Er:YAG laser followed by topical podophyllotoxin for hard-to-treat palmoplantar warts.
OBJECTIVE
Palmoplantar warts are often hard to treat. They tend to relapse and the course of therapy is frustrating in many cases. The erbium:YAG laser(Er:YAG) with a wavelength of 2.94 rm is capable of achieving a rapid and precise ablation of warts, but about 14% of patients are non-responders as shown in a previous study. Podophyllotoxin is an established antimitotic agent derived from podophyllum plant resin, approved for human papilloma virus (HPV)-induced genital warts. The combination of both ablative Er:YAG laser and topical 0.5% podophyllotoxin solution in hard-to-treat palmoplantar HPV warts was investigated.


METHODS
Thirty-five patients with hard-to-treat warts(palmar or plantar) with a mean age of (32.2+12.1) years, range 17-50 years, with various pretreatments that had failed, were treated once by Er:YAG laser ablation with a spot size of 3 mm, a frequency between 8 Hz and 10 Hz, and a fluence of 5.7-11.3 J/cm2. After wound healing, topical podophyllotoxin 0.5% solution was applied for 3 days followed by a break of 4 days. Four to six treatment cycles with podophyllotoxin were performed.


RESULTS
After laser treatment followed by topical podophyllotoxin cream a complete response was observed in 31 patients (88.6%). Two patients with plantar warts and a complete response showed a relapse within 3 months after treatment (5.7%). None of the patients developed pigmentary changes,wound infections or scarring.


CONCLUSIONS
The therapy of hard-to-treat warts with a combination of Er:YAG laser and topical podophyllotoxin is safe and effective. Compared with laser alone, the CR percentage seems to be higher and the percentage of relapses reduced.
Department of Dermatology, Hospital Dresden-Friedrichstadt, Dresden, Germany.
Uwe
U
Wollina
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D005260:Female; D005533:Foot Dermatoses / Q000628:therapy*; D006229:Hand Dermatoses / Q000628:therapy*; D006801:Humans; D007641:Keratolytic Agents / Q000627:therapeutic use*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae; D011034:Podophyllotoxin / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome; D014860:Warts / Q000628:therapy*
D007641:Keratolytic Agents; D011034:Podophyllotoxin