Recalcitrant Palmar Warts Treated With Q-Switched Potassium Titanyl Phosphate Laser and Cryotherapy: A Case Report

Recalcitrant palmar common warts pose a considerable challenge in dermatology due to their frequent persistence despite various treatment attempts. The thick stratum corneum of the palms and the constant pressure and friction in this location contribute to their resistance to therapy and a high rate of recurrence. We report the case of a 33-year-old male with a 26-month history of a progressively enlarging palmar wart refractory to extensive conventional therapies, including 18 intermittent sessions of liquid nitrogen cryotherapy administered over the course of his 26-month history, two electrofulguration sessions, and various topical agents. We applied a novel multimodal treatment involving superficial shaving, followed by Q-switched potassium titanyl phosphate laser at 12 J/cm² fluence, combined with cryotherapy using liquid nitrogen. After two sessions, administered two weeks apart, complete clinical and dermatoscopic resolution was achieved within two weeks of the final treatment. No recurrence was observed at a three-month follow-up. The patient experienced minimal adverse effects, with mild and transient discomfort and erythema, but no vesiculation, blistering, or pain. Our literature search revealed no previously reported cases of recalcitrant palmar verruca vulgaris successfully treated with Q-switched potassium titanyl phosphate laser using this multimodal protocol. This case highlights a promising and previously undescribed combined strategy for managing highly refractory palmar warts unresponsive to standard treatments.