title: 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.
abstract: 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.
  
  
  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/cm(2) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Chiropodist and Podiatrist at the Whiteley Clinic, Guildford, UK.
authors.forename: E A
authors.initials: EA
authors.lastname: Smith
authors.forename: S B
authors.initials: SB
authors.lastname: Patel
authors.forename: M S
authors.initials: MS
authors.lastname: Whiteley
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D005528:Foot; D006801:Humans; D053844:Lasers, Solid-State; D008297:Male; D008875:Middle Aged; D014860:Warts / Q000628:therapy*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local