Post-CO2 Laser Treatment for Viral Warts: Common Concerns

Recently underwent carbon dioxide laser surgery for viral warts?

Hello, my brother has developed several viral warts on the soles of his feet (including between the toes and under the toenails) and on the tops of his feet.
The number is quite significant, and it has extended to the back of his calves with 1 to 2 warts as well.
He also has several warts between his fingers, on the backs of his hands, and on his wrists.
He just underwent carbon dioxide laser surgery at Chang Gung Memorial Hospital about three days ago, but the doctor is unwilling to treat all the affected areas on both feet at once.
The treatment will be divided into 2 to 4 sessions (including the areas on his hands).
Could you explain why it cannot be done all at once? Shouldn't at least the feet be treated together? Additionally, since the laser treatment, his right foot has been severely swollen.
Is this a normal reaction?
Furthermore, I noticed that due to the extensive and widespread nature of the warts, it seems that the laser did not penetrate deeply enough (approximately the thickness of a five-dollar coin).
What is the recurrence rate for this carbon dioxide laser surgery? Although the doctor has prescribed oral medication to boost his immune system, I am still concerned that if the laser treatment was not deep enough, it may not effectively remove the warts from the root.
Would the combination of the oral medication be effective in this case? Given that he has delayed treatment for several years (initially thinking they were corns), could this have caused the virus to become entrenched?
Lastly, can the warts on his extremities be treated with products like 3M's Cavilon or phenol-based ointments used for genital warts?
(I apologize for the numerous questions, and I greatly appreciate your patience in answering them!)

Rou, 20~29 year old female. Ask Date: 2017/05/20

Dr. Wu Yuxin reply Dermatology

You should consult your attending physician about this issue, as they are the most familiar with your condition.

Reply Date: 2017/05/20

More Info

Post-CO2 laser treatment for viral warts can raise several concerns, especially when dealing with multiple lesions on the feet and hands, as you've described. It's understandable to have questions about the treatment process, recovery, and recurrence rates.

Firstly, regarding the decision to perform the CO2 laser treatment in multiple sessions rather than all at once, this is a common practice in dermatological procedures. The primary reasons for this approach include minimizing trauma to the skin, reducing the risk of complications, and allowing for better healing. When multiple areas are treated simultaneously, it can lead to increased swelling, pain, and a higher risk of complications such as infection or scarring. By spacing out the treatments, the physician can monitor the healing process and ensure that each area is responding well to the treatment before proceeding with additional sessions.

As for the significant swelling in your brother's right foot post-treatment, some degree of swelling is a normal response to laser surgery. The CO2 laser works by vaporizing the wart tissue, which can cause localized inflammation and swelling as part of the healing process. However, if the swelling is severe or accompanied by other symptoms such as increased pain, redness, or discharge, it would be advisable to contact the treating physician for further evaluation.

Concerning the depth of the laser treatment, CO2 lasers are designed to target the wart tissue effectively. However, the depth of penetration can vary based on the settings used and the specific characteristics of the warts. If the warts are particularly deep-rooted, there is a possibility that some residual virus could remain, leading to recurrence. The recurrence rate for warts treated with CO2 laser can vary, but it is generally lower than with other treatments, especially when combined with immune-boosting medications. The oral medications prescribed to enhance immune response can be beneficial in helping the body fight off the virus that causes warts.

It's important to note that warts are caused by the human papillomavirus (HPV), which can be persistent. If the warts have been present for several years, there is a chance that the virus may have established itself more deeply in the skin. This is why follow-up treatments and possibly additional therapies may be necessary to ensure complete removal and to reduce the likelihood of recurrence.

Regarding the use of topical treatments like 3M's "Lidocaine" or other over-the-counter wart treatments, it's crucial to consult with a healthcare professional before applying any new treatments, especially on areas that have recently undergone laser therapy. Some topical treatments may irritate the skin or interfere with the healing process.

In summary, while the concerns you have are valid, they are not uncommon in the context of post-laser treatment for viral warts. It is essential to maintain open communication with the treating physician, follow their post-operative care instructions, and attend all follow-up appointments to monitor healing and address any concerns that may arise. If the swelling or any other symptoms persist or worsen, seeking medical advice promptly is crucial to ensure proper care and recovery.

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