Pulsed Dye Laser Treatment of Warts: An Update

BACKGROUND: Warts are a therapeutic challenge. New studies indicate that pulsed dye laser therapy may be effective, with clearance rates of 72 to 93%. OBJECTIVE: To determine clearance rate in pulsed dye laser treatment of warts and compare our rate to those of other published studies. METHODS: Thirty-three patients with 96 warts received pulsed dye laser treatment for recalcitrant plantar, digital, peri- and subungual, and body warts. RESULTS: Forty-eight percent of patients had complete wart clearance; 45% partially cleared. Sixty-nine percent of those who cleared remained wart-free for an average of 11 months. Mean fluence was 9.4 J/cm2, with an average of 3.4 treatments. Body and palmar warts responded best, digital and peri- and subungual next, and plantar lesions worst. No significant side effects were observed. CONCLUSION: Pulsed dye laser is an effective treatment option for recalcitrant warts with an excellent side effect profile. However, our response rates were not as high as those previously reported, and we feel that further studies would be useful.     

Pulsed dye laser treatment of genital warts

BACKGROUND AND OBJECTIVES: Genital warts represent benign epithelial proliferations induced by human papillomavirus. The goal of treatment is the clearance of visible warts. Different regimens are available. Flashlamp-pumped pulsed dye laser (FPDL) represents one of many treatment options for the management of viral warts (verrucae vulgares), its effectiveness being comparable with that of conventional therapies. We evaluated the effectivity of FPDL light for the treatment of genital warts. STUDY DESIGN/MATERIALS AND METHODS: A prospective study was performed to examine the efficacy of FPDL in untreated genital warts in which 22 patients were included. RESULTS: All patients showed complete remission after 1.59 (1-5) laser sessions and no scarring was observed. CONCLUSIONS: This study demonstrate that FPDL is a simple and safe, cost and time saving alternative treatment option for genital warts and should be listed in genital warts treatment guidelines.     

Verrucae plantaris--effective treatment with bleomycin: review of the literature and case presentations

Single and multiple verrucous plantaris lesions are well known for their resistance to conservative methods of treatment. In an effort to destroy verrucous growth, the authors have attempted to alter the genetic structure of these obstinate, benign warty lesions by using the antibiotic, bleomycin sulfate. This study provides a review of the medical literature and presents the intralesional injection technique of 0.1% bleomycin into the wart tissue itself. The impressive and significant success rate for complete resolution of verrucous lesions without subsequent scarring has shown this approach to be an effective treatment for plantar warts.     

Recalcitrant Adverse Reaction to Vitamin K: Response to Pulsed Dye Laser

BACKGROUND: Adverse cutaneous reaction to vitamin K manifests in sclerodermatous or erythematous plaque-like reactions. Most of the cases with erythematous plaque-like dermatitis arising at the site of intramuscular vitamin K injection were recalcitrant and did not respond to various attempts with topical and intralesional corticosteroid. OBJECTIVE: The objective was to describe a 25-year-old woman with recalcitrant adverse reaction owing to vitamin K who was successfully treated with pulsed dye laser. METHODS: Two consecutive pulsed dye laser treatments were performed 3 weeks apart with 450-microec pulse duration, 585-nm pulse width, and fluence of 5 and 7 J/cm(2), respectively, using a 7-mm handpiece. RESULTS: One week after the second treatment, her skin lesion was cleared and she was followed without recurrence for 7 months. CONCLUSION: Although the precise mechanism remains yet to be proven, we have demonstrated successful treatment of localized adverse cutaneous reaction to vitamin K in one patient with the pulsed dye laser.     

Pulsed dye laser therapy for viral warts.

Twenty-eight patients with 103 recalcitrant and 20 simple viral warts were treated with the Cynosure PhotoGenica V pulsed dye laser at 585 nm, and fluencies of 6.0-9.0 J/cm(2). An eradication rate of 92% for recalcitrant warts after an average of 2.1 (range 1-7) treatments and 75% for simple warts after an average of 1.6 (range 1-2) treatments was achieved with a mean follow-up period of 7.2 (range 3-15) months. Mild hypopigmentation was noted in one patient and superficial infection in another. Unlike ablative treatment modalities, with pulsed dye laser therapy, no wound was created thus avoiding prolonged postoperative pain, disability and scarring. Treatment was well tolerated by patients, most of whom returned to work or normal activities immediately postoperatively. Pulsed dye laser is an effective treatment for both recalcitrant and simple warts. It is the treatment of choice for these lesions in cosmetically sensitive areas.     

