Pulsed 1064nm Nd:YAG in the Treatment of Verruca Vulgaris Versus Conventional Therapy With Liquid Nitrogen Cryotherapy

Verruca vulgaris (VV), or the common wart, is a relatively prevalent and often frustrating cutaneous disease to treat. A single, highly effective therapy for the treatment of VV has not been found. Liquid nitrogen is considered the standard of care for VV and studies report a 44% to 47% cure rate. In search of more efficacious and convenient therapeutic options, a variety of lasers have been reported in the treatment of VV including the Nd:YAG laser (1064nm). Lasers offer the potential for decreased treatment associated pain, fewer office visits, higher cure rates and lower recurrence rates. However, many of the available published studies draw conclusions from case reports and small case series without any randomized controlled trials. A randomized, controlled study is needed to evaluate the efficacy of the microsecond Nd:YAG (1064nm) compared to conventional cryotherapy. This study will use the Cutera CoolGlide Nd:YAG laser that operates in the infrared spectrum at a wavelength of 1064nm. This a single site, double blind, randomized controlled clinical trial to evaluate the efficacy of the Nd:YAG laser (Cutera) in the treatment of verruca vulgaris of the hands and feet versus conventional liquid nitrogen therapy. The investigators hypothesize that there will be a significantly higher number of warts with complete resolution at 4 months follow-up in the Nd:YAG treated group versus the liquid nitrogen therapy group. The investigators also hypothesize that there will be a faster time to complete resolution of the verruca in the Nd:YAG treated group versus the liquid nitrogen treated group.

Sex

All

Minimum age

18 Years

Maximum age

75 Years

Inclusion Criteria:

1. Adult males or females, ages 18 - 75
2. Fitzpatrick skin types 1-6
3. Patient is able to read and understand English and will give written informed consent to participate.
4. Patient elects to undergo laser therapy or conventional therapy with liquid nitrogen for the treatment of verruca vulgaris.
5. Clinical evidence of at least one verruca vulgaris, but no more than ten that have not received treatment for at least one month prior to their study start date.
6. Warts to be treated will be located only on the hands or the feet.

Exclusion Criteria:

1. Less than 18 years of age or greater than 75 years of age.
2. Non-English speaking people, who cannot read, understand and sign the consent.
3. Pregnant females.
4. Any form of prior treatment to the area within the last 1 month.
5. Immunosuppressed patients including patients with internal malignancy, on immunosuppressive drugs (including oral steroids), HIV positive or history of connective tissue disease (ie. SLE, DM, Scleroderma).
6. Patients undergoing light therapy including NBUVB, PUVA, high UVB will be excluded from the study until their treatment is complete.
7. Allergy to any components of the topical lidocaine (LMX, 4% lidocaine).

• BACKGROUNDEl-Tonsy MH, Anbar TE, El-Domyati M, Barakat M. Density of viral particles in pre and post Nd: YAG laser hyperthermia therapy and cryotherapy in plantar warts. Int J Dermatol. 1999 May;38(5):393-8. doi: 10.1046/j.1365-4362.1999.00719.x. PMID 10369554
• BACKGROUNDRobson KJ, Cunningham NM, Kruzan KL, Patel DS, Kreiter CD, O'Donnell MJ, Arpey CJ. Pulsed-dye laser versus conventional therapy in the treatment of warts: a prospective randomized trial. J Am Acad Dermatol. 2000 Aug;43(2 Pt 1):275-80. doi: 10.1067/mjd.2000.106365. PMID 10906651
• BACKGROUNDKuykendall-Ivy TD, Johnson SM. Evidence-based review of management of nongenital cutaneous warts. Cutis. 2003 Mar;71(3):213-22. PMID 12661750
• BACKGROUNDPark JH, Hwang ES, Kim SN, Kye YC. Er:YAG laser treatment of verrucous epidermal nevi. Dermatol Surg. 2004 Mar;30(3):378-81. doi: 10.1111/j.1524-4725.2004.30104.x. PMID 15008864
• BACKGROUNDTan OT, Hurwitz RM, Stafford TJ. Pulsed dye laser treatment of recalcitrant verrucae: a preliminary report. Lasers Surg Med. 1993;13(1):127-37. doi: 10.1002/lsm.1900130120. PMID 8426521
• BACKGROUNDGooptu C, James MP. Recalcitrant viral warts: results of treatment with the KTP laser. Clin Exp Dermatol. 1999 Mar;24(2):60-3. doi: 10.1046/j.1365-2230.1999.00418.x. PMID 10233653
• BACKGROUNDKopera D. Verrucae vulgares: flashlamp-pumped pulsed dye laser treatment in 134 patients. Int J Dermatol. 2003 Nov;42(11):905-8. doi: 10.1046/j.1365-4362.2003.01994.x. PMID 14636211
• BACKGROUNDHan TY, Lee JH, Lee CK, Ahn JY, Seo SJ, Hong CK. Long-pulsed Nd:YAG laser treatment of warts: report on a series of 369 cases. J Korean Med Sci. 2009 Oct;24(5):889-93. doi: 10.3346/jkms.2009.24.5.889. Epub 2009 Sep 23.