C02 laser for verrucae vulgares 
Short report 
CARBON DIOXIDE LASER 
VAPORIZATION IN TREATMENT 
OF VERRUCAE VULGARES 
J. Kozarev 
ABSTRACT 
In this paper the author presents an effective method of surgical treatment using the carbon dioxide laser 
for removal of vira! induced benign epithelial tumors i.e. warts on surface of the hands. With carbon dioxide 
laser were treated 30 patients with more than 5 warts or with a single wart larger than 2 cm in diameter, 
which were on the skin more than six months. Eighty-one percent of the patients required only one laser 
treatment to complete the eradication of warts. Retreatments during the early postoperative months were 
necessary in 6 patients. 
The carbon dioxide laser vaporization is an excellent method for treating problematic or recurrent warts. 
The author concludes that carbon dioxide laser treatment is now an important method in the treatment of 
recurrent, gigantic or widespread warts. 
KEY WORDS 
warts, carbon dioxide laser vaporization 
INTRODUCTION 
This is a report on using the carbon dioxide 
(C02) laser for removal of verrucae vulgares. Ali 
warty lesions tend to show erratic growth patterns, 
remaining static for a long period or proliferating 
with alarming speed. The growth may be generated 
by altered immune conditions in transplant or 
lymphoma patients or by intake immunosuppressive 
drugs. 
It is known that about 67% of warts disappear 
spontaneously (1). A lot of them are unusually 
extensive or unresponsive to other routine treatments 
acta dennatovenerologica A.P.A. Vol 7, 98, No 2 
such as cryosurgery, electrosurgery, or local acid 
application. The C00 laser is an efficacious instrument 
for treating that kind of warts (2). 
MATERIALS AND METHODS 
Thirty patients were treated for vira! warts on 
surface of the hands by means of C0
2 
laser. Ali 
patients were selected for this treatment bečause 
their warts did not respond well to other routine 
treatments, they were unusually extensive or they 
persisted longer than a year on the hand. If there 
83 
CO
2 
laser far vem1cae vulgares 
were more than 5 warts or a wart larger than 2 cm, 
the author considered them as extensive. 
In the treatment of verrucae vulgares we used 
IRRADIA 315M surgical C0
2 
laser, with an invisible 
beam wavelength of 10.6 nm. The power leve! was 
15 watts in impact spots of 1 mm2• This produced 
the power density of 1910 watts/cm2 that delivered 
series of pulsed impacts with the shutter operating 
at either 0.05 or 0.1 sec (2,3) . Treatment is carried 
out under magnified vision in order to see ali small 
satellite warts and to judge more precisely when all 
wart tissue has been vaporized. 
Involved areas of tissue were triple cleansed, with 
soap and water, a povidon-iodine solution and isotonic 
saline solution. One-percent lidocaine hydrochloride 
was injected locally. 
The warts were vaporized by moving the laser 
beam slowly over the surface. The skin was vaporized 
superficially. There was a difference in the vaporization 
of normal tissue and warts. Warts vaporize quickly 
with a char as a resultant on the top of the tissue. 
The charred tissue was removed using a scalpel 
blade or by rubbing with a swab moistened with 
hydrogen peroxide. This process was easily repeated 
until no visible differences between normal and 
treated tissue were distinguishable. 
Additionally, the wound was dressed twice a day 
with an antibiotic ointment in order to reduce 
postoperative inflammation and to decrease scar 
formation. The patients were checked in the first 
and second postoperative week, i.e. during the tirne 
when active granulation was visible in ali patients. 
Further visits were scheduled at four weeks and 
three months after the treatment. 
RESULTS 
In this study there were 30 patients, 19 females 
and 11 males. The age range was from 19 to 60 
years, with a mean age of 40.2 years. In ali patients 
the verrucae vulgares were located on surface of 
the hands. In four patients there was only one site 
of involvement but 15 patients had periungual 
involvement. After laser surgery the verrucae vulgares 
were eradicated in 81 % of the treated patients. Six 
patients had immediate recurrence of warts and 
required two additional treatments. Others were 
free of lesions at 3-month follow-up. These laser 
treatment failures occurred in immunosuppressed 
and lymphoma patients. 