Pulsed dye laser treatment of recalcitrant verrucae: A preliminary report

Patients with recalcitrant warts on the fingers and hands, periungual, and other parts of the body including verrucae plana and plantar surfaces were treated using the pulsed dye laser at 585 nm, 450 usec, and a spotsize of 5 mm diameter. Of the 39 patients treated, 28 (72%) were cleared of their warts after an average of 1.68 treatments at fluences of 6.25–7.5 J/cm². Seven (18%) patients had a reduction of between 80–95% of their warts after 1.3 treatments, and verrucae reduced by 50% in four of the 39 patients after one treatment. The average follow-up period of the 28 cases cleared of their warts has been 5 months. Of this group, those with periungual warts have been followed for up to 6.4 months, compared to 4.8 months for those with warts on other parts of their body, 4.0 months for those with finger and hand warts, and 2.0 months for plantar warts. Only one of the 28 patients has had a recurrence after 3 months of clearance. © 1993 Wiley-Liss, Inc.     

Treatment of Anogenital Warts by Pulsed Dye Laser

BACKGROUND: Treatment of anogenital warts is difficult in that the disease spectrum is wide. Moreover, varying degrees of improvement are obtained. OBJECTIVE: To study the treatment of persistent anogenital warts by pulsed dye laser. METHODS: Pulsed dye laser was used with the following settings: spot size 7 mm, pulse duration 1500 microsec, and fluence 7.5 J/cm2. Two different wavelengths were used: 585 and 595 nm. RESULTS: Lesions healed completely using both wavelengths after one treatment. CONCLUSION: Pulsed dye laser has been found to be safe, effective, satisfactory, and less traumatic compared to other options for treatment of perianal warts in children.     

Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine: A Prospective Placebo-Controlled, Double-Blind Randomized Trial

BACKGROUND 5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts.
OBJECTIVE The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts.
MATERIALS AND METHODS Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection.
RESULTS Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo ( p <.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups.
CONCLUSION The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate.     

Pulsed Dye Laser Treatment is Effective in the Treatment of Recalcitrant Viral Warts

BACKGROUND Verrucae vulgaris can be removed in a variety of ways but a specific therapy of choice has not yet been developed. Doctors are faced with a challenge, especially in the treatment of recalcitrant warts. It has been suggested that the success of pulsed dye laser treatment lies in the fact that warts contain an increased number of dilated blood vessels.
METHODS Seventy-three patients (42 female, 31 male) with verrucae vulgaris on their hands or feet (1:1.5) were given a maximum of 12 treatments with a flashlamp-pumped pulsed dye laser every 2 weeks over a period of 24 weeks until complete clearance had been achieved. A laser energy density of 8 to 12 J/cm² with a spot size of 5 mm and a pulse duration of 450 μsec were used. The minimum follow-up period was 6 months.
RESULTS A total of 15.1% patients achieved complete clearance after 1 session and 47.9% after 2 to 5 sessions, resulting in a remission of 63.0% patients after a maximum of 5 treatment sessions. A remission of 23.3% patients was seen after 6 to 9 treatments and a total of 89.0% of patients showed remission after a maximum of 10 sessions. Only three patients (4.1%) failed and five patients (6.9%) stopped the treatment on account of pain/noncompliance. Only one patient, from a group of patients treated between January 2003 and April 2004, has relapsed.
CONCLUSION Pulsed dye laser treatment is effective and safe in the treatment of recalcitrant viral warts.     

