Introduction
Plantar warts can be resistant to treatment, requiring many patients to undergo numerous treatment
modalities to eradicate them. An extensive search of the literature was performed to compare and contrast
four modalities of light therapy on recalcitrant plantar warts that have failed previous topical and nontopical
treatments.
Study design
A qualitative systematic review of electronic databases was performed to compare light therapy on
recalcitrant plantar warts.
Materials and Methods
A search was performed using PubMed and ScienceDirect databases. Inclusion criteria consisted of
recalcitrant warts, yttrium-aluminum-garnet (YAG) laser, photodynamic therapy (PDT), CO2 laser, and
pulse dye laser (PDL) restricted from 1985 to present. Inclusion criteria were not limited to a particular type
of a study for this literature review; criteria were open to case report, cross sectional study, randomized
trials, and double-blinding study. Studies were excluded if their patient population was:
immunocompromised on hemodialysis, taking immunosuppresants, had systemic illness, were pregnant,
breast-feeding, or if they had photosensitivity.
Results
The search on PubMed for ‘Plantar Warts’ and ‘Laser Therapy’, and ‘Plantar Warts’ and ‘YAG’ yielded 44
and 7 articles respectively. From a combined total of 51 articles, 11 met the parameters of the inclusion
criteria. An additional search on ScienceDirect resulted in 144 articles, and only 1 article fulfilled the
criteria. Overall, 12 articles were selected for further qualitative review.
Conclusion
All light treatment option studies demonstrated reasonable outcomes to be used as alternative treatment
modalities for recalcitrant plantar warts. However, there are minor differences amongst these different light
types and studies. Although CO2 therapy demonstrated effective results, its side effects were notable: postop
pain, scarring and pigment changes. PDL demonstrated similar treatment outcomes as CO2 therapy, but
yielded in significantly less side effects because it able to selectively injure the feeding vessels of the warts
without damaging surrounding structures. YAG laser is ten times more selective for water than CO2 therapy
causing less thermal damage and minimizing adjacent tissue damage leaving minimal pain, scarring, and
pigment changes. PDT is a new type of light therapy that displays effective clearance of recalcitrant plantar
warts and causes less pain and discomfort compared to the above mentioned light-therapy armamentarium.
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