Laser wart removal for adults and children

Various skin growths can not only spoil its aesthetic appearance, but also cause certain physical inconveniences. If you can find something attractive in a small dark spot above the lip or on the shoulder, called a mole, then a flesh-colored bump on any part of the body will be out of place. Warts are exactly such unwanted bumps, bringing their owner a lot of trouble, ranging from psychological discomfort to increased trauma of nodules and pain when walking, if such "happiness" appeared on the sole or toes. Removing warts with a laser or other possible methods is the only way to get rid of a dermatological defect. And although this method does not have much therapeutic value, from a cosmetological and psychophysical point of view it is quite justified.

Etiology of warts

Warts are small growths on human skin that are oval or round in shape. They can appear on any part of the body, including the genitals and soles of the feet. Warts on the sole are often confused with calluses, although these phenomena have a completely different nature.

The appearance of warts and their sizes can also vary somewhat. Dermatologists distinguish between:

• flat warts (juvenile), located almost flush with the skin on the back of the hands and face,
• common warts in the form of elastic tubercles and convex plaques of flesh color (they can be found all over the surface of the body),
• senile warts (loose soft plaques of various sizes and colors: from grayish to brown and almost black).
• warts that form on the mucous membrane of the genitals, are small in size and often have a sharp tip; they are called pointed condylomas. The color of the condylomas corresponds to the color of the mucous membrane, so it is not so easy to see them on the internal genital organs of women.

Most warts have a viral etiology, i.e. they arise as a result of a virus entering the body. But not any viral infection, but a specific one, called papillomavirus infection. That is why warts are often called papillomas. And their widespread prevalence is explained by the resistance of the papillomavirus, which is impossible to remove from the body. [ 1 ]

A person infected with papillomavirus infection becomes a source of infection for other people. However, for the virus to be transmitted, there must be a wound on the skin and a reduced protective barrier. This infection is especially easily transmitted sexually, given the increased sensitivity of the mucous membranes and their vulnerability to the slightest negative factors, such as friction during sexual intercourse. [ 2 ]

Most warts, with the exception of senile warts (age keratomas), are caused by the introduction of the papillomavirus into the body. Keratomas are darker in color and are usually located on the face and neck - areas with more delicate skin exposed to solar radiation, less often on the body. In appearance and color, they are more reminiscent of convex soft moles. There is no particular need to remove them, because they do not carry a pathological basis. [ 3 ]

Removing warts at a young age is justified by the cosmetic and some therapeutic effect, because together with the wart, the active virus that has settled in the skin cells and forces them to divide (reproduce) is also removed. Despite the fact that the wart removal procedure does not have a systemic effect, i.e. does not contribute to the complete removal of the virus from the body, it reduces the number of active virions.

True, removing a wart with a laser or other methods on one small area of skin does not guarantee that the neoplasms will not reappear somewhere nearby or on a distant area of the skin. Only a strong immune system can contain a viral infection.

Indications for the procedure

Warts can have different localizations and do not always cause psychological or physical discomfort to their owner. Some neoplasms, for example, in the area of the internal genital organs, may not even be suspected. In women, they are often detected accidentally during a full gynecological examination. It is clear that the attitude to the practically invisible from the outside tubercles in most cases is indifferent, and one can even say careless.

Yes, the prevalence of the papillomavirus is high enough that people simply stop taking it into account and fear the consequences. In most cases, there are no consequences other than the appearance of warts (and not always). But the problem is that the formation of unusual flesh-colored growths on the body can be caused by different types of the virus (and there are more than 100 varieties), and not all of them are safe.

There are a number of highly oncogenic strains of the papillomavirus, including those that cause the formation of genital warts. The word "highly oncogenic" means that a wart caused by this type of virus may well develop into a cancerous tumor under certain conditions. [ 4 ] It is clear that such conditions do not always exist (we are talking about a predisposition to cancer, radiation, etc.), but sometimes even a minor injury to a wart can cause its degeneration and uncontrolled growth. [ 5 ], [ 6 ] So it is not worth testing the possibility of such changes on yourself.

Laser wart removal, especially when it comes to pointed condylomas (gynecologists themselves insist on this), should be considered as a preventative measure against oncological diseases. But not only that. Any bumps on the skin are more susceptible to injury than other areas. A wound forms at the site of the injured wart, into which a bacterial infection can easily penetrate, causing pain and suppuration. [ 7 ]

Dermatologists recommend removing any warts that cause a person some discomfort. Indications for the procedure, in addition to the risk of malignancy (degeneration into a malignant tumor and spread to other parts of the body), are:

• High risk of trauma to the neoplasm. Particular attention should be paid to growths on the cheeks of men (they can be damaged during shaving), in the armpits (again, the problem with shaving the armpits, which many women and even men practice today, as well as the risk of trauma to the wart as a result of rubbing against rough seams of clothing), on the neck (risk of injury by the collar). Pointed condylomas can be injured during hygiene procedures and sexual intercourse, moreover, in this case there are also medical indications. And warts on the back are often touched and rubbed by bra straps, causing discomfort to the fair sex.

