Treatment of recalcitrant warts with the carbon dioxide laser using an excision technique

Recalcitrant warts remain a challenging problem to treat, with considerable morbidity for patients. Our technique uses the carbon dioxide (CO2) laser as a bloodless scalpel to excise and treat recalcitrant warts. This paper reviews the results of patients with recalcitrant warts treated by the senior author using this technique.

A retrospective case note review and questionnaire-based survey of patients treated by this technique.

Seventy-one recalcitrant warts treated in 22 patients, all as day case procedures. A total of 54.5% of patients had complete remission after one treatment and the average length of follow-up was 71.5 months. Recurrence occurred on average 5.29 months following treatment. Of those patients, 90% were successfully retreated, giving an overall rate of 95.5%. In total, 46.7% of patients were left with scarring, but all felt this was acceptable given the benefits of the treatment, and 80.0% of patients would have the procedure again. Four patients had spontaneous regression of warts at other body sites not treated with the CO2 laser.

This study illustrates the efficacy of our technique with a favourable outcome comparable to published studies. Recurrence occurred within 12 months; therefore, we would recommend this as a minimum follow-up period. In addition, the disappearance of warts at distant sites suggests that the effects of the CO2 laser therapy modulate the immune system, thereby extending it beyond simple excision or ablation.