595 nm脉冲染料激光联合曲安奈德皮损内注射治疗痤疮后增生瘢痕的效果

目的 观察595 nm脉冲染料激光联合曲安奈德皮损内注射治疗痤疮后增生瘢痕的效果及安全性。 方法 选取2020年1月-2022年12月本院收治的114例痤疮后增生瘢痕患者为研究对象,根据治疗方法 不同分为药物组（n =35）、激光组（n =42）、联合组（n =37）。药物组采用曲安奈德皮损内注射治 疗,激光组采用595 nm脉冲染料激光治疗,联合组采用595 nm脉冲染料激光联合曲安奈德皮损内注 射治疗,比较三组临床疗效、疼痛及瘙痒程度、瘢痕情况及不良反应发生情况。结果 联合组治疗总 有效率为81.08%,高于药物组的54.29%及激光组的54.76%（P ＜0.05）;三组治疗后疼痛、瘙痒评分均 低于治疗前,且联合组低于药物组和激光组（P ＜0.05）;联合组和激光组治疗后瘢痕色泽、厚度、血 管分布、柔软度评分均低于治疗前（P ＜0.05）;药物组治疗后瘢痕色泽、厚度、柔软度评分均低于治 疗前（P ＜0.05）;但药物组治疗前后血管分布评分比较,差异无统计学意义（P ＞0.05）;联合组治疗 后瘢痕色泽、厚度、血管分布、柔软度评分均低于药物组和激光组（P ＜0.05）;三组不良反应发生率比 较,差异无统计学意义（P＞0.05）。结论 595 nm脉冲染料激光联合曲安奈德皮损内注射治疗痤疮后增生 瘢痕的效果良好,有助于淡化瘢痕,且不会增加不良反应发生几率。     

Treatment of Inflamed Hypertrophic Scars Using Intralesional 5-FU

BACKGROUND: Hypertrophic scars and keloids may complicate wound healing secondary to trauma or surgery. A variety of treatment regimens have been used with a range of success. OBJECTIVE: The purpose of this paper is to report the use of 5-fluorouracil (5-FU) intralesionally in treatment of inflamed hypertrophic scars, both as an individual agent as well as in conjunction with low-dose intralesional corticosteroids plus pulsed dye laser therapy. METHODS: The author's 9-year experience in the use of this agent in treating hypertrophic scars is summarized, and case reports are used to demonstrate its efficacy at 50 mg/cc as well as mixed with Kenalog (1 mg/cc) plus concomitant use of the pulsed dye laser. RESULTS: Frequent initial injections (once to thrice weekly) were found to be more efficacious with decreasing frequency (weekly to monthly) during a period of stabilization and resolution of the scars. The combination of 5-FU and Kenalog appeared to be more effective and less painful. The addition of the pulsed dye laser treatments simultaneous with injection therapy was found to be most effective. CONCLUSION: The use of 5-FU intralesionally for treatment of hypertrophic scars appears to be both effective and safe. Further study is warranted.     

Lichenoid dermatitis--treatment with pulsed dye laser: a case study

BACKGROUND AND OBJECTIVES: Both the diagnosis and the treatment of lichenoid dermatosis are often difficult and can be time-consuming. There are now more and more publications about the use of laser systems--especially the flashlamp-pumped pulsed dye laser--in the treatment of inflammatory dermatoses, although the laser's exact mechanism of action in these cases is not yet clear. STUDY DESIGN/PATIENTS AND METHODS: We report on a female patient with lichenoid dermatitis that was presumably drug-induced (roxatidine, H(2) receptor antagonists). After a 10-month treatment with local corticosteroids, without significant clearance the drug was discontinued and the pulsed dye laser was used (wavelength 585 nm, pulse duration 450 microseconds). RESULTS: Six laser treatments resulted in complete clearance of the lesions. No recurrence occurred during the follow-up period of 54 months. Scars were not observed. A post-operative biopsy showed no evidence of lichenoid dermatitis. CONCLUSIONS: The pulsed dye laser seems to accelerate the clearance of presumably drug induced corticosteroid-resistant lichenoid dermatoses. No permanent pigmental changes or scarring were observed.     

