[The CO2 laser and verruca vulgaris]

Verruca vulgaris, or a common wart, is a benign epithelial contagious tumour. It is usually flesh-coloured hyperkeratotic papule of a small size (few millimetres in diameter) although sometimes it may reach up to 2 cm in diameter. Milder, more conservative chemical therapy often requires weeks or months and is often unsuccessful. More aggressive therapy (e.g. electrodesiccation and curettage) may result in significant morbidity, tissue damage, and scarring. Plantar warts are particularly problematic. CO2 laser has numerous applications in dermatology and dermatologic surgery. It is versatile, being either a vaporising tool or a light scalpel. CO2 laser is an excellent modality for treating problematic or recurrent warts. In our experience it has now become the method of choice for warts. The aim of the present investigation was to evaluate the efficacy of the laser treatment in comparison to more conventional forms of treatment.

Surgical laser was used at 15 W power at superpulsating, pulsating and continuous beam. The wavelength was 10,600 nm and the laser was used at infrared spectrum. Active substance was CO2 in combination with nitrogen and helium at following proportion: CO2:N2:He = 4.5%:13.5%:82%. It was used under the pressure of 20-80 mbars. Lesions are treated with laser in a focused mode at low to medium-power density in a series of brief pulses (0.05-0.1 sec). Treatment was carried out under magnified vision (2.5x magnifying loupes) in order to see all small satellite warts and to judge more precisely when all wart tissue has been vaporized. All interventions were performed under local anaesthesia with either carticaine-chloride or 2% lidocaine-chloride. All interventions were performed between 1992-1996 in an outpatient clinic. Warts were excised with a combination of vaporization and resection of the wart root.

The laser beam promptly sterilized the operative field more efficiently than any other commonly used disinfectant. Healing was by granulation and the post-operative period was relatively painless for the patient. Healing resulted in either no scar or a supple flexible scar which was asymptomatic.

Verruca vulgaris most often occurs on fingers and hands of children and teenagers (most commonly between ages 18 to 20). Resistance to therapy is common, and recurrences are frequent. Carbon dioxide laser is a high-precision, bloodless light scalpel used for incising and excising tissues with sealing of small blood vessels. It is the treatment of choice for local destruction of intraephithelial neoplastic lesions. The carbon dioxide beam may be used to remove tissue in one of two ways. First, the lesion may be vaporized until a bed of healthy tissue is reached. The second and better technique is to use the beam as a scalpel to excise a lesion with appropriate margins. Post-operative morbidity and complications are low, and long-term results appear to be excellent.

Laser therapy of common warts is a novel form of treatment of these papillomavirus-induced skin tumours. Our results show that this method has numerous advantages over more conventional forms of treatment.