The Laryngoscope
Lippincott Williams & Wilkins, Inc., Philadelphia
© 2002 The American Laryngological,
Rhinological and Otological Society, Inc.
The Treatment of Facial Verrucae With the
Pulsed Dye Laser
Hannah Vargas, MD; Christopher R. Hove, MD; Marsha L. Dupree, MD; Edwin F. Williams, MD
Objectives/Hypothesis: To evaluate the treatment
of facial verrucae with the pulsed dye laser. Study
Design: A prospective, nonrandomized, nonblinded
pilot study evaluating the treatment of facial verru-
cae with the pulsed dye laser. Methods: Twelve pa-
tients with facial verrucae (four recalcitrant) were
identified and followed in the study in the setting of a
tertiary referral center. The treatment consisted of
the flash-lamp pumped pulsed dye laser (585 mn) with
a spot size of 5 mm at fluences between 9.0 and 13
J/cm2. Each lesion received one or two pulses with 2
mm of surrounding normal skin included in the treat-
ment. One patient had paring prior to pulse treat-
ment. The patients were examined 3 to 4 weeks after
each procedure, and clinical assessment of the lesion
was documented. Results: Patient ages ranged from
18 to 47 years. Four patients had refractory lesions,
and eight patients had never undergone previous
treatment. All 12 patients had full resolution of their
facial warts after one to three treatment sessions. No
complications such as scarring, alopecia, or recur-
rence were encountered. Follow-up ranged from 10 to
33 months. Conclusions: Pulsed dye laser therapy is
highly effective and safe therapy for facial verrucae.
This method appears to selectively destroy warts
without damaging surrounding skin. Key Words:
Pulsed dye laser, warts, verrucae.
tified that effectively cures the patient with few complica-
tions. Conventional treatment consists of nonspecific tis-
sue destruction including repeated application of topical
medications, cryotherapy, electrocautery, surgical exci-
sion, and the carbon dioxide (CO2) laser. These therapies
can cause bleeding, infection, scarring, and recurrence
and can frustrate the patient as well as the clinician.2,3
This frustration has prompted clinicians to search for
alternative methods of treating VV.
Recently, investigators have reported treating VV
with the pulsed dye laser (PDL) at 585 nm. This is based
on the theory of specific destruction of superficial dilated
capillaries in the verrucae, as well as killing virally in-
fected cells. Overall cure rates have ranged from 33% to
99% but appear to be site dependent.4–8 Reports of ver-
rucae of the head and neck have been scant in the litera-
ture and, to date, there have been no studies examining
the effectiveness of PDL in the treatment of facial verru-
cae. These warts are can be particularly disturbing to the
patient because of their high visibility and social taboo.
Nonspecific destruction of adjacent skin can lead to sig-
nificant scarring. A therapy that could combine efficient
treatment with low rates of complications and recurrences
makes PDL an attractive possible therapy for facial
verrucae.
Laryngoscope, 112:1573–1576, 2002
PATIENTS AND METHODS
INTRODUCTION
Verruca vulgaris (VV) is extremely common in the
United States, affecting approximately 10% of the popu-
lation.1 Although extensively studied, the treatment re-
mains less then ideal. As with many diseases in which
multiply therapies exist, no one treatment has been iden-
Study Design
The present prospective, nonblinded, nonrandomized study
was conducted at a private practice surgery center.
Patients
All patients who were identified as having facial VV who
consented for PDL treatment were followed. One patient with
numerous confluent facial and neck verrucae who was immuno-
compromised was excluded from the study.
Presented at the Meeting of the Southern Section of the Triological
Society, Captiva Island, FL, January 11, 2002.
From the Section of Facial Plastic and Reconstructive Surgery, Di-
vision of Otolaryngology (H.V., E.F.W.), and the Department of Dermatology
and Pathology (M.L.D.), Albany Medical College, Albany, New York, U.S.A.
Dr. Hove is currently a fellow in the Section of Facial and Recon-
structive Surgery, Stanford University, Stanford, California.
Editor’s Note: This Manuscript was accepted for publication April
25, 2002.
Send Correspondence to Hannah Vargas, MD, Section of Facial
Plastic and Reconstructive Surgery, Division of Otolaryngology, Albany
Medical Center, 47 New Scotland Avenue, Albany, NY 12208, U.S.A.
E-mail: hvargas68@yahoo.com
Therapy
The treatment consisted of the flash-lamp pumped pulsed
dye laser (585 mn) with a spot size of 5 mm at fluences between
9.0 and 13 J/cm2. Each lesion received one or two pulses with 2
mm of surrounding normal skin included in the treatment. Joule
settings and pulse numbers were based on the standard settings
in the literature and the subjective opinion of the physician in
regard to the size and thickness of verrucae. One patient (patient
Laryngoscope 112: September 2002
Vargas et al.: Facial Verrucae
1573