The depth measuring videomicroscope (DMV): a non-invasive tool for the assessment of capillary vascular malformations

BACKGROUND AND OBJECTIVES: The response of capillary vascular malformations (CVMs) to laser treatment is believed to be due to the pattern of capillary ectasia, the depth, diameter, and flow through these capillaries and the amount of competing chromophores within the skin. Videomicroscopy has successfully been used to determine CVM capillary pattern and diameter of vessels. The depth measuring videomicroscope (DMV) allows the depth of capillaries to be measured also. The aim of this study is to examine how capillary depths within a CVM are affected by dye laser treatment using DMV. STUDY DESIGN/MATERIALS AND METHODS: Thirteen previously untreated patients were examined in a temperature-controlled room. A DMV examination was carried out prior to and 6 weeks following a treatment with pulsed dye laser. A further cohort of 11 resistant CVM patients, who had all received over five treatments, was also examined for comparison. RESULTS: Using a Wilcoxon Signed rank test, the results showed that the remaining vessels within the CVM as measured using DMV were more deeply located and smaller (P < 0.01 and P < 0.02 respectively), following the laser treatment. Also in the resistant patients the vessels were again more deeply placed and smaller. CONCLUSIONS: The hypothesis that smaller and more deeply placed CVM vessels respond poorest to laser treatment is supported by these findings. Moreover, the DMV provides a simple non-invasive technique for demonstrating this.     

Conversion to sirolimus: a useful strategy for recalcitrant cutaneous viral warts in liver transplant recipient.

Dermatological complications following transplantation are very common and the majority of immunosuppressed transplant recipients develop some to many warts due to human papillomavirus (HPV) infection. In the setting of immunosuppression, therapeutic management may be disappointing because of the extent of the lesions in patients unable to develop a sufficient immune response directed against HPV. We report here a case of a young liver transplant recipient who developed diffuse recalcitrant HPV-induced warts leading to an impairment of her quality of life. Taking into account the antiproliferative and cytostatic properties of the target-of-rapamycin (TOR) inhibitors, a new class of immunosuppressive drug, we significantly modified the immunosuppressive regimen. Conversion to sirolimus was followed by a rapid improvement of cutaneous state suggesting that this strategy may be useful for recalcitrant cutaneous viral warts in transplant recipient.     

Treating REM syndrome with the pulsed dye laser

BACKGROUND AND OBJECTIVE: REM syndrome (reticular erythematous mucinosis) is a benign but bothersome skin disease that common occurs in middle age and among women. Local and systemic treatment measures are often associated with a high rate of side effects and relapses are common. We evaluated the pulsed dye laser as an alternative method because of its good efficacy in vascular skin diseases. STUDY DESIGN/MATERIALS AND METHODS: We treated two female patients with REM syndrome using the pulsed dye laser. RESULTS: In both patients the erythematous skin changes were almost completely removed after five and three laser sessions, respectively. Other than transient hypopigmentation, no side effects occurred. In one case there is still no evidence of recurrence 6 years after a trial treatment was conducted. In the same patient, clinical success was histologically confirmed. CONCLUSIONS: This is the first report on the successful treatment of REM syndrome of two female patients with the pulsed dye laser.     

New approaches to the treatment of vascular lesions

BACKGROUND AND OBJECTIVE: The pulsed dye laser was developed based on the concept of selective photothermolysis. By using a wavelength of light well absorbed by the target and pulse duration short enough to spatially confine thermal injury, specific vascular injury could be produced. STUDY DESIGN/MATERIALS AND METHODS: Although the pulsed dye laser revolutionized the treatment of port wine stains (PWS) and a variety of other vascular lesions, the ideal thermal relaxation time for the vessels in PWS is actually 1-10 ms, not 450 micros of the original pulsed dye laser machines. These original theoretical calculations recently have been proven correct in a study that used both an animal vessel model and in human PWS. RESULTS: Longer wavelengths of light, within the visible spectrum, penetrate more deeply into the skin and are more suitable for deeper vessels, whereas longer pulse durations are required for larger caliber vessels. CONCLUSION: A variety of lasers recently have been developed for the treatment of vascular lesions which incorporate these concepts into their design, including pulsed dye lasers at 1.5 ms, a filtered flash-lamp pulsed light source with pulse durations of 1-20 ms, several 532-nm pulsed lasers with pulse durations of 1 ms to as high as 100 ms, long pulsed alexandrite lasers at 755 nm with pulse durations up to 20 ms, pulsed diode lasers in the 800 to 900 nm range, and long pulsed 1064 Nd:YAG sources.     

