You are welcome Peter! Hope it helps.
Bruce
----- Original Message -----
From: "Peter Barrow" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, June 06, 2004 3:08 PM
Subject: Re: Lasers for treatment of plantar warts
> 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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