Some of the treated patients described postoperative 
discomfort such as mild burning or pain. The intensity 
84 
of discomfort varied in proportion to the amount of 
tissue vaporized. Only three patients developed scarring 
after treatment. 
The healing tirne, which was in correlation to the 
amount of tissue vaporized, varied from 7 days to 3 
weeks. This was the tirne needed for complete loss 
of burn eschar. 
DISCUSSION 
Verrucae vulgares in hands induced by HPV types 
1,2,4 and 7 are the most widespread. Previous 
studies of verrucae vulgares treated with Iiquid 
nitrogen, salicylic and lactic acid or other keratolytic 
agents give a 65% cure rate at 6 months follow-up 
( 4). Even recurrent though published results using 
electrosurgery on extensive and recurrent warts didn't 
give a better cure rate at a same tirne follow-up 
period (5). The theoretical advantages of using C02 
laser compared with other electrocautery instruments 
are based on the principle that infrared waves are 
readily absorbed by tissue, which has a high water 
content. The laser beam produces a very narrow 
line of damage. The electrocautery causes relatively 
wide zone of tissue damage (6) . A reduction of the 
zone of thermal damage may therefore result in 
both more rapid healing and less scarring. The 
continuous wave C0
2 
lasers leave the large zone of 
thermal damage, but suitably short pulses of C02 
laser radiation can ablate tissue and leave a minimal 
zone of thermal damage (7,8,9,10). 
The results achieved by C0
2 
laser vaporization 
show that 81 % of the patients had only one laser 
treatment and in chosen follow-up period no recu-
rrences. It is very close to the results in E. Burney 
and D. Rosen laser study. They report about similar 
laser technique and 81 % success rates with one 
C0
2 
laser treatment (11). 
T. Muellar reports a 94.7% success rate with one 
C0
2 
laser treatment of plantar verrucae vulgares 
(11) . 
There are many advantages to the C02 laser. It is 
relatively powerful instrument, highly precise and 
effective. But there are a lot of other factors, which 
influence the success of laser treatment. Some of 
them are host genetic and immunologic factors, 
which may play a role in severity of the primary 
infection and the frequency of recurrent ones. 
In this study, a lot of lesions were multifocal. 
These are often difficult to eradicate and more than 
one treatment may be required. Multiple laser 
treatments will lead to the elimination of warts. 
acta dennatovenerologica A .P.A. Vol 7, 98, No 2 
CO
2 
laser for verrucae vulgares 
Even in the immunosuppressed patient (lymphoma 
patient), reasonable control of the disease is possible 
with continued, intermittent laser treatment. 
In contrast with other laser studies where 
postoperative scarring were seen in 50% of treated 
patients, in this study 10% of treated patients 
developed scarring (12). Short pulses of CO
2 
laser 
reduce the zone of thermal damage, which result in 
both more rapid healing and less scarring. 
CONCLUSION 
The CO
2 
laser is an efficacious instrument for 
treating verrucae vulgares. It should be now considered 
for extensive and recurrent warts. The most unpleasant 
aspect of CO
2 
laser treatment except discomfort 
associated with mild pain is that this kind of treatment 
is much more expensive than others. 
REFERENCES 
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vaporization. J Am Acad Dermatol 1990; 23: 115-20. 
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2 
laser treatment of dermatologic 
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1 O. Kamat ER. Cutaneous tissue repair following CO 
2 
laser i,radiation. J Invest Dermatol 1986, 87; 2: 268-71. 
11. Me Burney E, Rosen D. Carbon dioxide laser 
treatment of verrucae vulgares. J Dermatol Surg Oncol 
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AUTHOR'S ADDRESS 
Jasmina Kozarev, MD, MS, Dermatology practice Dr. Kozarev, Jovice Trajkovica 13, 
22000 Sremska Mitrovica, Yugoslavia 
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