Bleomycin Tattooing as a Promising Therapeutic Modality in Large Keloids and Hypertrophic Scars

BACKGROUND: Cryotherapy combined with intralesional triamcinolon injection is the most common traditional therapy for hypertrophic scars and keloids. The literature contains few articles on the use of bleomycin tattoo for treatment of these conditions. OBJECTIVE: This study compares the efficacy of bleomycin tattoo with that of cryotherapy combined with intralesional triamcinolon injection for the treatment of keloids and hypertrophic scars. MATERIALS AND METHODS: Forty-five patients with hypertrophic scars or keloids were randomly divided into two groups. Group A was treated with bleomycin tattoo, and group B, with cryotherapy combined with intralesional triamcinolon injection. There were four therapeutic sessions at 1-month intervals. All patients were followed for 3 months after the end of treatment. RESULTS: Therapeutic response in lesions less than 100 mm2 was higher than 88% in both groups, but in larger lesions, the therapeutic response to bleomycin was significantly better than cryotherapy combined with intralesional triamcinolon injection (p = .03). In group A, no relationship was observed between therapeutic response and lesion size (p = .58); however, in group B smaller lesions (< 100 mm2) displayed better therapeutic response (p = .007). CONCLUSIONS: Bleomycin tattoo may be more effective than cryotherapy combined with intralesional triamcinolon injection in treatment of larger keloids and hypertrophic scars (size > 100 mm2).     

A Pilot Study on the Treatment of Facial Rhytids Using Nonablative 585-nm Pulsed Dye and 532-nm Nd:YAG Lasers

BACKGROUND: There have been reports of successfully using the pulsed dye laser and long-pulse Nd:YAG laser to improve skin wrinkles. OBJECTIVE: To evaluate the efficacy of these lasers in the treatment of moderate to severe wrinkles. METHODS: Seven subjects had one side of their periorbital wrinkles treated with pulsed dye laser (585 nm, 0.45 ms, 2.5 J/cm2, single-pass 10% overlap, three treatments at 6 weeks apart). The second part of the study involved using the long-pulse Nd:YAG laser (532 nm, 2 ms, 7.0 J/cm2 with cooling, three laser passes, three treatments at 6 weeks apart) to treat the contralateral wrinkles in five subjects. Pretreatment and posttreatment photographs were taken, and blinded assessors were asked to choose the better of the two unlabeled photographs. RESULTS: Assessors found that two of the seven subjects had a better posttreatment photograph in the pulsed dye laser-treated group. Three of five subjects had a better posttreatment photograph in the long-pulse Nd:YAG laser-treated group. None of the subjects reported any subjective improvements. CONCLUSION: Neither the pulsed dye laser nor the long-pulse Nd:YAG laser at the previously mentioned parameters produced any improvement in moderate to severe facial wrinkles.     

Nonablative dermal remodeling with a 585-nm, 350-microsec, flashlamp pulsed dye laser: clinical and ultrastructural analysis.

BACKGROUND: A nonablative 350-microsec, 585-nm, flashlamp pulsed dye laser is currently being used for the treatment of rhytides. OBJECTIVE: To analyze both clinical rhytid improvement and electron microscopic evidence of ultrastructural changes after treatment with a nonablative 350-microsec, 585-nm, flashlamp pulsed dye laser. RESULTS: At 6 months after two treatments, 40% of the treated subjects noted mild improvement in rhytid appearance. Nontreating physician evaluation revealed some degree of improvement in 50% of the treated subjects. Mild improvement in quality and texture of the skin was also reported by 50% of the subjects. Electron microscopic evaluation showed ultrastructural changes that are consistent with new collagen formation. CONCLUSION: Treatment with a nonablative 350-microsec, 585-nm, flashlamp pulsed dye laser can lead to both clinical and electron microscopic evidence of improvement in photo-damaged skin.     

Pulse dye laser treatment for plantar warts

Warts are a common problem faced by podiatrists, dermatologists and GPs in the UK and they account for a large proportion of referrals to dermatology and podiatry departments. Plantar warts can be a particular source of pain and distress as they may interfere with normal activity. The use of the pulsed dye laser (PDL) for this condition has been documented in the USA. We report on two cases successfully treated in our department with favourable results, using the Candela SPTL-1 pulsed dye laser.