I Have a Huge, Bigger Than a Fifty Cent Piece Plantar Wart Foot,all conventional tx has failed. Last treatment was bleomycin. Doctors have no more options. I heard radiation works, can't fine someone in the bay area, calif. What about pulse dye laser. How effective?
Pulsed Dye Laser for Plantar's Wart on Foot?
Doctor Answers 3
Pulsed Dye Laser for Warts
I have had both great success in select cases with pulsed dye laser for plantars warts as well as numerous minimal-responders. It has an advantage over CO2 laser because there is much less destruction and typically less healing time.
Quick reminder: Any wart that persists despite adequate treatments should be looked at and considered for biopsy to exclude other conditions including (uncommon but possible) skin cancer.
Pulsed dye laser can work for difficult warts, but so can CO2 laser excision.
The advantage of pulsed dye laser over CO2 laser excision (vaporization) is that the pulsed dye laser still leaves the warty tissue in place. You may develop a blister, but there is generally no open wound to bandage or hurt. The pulsed dye laser works by sealing the blood vessels in the upper layers of skin, (hopefully) killing the virus-containing skin cells. Pulsed dye laser treatment is easier for both the doctor and the patient, but it works only if done properly.
For large plantar warts, there is almost always substantial thick callous over the living wart-virus-infected tissues, and this requires that the laser surgeon first "shave down" the top dead layers of callous, or the pulsed dye laser energy cannot reach the cells it needs to hit! You simply need to kill as much of the virus-containing cells as possible; your body will generally do the rest (assuming you are not on immunosuppressive drugs or have HIV). More than one treatment with the pulsed dye laser is generally required, but this technique (properly done) can work where others fail. The laser pulses are quite uncomfortable and local anesthesia is not possible when you are trying to get laser energy to seal vessels. Oral pain medication/sedation can be used.
CO2 laser vaporization is another technique I have used for years as well, and although this leaves a large and often somewhat uncomfortable open wound that takes weeks to heal, it can be effective when everything else has failed. It typically is a one-procedure treatment (at least local anesthesia or sedation is necessary), but any sign of persistent or recurrent wart should be re-lasered immediately! With this technique I have cured plantar warts that have involved as much as one third of the bottom of the foot and toes. If this technique is used, you must not put the foot with a new open wound into socks or shoes that may have come into contact with virus-containing wart tissue.
Radiation is not recommended.
Pulse dye laser for plantar warts