Comparative study between ablative carbon dioxide and long-pulsed Nd:YAG laser in treatment of recalcitrant warts

Background Verrucae are benign lesions that appear in skin and mucosa owing to infection with papillomaviruses. Although some lesions grow rapidly, other lesions may regress spontaneously over several weeks or over long period of time, whereas some persist without any change. Laser therapy has been used as an effective treatment of recalcitrant warts. The lasers that have been used are CO2 laser, pulsed dye laser, and Nd:YAG laser. Objective To compare the therapeutic efficacy and adverse effects of long-pulsed Nd:YAG laser versus ablative carbon dioxide laser in the treatment of recalcitrant warts. Patients and methods Twenty patients with recalcitrant warts were included. Ten patients were treated by ablative CO2 laser at wavelength of 10 600 nm for one session, whereas the other 10 patients were treated by long-pulsed Nd:YAG of 1064 nm for one session per month for a maximum of three sessions. Patients were followed up monthly for 3 months after the last session. Results Although complete healing occurred in 100% of patients of CO2 laser group after one session and after variable number of sessions in Nd:YAG laser group, recurrence of lesions was reported in 50% of patients treated by CO2 laser, whereas it was in only 10% of patients treated by Nd:YAG laser (P= 0.02). Conclusion CO2 laser carries the advantages of being safe, with few sessions, but with more time for healing, hazards of fumes to the patients and practioners, and high recurrence rate. Nd:YAG laser requires multiple treatment sessions, but has rapid healing, low recurrence rate and fewer complications.