Fractional Laser-Assisted Topical Imiquimod 5% Cream Treatment for Recalcitrant Common Warts in Children: A Pilot Study.
BACKGROUND
Conventional treatments for warts like cryotherapy are limited by the pain during procedures, especially in pediatric patients. Imiquimod is a topical immune response modifier, but the thick stratum corneum of common warts prevents drug permeation through skin.


OBJECTIVE
To evaluate the efficacy and safety of fractional laser/topical 5% imiquimod cream for the treatment of warts in children.


METHODS
Eleven pediatric patients with multiple recalcitrant common warts were included. Lesions were treated using an ablative fractional 2,940-nm Er:YAG laser at 1- or 2-week interval. After each laser treatment session, imiquimod 5% cream was self-applied once daily 5 days a week. Response and adverse effects were assessed 2 weekly until complete clearance or up to maximum of 48 weeks. Pain during fractional laser was assessed using a visual analogue scale (0-10).


RESULTS
Eight of the 11 (72.7%) children experienced complete clearance. Mean duration was 29.7 (16-48) weeks, and the mean number of fractional laser was 17.5 (8-37). No significant adverse effect was observed. Pain visual analogue scale during fractional laser was 2.4 (1-4) compared to 6.2 (5-8) during cryotherapy.


CONCLUSIONS
This pilot study indicates that fractional laser-assisted topical imiquimod may provide benefit for recalcitrant warts in children.
*Department of Dermatology, Pusan National University Hospital, Busan, Korea; †Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea; ‡Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Sung-Min
SM
Park
Gun-Wook
GW
Kim
Je-Ho
JH
Mun
Margaret
M
Song
Hoon-Soo
HS
Kim
Byung-Soo
BS
Kim
Moon-Bum
MB
Kim
Hyun-Chang
HC
Ko
D000287:Administration, Topical; D000293:Adolescent; D000634:Aminoquinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D000772:Anesthesia, Local / Q000379:methods; D002648:Child; D005260:Female; D006801:Humans; D000077271:Imiquimod; D007369:Interferon Inducers / Q000008:administration & dosage / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D010147:Pain Measurement; D010865:Pilot Projects; D016896:Treatment Outcome; D014860:Warts / Q000188:drug therapy*
D000634:Aminoquinolines; D007369:Interferon Inducers; D000077271:Imiquimod