Bruce,
Many thanks for the informative reply, much appreciated.
Regards,
Peter Barrow
-----Original Message-----
From: A group for the academic discussion of current issues in podiatry
[mailto:[log in to unmask]]On Behalf Of Bruce Williams
Sent: 03 June 2004 14:05
To: [log in to unmask]
Subject: Re: Lasers for treatment of plantar warts
Peter;
You Asked: I understand that pulsed dye lasers are
> suitable and that so are carbon dioxide lasers, although with the latter
> there have been incidents of scarring and a poss hazard from Human
Papilloma
> Virus genetic material in the smoke-plume.
Bruce: I use a pulsed dye laser weekly w/ great effect. Up until about 4
years ago I used a CO2 laser as well. In our facility they use a medical
grade filtered vacuum for both lasers, though there is rarely a plume from
the pulsed dye laser.
>
> Is laser therapy a) really effective for verucae? If so can verrucae be
> treated in just one session?
Bruce: It depends on how many lesions you are treating. For small focal
lesions less than 1.0cm in diameter up to 3-5 lesions on a foot but not in
one mass (mosaic), I find it highly successful, but still we have to do
multiple treaments.
b) Is it painful and requires injected
> analgesia?
Bruce:You will need analgesia for the CO2 laser. For the Pulsed Dye, it is
up to you and the patient. I use a high power setting, about 15j/cm2, and
that requires anesthesia. You can do 6-8j/cm2 without anesthesia, but you
will have to take your time with younger patients. EMLA cream helps w/o
anesthesia.
c) What is the capital cost of the preferred type of laser and
> are there issues regarding eliability and running costs?
Bruce: I could purchase a Pulsed Dye laser for 10K U.S. Not sure about the
cost of a CO2, but I'd figure 50-60% of the cost of the other.
d) Presumably high
> power lasers require special training and precautions.
Bruce: They all require basic training which is very easy. When I first got
my CO2 laser certification I had to go to an all day seminar adn get my CME
credits and certificate.
Finally, I use Aldara cream post op with the majority of my patients. It is
specific for the papilloma virus and was developed for peri-anal warts. I
find that I rarely have to repeat the procedure, laser, with use of the
Aldara cream as well. Also, if you opt to use the CO2 laser I will tell you
about one cas I had w/ a patient w/ several years of recalcitrant warts on
one foot. He failed treatment w/ Cryo-therapy, acid therapy with other
docs. With me he had failed pulsed dye twice and failed CO2 once. The
second time w/ CO2 I had him use the aldara cream to the wounds. He was
uncomfortable with that because it caused a burning sensation for several
hours if he did it daily. Eventually, he discovered that he could apply it
every three days to the wounds w/o any burning sensation. His warts finally
went away for good w/ this treatment. As I said, it is anecdotal, but
interesting nontheless.
Good luck.
Bruce Williams
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