|Today, laser therapy is used throughout the world to treat podiatric problems such as warts, ingrown toenails, unusual skin growths and spider veins. Prior to the availability of lasers, treatment options for wart treatment were limited to topical therapy or surgical excision. Both methods produced a certain degree of success with a limitation in activities during the healing process. Now, Dr. Cusumano incorporates the Pulse Dye Laser with therapy and patients show a timelier recover with less discomfort.
Dr. Cusumano has been using the Candella V-Beam pulse dye laser at the Pascack Valley Hospital Laser Center for the treatment of warts and finds it to be most beneficial on the resistant warts. The laser is specific and with 3-4 treatments most warts are resolved.
The common wart is known as verruca vulgaris. They are caused by a viral infection of the skin. This occurs as a result of direct contact with the virus. The warts are contagious and can spread to other parts of the body and to other family members. They do not spread through the blood stream. They occur more commonly in children than adults. When they occur on the bottom of the foot, they are called plantar warts. This name is derived from the location of the foot on which they are found; the bottom of the foot is called the plantar aspect of the foot. A common misconception is that plantar warts have seeds or roots that grow through the skin and can attach to the bone. The wart may appear to have a root or seeds, but these are in fact small clusters of the wart just beneath the top layer of the skin. The wart cannot live in any tissue except the skin. Moist, sweaty feet can predispose to infection by the wart virus. They can be picked up in showers and around swimming pools. They are not highly contagious, but being exposed in just the right situation will lead to the development of the wart. Avoiding contact in the general environment is nearly impossible. If a member of the family has the infection, care should be taken to keep shower and tile floor clean. Children who have plantar warts should not share their shoes with other people. Young girls often share shoes with their friends and this should be discouraged.
A wart has an appearance of thick, scaly skin with callus tissue that are commonly mistaken for a simple callus. They can occur as small, single warts or can cluster into large areas called mosaic warts. A simple test to tell the difference between a wart and a callous is to squeeze the callus between your fingers in a pinching fashion and a wart is typically painful.
Chemical Treatment: Various topical acids are available over the counter and most are salicylic acids of different strengths that are applied to the wart daily. The effectiveness of this treatment is improved with proper debridement of remaining white discolored tissue and we recommend weekly debridements by a specialist. It is very important to debride off all of the dead skin in order for acid applications to continue to be effective.
5% Flourouricil is a drug used safely and effectively on warts, and skin tumors. This effects the skin cell to damage the cells containing the warts by daily applications and by debrided by the doctor weekly.
Surgical Treatment: Surgically cutting around the lesion to allow for a biopsy of the entire lesion. A local anesthesia is necessary and there is a risk of scarring.
Cryogenic Treatment: (cold therapy) Applied with a probe or applicator directly to wart. Will create a burn and can scar.
Hyfercation: Using an electric needle to burn the wart. The lesion will vaporize at certain settings and will burn at higher settings. This will usually involve several sessions and possibly an anaesthetic injection.
Many different laser treatments are being discovered and utilized. Here are a few more common ones.
Pulse Dye Laser: A modern technology replacing the CO2 laser and is preformed by Dr. Cusumano with a success rate reported as high as 80 -95%. The device emits a tiny but powerful pulse of light that is absorbed by the pigment within the red blood cells of the wart. The light is generated when the laser dye, is stimulated by a flash lamp energy source. This light is then directed at the wart using a pencil-like hand piece. The absorption of the light by the cells of the wart results in the reducing the wart's nutritional blood flow.
The pulsed dye laser is safe and effective because of its unique ability to selectively treat the wart without adversely affecting the surrounding skin. Patients generally require no anesthetic, which means no painful injections prior to treatment. There is also no risk of scar formation or infection because the skin surface is not broken. The patients can return to most activities the following day. Multiple treatments may be required based on the clinical presentation.
CO2 Laser: Used to cut and vaporize the wart by cutting around the lesion to perform a complete excision of the wart while cauterizing the blood vessels and vaporizing the lesion by creating a mild burn or blister