, 1993, pp. 127-137. doi:10.1002/lsm.1900130120
[6]	A. N. B. Kauvar, D. H. McDaniel and R. G. Geronemus, “Pulsed Dye Laser Treatment of Warts,” Archives of Family Medicine, Vol. 4, No. 12, 1995, pp. 1035-1040. doi:10.1001/archfami.4.12.1035
[7]	A. Jain and G. S. Storwick, “Effectiveness of the 585 nm Flashlamp-Pulsed Tunable Dye Laser (PTDL) for Treatment of Plantar Verrucae,” Lasers in Surgery and Medicine, Vol. 21, No. 5, 1997, pp. 500-505. doi:10.1002/(SICI)1096-9101(1997)21:5<500::AID-LSM13>3.0.CO;2-C
[8]	E. Jacobsen, R. McGraw and S. McCagh, “Pulsed Dye Laser efficacy as Initial Therapy for Warts and Against Recalcitrant Verrucae,” Cutis, Vol. 59, No. 4, 1997, pp. 206-208.
[9]	C. Wu, S. Langan, M. Kilmurray, D. Lawlor and R. Watson, “Efficacy of Pulsed-Dye Laser for Viral Warts— An Internal Audit,” The Irish Medical Journal, Vol. 96, No. 3, 2003, pp. 82-83.
[10]	B. S. Ross, V. J. Levine, K. Nehal and R. Ashinoff, “Pulsed Dye Laser Treatment of Warts: An Update,” Dermatologic Surgery, Vol. 25, No. 5, 1999, pp. 377-380. doi:10.1046/j.1524-4725.1999.07165.x
[11]	K. J. Robson, N. M. Cunningham, K. I. Kruzan, D. S. Patel, C. D. Kreiter, M. J. O’Donnell and C. J. Arpey, “Pulsed-Dye Laser versus Conventional Therapy in the Treatment of Warts: A Prospective Randomized Trial,” Journal of the American Academy of Dermatology, Vol. 43, No. 2, 2000, pp. 275-280. doi:10.1067/mjd.2000.106365
[12]	T. Passeron, K. Sebban, F. Mantoux, E. Fontas, J. P. Lacour and J. P. Ortonne, “Traitement des Verrues Palmo-Plantaires par le Laser à Colorant Pulsé à 595 nm: Etude Randomisée em Simple Insu Contre Place- bo,”Annales de Dermatologie et de Vénéréologie, Vol. 134, No. 2, 2007, pp. 135-139. doi:10.1016/S0151-9638(07)91604-X
[13]	D. Elder, R. Elenitsas, C. Jaworsky, B. Johnson Jr., “Lever’s Histopathology of the Skin,” 8th Edition, J. B. Lippincott, Philadelphia, 1997, pp. 578-582.
[14]	R. R. Anderson and J. A. Parrish, “Selective Photo- thermolysis: Precise Microsurgery by Selective Absorption of Pulsed Radiation,” Science, Vol. 220, No. 4596, 1983, pp. 524-527. doi:10.1126/science.6836297
[15]	S. Sood and G. J. Hruza, “Treatment of Verruca Vulgaris and Condyloma Acuminatum with Lasers,” Dermatologic Surgery, Vol. 13, No. 1, 2000, pp. 90-101. doi:10.1046/j.1529-8019.2000.00010.x
[16]	H. Vargas, C. R. Hove, M. L. Dupree and E. F. Williams, “The Treatment of Facial Verrucae with Pulsed Dye Laser,” The Laryngoscope, Vol. 112, No. 9, 2002, pp. 1573-1576. doi:10.1097/00005537-200209000-00007
[17]	S. Akarsu, T. Ilknur, M. Demirtasoglu and S Ozkan, “Verruca Vulgaris: Pulsed Dye Laser Therapy Compared with Salicylic Acid + Pulsed Dye Laser Therapy,” Journal of the European Academy of Dermatology and Venereology, Vol. 20, No. 8, 2006, pp. 936-940. doi:10.1111/j.1468-3083.2006.01679.x