Evaluating the success of Nd: YAG laser ablation in the treatment of recalcitrant verruca plantaris and a cautionary note about local anaesthesia on the plantar aspect of the foot

Background There are various methods advocated for the treatment of verruca plantaris. However, many verrucas do not respond to simple treatment. Objective This study presents our results using Nd: YAG laser ablation therapy for such recalcitrant cases. Methods We performed a retrospective audit by sending a questionnaire to all patients with recalcitrant verrucas who had been treated with Nd:YAG laser ablation over the previous 12 months. The questionnaire asked whether treatment had been successful, successful but new lesions had emerged, partially successful with improvement or unsuccessful. A Fontana Nd:YAG laser was used at the following specifications; long pulsed mode with pulse width 25 ms, frequency 1.0 Hz; fluence 240 J/cm2 and spot size 2 mm. Some patients requested local anaesthesia and had direct infiltration with 0.5% plain lidocaine. Results Fifty‐three of the original 87 patients responded (60.9% response rate) with a male to female ratio of 24:29, mean age of 47 years and an age range between 22–72. Thirty‐seven patients reported complete success post treatment (69.8%) and a further five reported improvement. The remaining 11 felt their treatment was unsuccessful. The cure rate was 81.8% in unilateral single cases, 68.1% in unilateral multiple cases and 65% in bilateral cases. Ten patients requested sublesional lidocaine injections of which 4 had skin breakdown after Nd: YAG ablation. Conclusion Nd:YAG laser ablation is effective in the treatment of recalcitrant verruca plantaris. However, we caution against the use of direct local anaesthesia infiltration before laser treatment.