Evaluating the success of Nd: YAG laser ablation in the treatment of recalcitrant verruca plantaris and a cautionary note about local anaesthesia on the plantar aspect of the foot
Smith EA, Patel SB, Whiteley MS.
J Eur Acad Dermatol Venereol. 2015 Mar;29(3):463-7.
Background:
There are various methods advocated for the treatment of verruca plantaris. However, many verrucas do not respond to simple treatment. Objective This study presents our results using Nd: YAG laser ablation therapy for such recalcitrant cases.
Materials and Methods:
We performed a retrospective audit by sending a questionnaire to all patients with recalcitrant verrucas who had been treated with Nd:YAG laser ablation over the previous 12 months. The questionnaire asked whether treatment had been successful, successful but new lesions had emerged, partially successful with improvement or unsuccessful. A Fontana Nd:YAG laser was used at the following specifications; long pulsed mode with pulse width 25 ms, frequency 1.0 Hz; fluence 240 J/cm2 and spot size 2 mm. Some patients requested local anaesthesia and had direct infiltration with 0.5% plain lidocaine.
Results:
Fifty-three of the original 87 patients responded (60.9% response rate) with a male to female ratio of 24:29, mean age of 47 years and an age range between 22–72. Thirty-seven patients reported complete success post treatment (69.8%) and a further five reported improvement. The remaining 11 felt their treatment was unsuccessful. The cure rate was 81.8% in unilateral single cases, 68.1% in unilateral multiple cases and 65% in bilateral cases. Ten patients requested sublesional lidocaine injections of which 4 had skin breakdown after Nd: YAG ablation.
Conclusion:
Nd:YAG laser ablation is effective in the treatment of recalcitrant verruca plantaris. However, we caution against the use of direct local anaesthesia infiltration before laser treatment.