Low-power carbon dioxide laser and conventional electrosurgery in the treatment of verrucae vulgaris: which stands first?

Background Electrosurgery and CO2 laser are effective therapeutic approaches for the treatment of warts. However, no double-blind studies have compared both modalities. Objective To compare two low powers of a CO2 laser with electrosurgery in the treatment of common warts. Patients and methods This double-blind study was carried out on 35 patients with at least three verrucae vulgaris lesions. Two lesions were treated using two different low powers of a continuous CO2 laser (1 and 3 W), whereas the third one was treated by electrodessication (6 W). Follow-up was carried out at weeks 1, 4, and 12. Results There was no significant difference between the CO2 laser and electrodessication in terms of re-epithelialization, post-treatment erythema, dyspigmentation, or scar formation. However, edema and tenderness were significantly higher in patients treated with electrodessication both at the week 1 (P = 0.039) and at the week 4 follow-up (P = 0.042). In contrast, the incidence of recurrence at the week 4 follow-up was significantly higher in CO2 laser-treated lesions (P= 0.020). The use of a larger number of CO2 passes was significantly correlated with a higher incidence of lesional postinflammatory hyperpigmentation (P= 0.008). Complete re-epithelialization as well as recurrence rate were significantly higher in lesions treated with CO2 (1 W) compared with CO2 (3 W) (P = 0.041 and 0.022, respectively). On comparing the three groups, edema and tenderness occurred significantly more in lesions treated with electrodessication at week 1 (P= 0.043), and the incidence of recurrence occurred significantly more in lesions treated with CO2 (1 W) at week 4 (P= 0.002). No difference was found at week 12. Conclusion Both electrodessication and low-power CO2 are effective and relatively safe modes of treatment for warts. Electrodessication results in a significantly lower incidence of recurrence.