Risk of acquiring human papillomavirus from the plume produced by the carbon dioxide laser in the treatment of warts

Gloster, Hugh Morris; Roenigk, Randall K.

doi:10.1016/0190-9622(95)90065-9

Cited by 218 publications

(179 citation statements)

References 10 publications

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“…HPV DNA has been demonstrated in CO2 laser vapor, as well as in the vapors from electrocoagulation. [121][122][123][124][125] Erbium:Yttrium/Aluminum/Garnet (Er:YAG) Laser The Er:YAG laser emits a shorter wavelength infrared radiation (2940 nm) that is absorbed 12 to 18 times more efficiently by water-containing superficial cutaneous tissues than is the 10,600 nm wavelengths emitted by the CO2 laser. 126 The Er:YAG laser has a smaller zone of thermal damage, thereby allowing more precise thermal ablation with minimal scarring.…”

Section: Carbon Dioxide (Co2) Lasermentioning

confidence: 99%

An Armamentarium of Wart Treatments

Lipke¹

2006

Clinical Medicine & Research

282

295

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Patients and clinicians experience the frustration of cutaneous viral warts caused by infection with the human papilloma virus (HPV).Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas. Cervical infection with HPV is now known to cause cervical cancer if untreated. A review of the medical literature reveals a huge armamentarium of wart monotherapies and combination therapies. Official evidence-based guidelines exist for the treatment of warts, but very few of the reported treatments have been tested by rigorous blinded, randomized controlled trials.Therefore, official recommendations do not often include treatments with reportedly high success rates, but they should not be ignored when considering treatment options. It is the purpose of this review to provide a comprehensive overview of the wart treatment literature to expand awareness of the options available to practitioners faced with patients presenting with problematic warts. Warts of the genital tract carry a much more ominous and pernicious threat for women in particular. It has been estimated that up to 70% of sexually active women become infected during their lifetime with human papillomavirus (HPV), the infective agent that causes warts. 3-5 A causal role for HPV infections in cervical cancer has been documented beyond reasonable doubt. HPV DNA is present in virtually all cervical cancer cases worldwide, with it being detected in 99.7% of an international series of cervical cancers by genetic amplification techniques and in 100% of cases as confirmed by histological review. 6,7 Cervical cancer is the most frequent common cancer in developing countries and the second most common cancer in women worldwide. 3 The association between HPV infection and cervical cancer is so strong that HPV is now considered the first positive cause of any human cancer ever identified. 3This raises the level of concerns over HPV prevention, screening and treatment from that of a nuisance condition to that of a major public health concern. Attention is beginning to focus on the viral factors that determine persistence and neoplastic progression to cancer and the possible role of HPV in other nongenital cancers (e.g., skin, upper aerodigestive tract). [8][9][10][11][12][13][14][15][16][17] Patients with warts seek advice from general practitioners, pharmacists, naturopaths, allied health professionals, family or friends, dermatologists, gynecologists, obstetricians and pediatricians for treatment and may present with recalcitrant warts that have been previously treated with anything from folk remedies to hypnosis to over-the-counter medications to more aggressive clinic-based treatments. Unfortunately, even with years of medical literature on this subject, high-quality, level I evidence for the efficacy of almost all treatments is no...

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Section: Carbon Dioxide (Co2) Lasermentioning

confidence: 99%

An Armamentarium of Wart Treatments

Lipke¹

2006

Clinical Medicine & Research

282

295

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“…Also, clinical surveys of laser users have revealed increased user infections with HPV; however, direct lesional contact may be the source of infectivity. [12][13][14] Intact papillomavirus DNA is a potential infectious agent. [15][16][17] Although in vitro methods have detected liberated infective virus in the collected plume, in the papillomavirus 6 and the human immunodeficiency virus 11 models using the CO 2 laser, and in an in vitro study 18 of erbium (ER):YAG laser-generated aerosol, STUDY the induction of actual infection by the laser plume, to our knowledge, has not been documented.…”

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confidence: 99%

Viral Disease Transmitted by Laser-Generated Plume (Aerosol)

Garden¹

2002

Arch Dermatol

193

158

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“…The necessary precision in treatment delivery to such lesions may be best achieved using scissors [2, 5]rather than electrocoagulation, as the thermal damage induced by the latter may extend beyond the targeted lesions to burn the bridges of healthy skin, especially of the very sensitive anoderm. Moreover, sharp excision avoids the potential risk of transmission of the infectious papillomavirus to the operating surgeon associated with laser and electrocoagulation vapour [6, 7]. …”

Section: Discussionmentioning

confidence: 99%

Electrocoagulation of Perianal Warts: A Word of Caution

Ammori

Ausobsky²

2000

Dig Surg

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Background: Perianal warts are common, and may be extensive. Electrocoagulation is a recognised management option. Method: A 20-year-old male underwent electrocautery of extensive perianal warts. He presented 3 months postoperatively with constipation and inability to defecate. Examination revealed severe perianal stricture, which necessitated a defunctioning colostomy. Result: A gradual and spontaneous resolution of the stricture was observed over the following 18 months. Closure of the colostomy was followed by satisfactory anal function. Conclusion: Electrocautery of extensive perianal warts should be used with caution. Preservation of healthy skin bridges between lesions is essential if perianal stricture is to be avoided, and may best be achieved by sharp scissors dissection.

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Risk of acquiring human papillomavirus from the plume produced by the carbon dioxide laser in the treatment of warts

Cited by 218 publications

References 10 publications

An Armamentarium of Wart Treatments

An Armamentarium of Wart Treatments

Viral Disease Transmitted by Laser-Generated Plume (Aerosol)

Electrocoagulation of Perianal Warts: A Word of Caution

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