Dobson Joelle S, Harland Christopher C
St.George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
Lasers Surg Med. 2014 Feb;46(2):112-6. doi: 10.1002/lsm.22199. Epub 2013 Nov 20.
Viral warts are a common ailment. Clinicians often combine multiple treatments to boost efficacy. One such novel combination is pulsed dye laser with bleomycin intralesionally (PDL + BI), described for the successful treatment of single hand warts.
To evaluate PDL + BI for the treatment of poor prognosis hand and foot warts.
STUDY DESIGN/PATIENTS AND METHODS: This 4-year retrospective case series examined the efficacy of PDL + BI used consecutively on patients whose warts were treated with this modality alone. PDL 595 nm was used in stacking mode to achieve hemorrhagic blistering prior to intralesional bleomycin (1 mg/ml normal saline).
Twenty cases (65% male, age 13-62, mean age 42) were identified. Two (10%) were immunocompromised. Twenty five percent of warts affected hands, 55% feet, 20% both. Thirty five percent were solitary >1 cm(2) , 40% were multiple or mosaic verucae. The mean duration was 5.1 years (0.5-15). Seventy five percent received local anesthetic. Mean number of treatments was two. Post-operative pain varied from none to severe, sometimes causing difficulty in walking. Blistering and crusting disappeared after 17 days (range 7-42). Outcome had a mean follow-up of 24 months (3-53) with 60% complete response, 15% partial, 25% no response. Mean satisfaction level was 7 (range 0-10, 10 highest). Outcome was better with local anesthetic (complete response 75%) as it permitted more aggressive treatment. Patients that had both anesthetic and repeat treatment sessions experienced 92% complete response.
PDL + BI offers a novel method for treatment of recalcitrant warts, but local anesthetic and repeat treatments are recommended.
病毒疣是一种常见疾病。临床医生常联合多种治疗方法以提高疗效。一种这样的新型联合疗法是脉冲染料激光联合博来霉素皮损内注射（PDL + BI），已有文献报道其成功用于治疗单发性手部疣。
评估PDL + BI治疗预后不良的手足疣的疗效。
研究设计/患者与方法：本项为期4年的回顾性病例系列研究，考察了连续使用PDL + BI单独治疗疣的患者的疗效。采用595 nm脉冲染料激光以叠加模式进行治疗，以在皮损内注射博来霉素（1 mg/ml生理盐水）前实现出血性水疱形成。
共纳入20例患者（男性占65%，年龄13 - 62岁，平均年龄42岁）。其中2例（10%）为免疫功能低下患者。25%的疣累及手部，55%累及足部，20%累及双手和双足。35%为直径>1 cm²的孤立性疣体，40%为多发性或镶嵌状疣体。疣体平均病程为5.1年（0.5 - 15年）。75%的患者接受了局部麻醉。平均治疗次数为2次。术后疼痛程度不一，从无疼痛到剧痛，有时会导致行走困难。水疱和结痂在17天（范围7 - 42天）后消失。平均随访24个月（3 - 53个月），完全缓解率为60%，部分缓解率为15%，无缓解率为25%。平均满意度为7分（范围0 - 10分，10分为最高分）。局部麻醉时疗效更佳（完全缓解率75%），因为这样可以进行更积极的治疗。接受麻醉且进行重复治疗的患者完全缓解率达92%。
PDL + BI为治疗顽固性疣提供了一种新方法，但建议采用局部麻醉和重复治疗。
