Combined treatment with Er: YAG laser and long-pulsed Nd: YAG laser highly effective for recalcitrant warts

Findings from the prospective randomized controlled trial published in the Journal of the European Academy of Dermatology and Venereology showed that using the combination treatment in the same treatment session resulted in a higher cure rate than Er: YAG alone rate after 5 weeks of a single treatment session.

"We, therefore, highly recommend using this combined treatment when these two modalities are available," Z. Khamaysi, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel, and colleagues wrote in their study.

Viral warts are common infectious skin diseases induced by HPV (human papillomavirus). Warts may eventually spontaneously disappear once the immune system finds a way for virus eradication but the time taken for this to occur varies and can range from months to years.

Most of the methods used today have their side effects and drawbacks. Topical management requires drug application for a long duration and therefore patient compliance plays a decisive role in treatment success. Surgical methods are somewhat effective but have the disadvantage of long recovery periods and pain.

Lasers are new methods of energy-based devices that have been used for warts treatment in recent years with variable success rates. Therefore, Dr. Khamaysi and the team aimed to prospectively evaluate combined treatment with Er: YAG laser and long-pulsed Nd: YAG laser compared to Er: YAG laser for treating recalcitrant warts after one session.

The study included 240 lesions from 24 patients. All lesions were diagnosed clinically as recalcitrant warts after failure of cryotherapy and topical treatment. 120 lesions underwent Er: YAG laser therapy only and 120 lesions underwent a combined therapy of Er: YAG and long-pulsed (LP) Nd: YAG lasers.

The evaluation of the clearance rate was done 5 weeks after and classified by three-graded evaluation: poor response, partial response and complete response.

Key findings include:

• The clearance rate in the combined Er: YAG + LP Nd: YAG lasers group was, statistically significant, higher than that of the Er: YAG laser group.
• The complete response rate was 48% (58 of 120 warts) for the Er: YAG +LP Nd: YAG lasers group and only 29% (35 of 120 warts) for the Er: YAG laser group.

"Our findings reveal that the combination of Er: YAG and long-pulsed Nd: YAG lasers is more effective than Er: YAG laser alone for treating recalcitrant warts after a single session," the researchers concluded.

Reference:

Jiryis, B., Avitan-Hersh, E., Mirmovich, O., Nevet, M. J., & Khamaysi, Z. Evaluation of combined treatment with Er:YAG laser and long-pulsed Nd:YAG laser for the treatment of recalcitrant warts: A prospective randomized controlled trial. Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.19388