Dr. Mario Atrelles, M.D., Ph.D.
Instituto Médico Vilafortuny, Antoni de Gimbernat Foundation, Cambrils, Spain.

Ines Allones, M.D.
Instituto Médico Vilafortuny, Antoni de Gimbernat Foundation, Cambrils, Spain.

Esther Mayo, P.T.
Instituto Médico Vilafortuny, Antoni de Gimbernat Foundation, Cambrils, Spain.

Objective: The aim of this study was to evaluate Er:YAG ablation of plantar verrucae with red light-emitting diode (LED) therapy to assist healing.

Background Data: Successful removal of troublesome plantar verrucae still presents problems, particularly regarding complete removal and pain both postoperatively and during healing. A further problem is a high recurrence rate due to the aggressive viral dissemination associated with this kind of wart.

Methods: Over 2 years, the author treated 121 plantar warts under local anesthesia in 58 patients with Er:YAG laser ablation followed by red LED therapy to assist wound healing. The Er:YAG laser (96 J/cm2, 2.0 J/pulse, 350 µsec pulsewidth, 2-mm collimated handpiece) is used first to ablate precisely the verrucous tissue until normal architecture is seen. Immediately after treatment, a red LED therapy system is applied (633 nm, 20 min, 96 J/cm2) to the wound and surrounding area. LED therapy at the same parameters is repeated on postoperative days 2, 6, and 10. Arepresentative plantar verruca case is presented.

Results: The Er:YAG laser precisely and cleanly ablates the plantar verrucae with clear margins into normal skin architecture, exhibiting minimal secondary thermal damage. After the first treatment session, patients are usually able to walk normally without any pain, even those who have bilateral verrucae, and no exudate is usually seen from postoperative day 2 on. By postoperative day 6, the wounds have shrunk noticeably and are filled with healthy granulation tissue, and by day 15 they are usually completely healed, with minimal scarring. At the 12-month follow-up, recurrence rates have been less than 6% (3/58 patients).

Conclusion: From the author's experience in 121 cases, the Er:YAG laser is ideally suited for precise and speedy ablation of plantar verrucae with minimal thermal damage to surrounding tissue, which, when coupled with visible red LED therapy, has given excellent, accelerated, and pain-free healing in these difficult-to-treat and slow-to-heal lesions with very low recurrence rates.