It's better to remove an uncomfortable wart right away than to worry when it turns red, becomes inflamed, or starts bleeding.

• Cosmetic defect. Warts on exposed parts of the body can cause their owners many unpleasant moments, affecting their self-esteem and behavior. This is very important in adolescence, when such defects become an obstacle in sexual relations. Some warts can disappear on their own under the influence of the immune system, but if this does not happen, it is better to take measures that will help make the neoplasm less noticeable, or better yet, remove it completely.
• Preventing the spread of warts to other parts of the body and infection of people in contact with the carrier. Warts are active infection sites on the skin surface with a high level of contagiousness, and if they are removed, the spread of infection to other parts of the body or transmission to another person can be avoided.
• Getting rid of pain and discomfort while walking. Plantar warts, which are very difficult to remove using folk methods, since they are localized on hardened skin, sometimes cause a change in a person's gait. Their pain when pressed forces a person to twist so as not to step on the growth, limits the ability to move and exercise, and affects work capacity. By removing plantar warts, a person gets the opportunity to move normally and perform their usual work.

As we can see, there are more than enough reasons to start fighting unsightly and potentially dangerous growths on the skin. All that remains is to choose a method that will help solve this problem as quickly and effectively as possible. [ 8 ]

Should warts be removed with a laser?

Warts are growths on the skin that humans first encountered many centuries ago. At that time, people did not yet know or understand the reasons for the appearance of bodily tubercles and did not suspect their danger, although at one point they perceived them as a punishment from the gods. Later, people began to think about how to correct a cosmetic defect visible to other people. Today, people are more interested in how safe neoplasms are, and when it became clear that they can cause cancer, attention to finding various methods to combat the manifestations of the virus increased. [ 9 ]

If you can't remove the virus itself, you should at least get rid of its active foci. If earlier this could be done surgically or with the help of folk recipes, then in the modern world many more effective and safe ways to say "goodbye" to warts have been developed:

• Thermocoagulation.
• Electro- or diatormocoagulation. [ 10 ]
• Cryodestruction.
• Laser removal of neoplasms.
• Radio wave therapy.
• Photodynamic therapy. [ 11 ]

Today, there is much talk about laser removal of neoplasms as one of the most accessible and effective methods. Laser therapy is practiced both in medical institutions and in many cosmetology clinics. But there is a lot of talk, and for yourself you want to choose the best. Comparison helps to determine the optimal method for removing warts.

Traditional medicine is the most affordable method, which includes many ways to combat warts, developed and tested over many years. Some methods are less painful, while others require patience to achieve results. But in most cases, the main disadvantage of traditional methods is that they have to be used repeatedly to achieve the desired result. Not all methods are equally effective, so you often have to try one method of combating warts to get results.

Moreover, the virus may not die under the influence of folk remedies, but only lie dormant for a while, so you can only count on a temporary effect. Other remedies (more aggressive) can leave behind burns on the body, which subsequently turn into unsightly scars. [ 12 ]

But the most unpleasant thing is that preliminary steaming of the wart, which is recommended before its removal, is a factor in the spread of infection to nearby tissues. The virus does not die at such a temperature, but gets the opportunity to easily penetrate into nearby tissues. The same thing happens when cutting off the wart, i.e. removing its top, while the active virus can be located in deeper layers. It is not surprising that sometimes the wart not only does not disappear, but even begins to increase in size. [ 13 ]

The surgical method of combating warts is more reliable and time-tested. But it has its drawbacks. Firstly, it is a painful procedure, because the tissue has to be cut alive. You can’t do without anesthesia. Secondly, there is a certain risk of infection of the wound if all aseptic requirements are not met. Thirdly, after the operation, a suture is often applied to the wound, in the place of which a scar often forms later. Another danger is bleeding if a large vessel is affected.

Thermocoagulation involves removing growths using a hot loop. This is also a very painful procedure that requires anesthesia. The risk of wound infection is lower, but still remains. In addition, a scar may remain at the site of the burn. With thermocoagulation, it is very difficult to regulate the depth of penetration of the loop into soft tissues so as not to damage healthy tissue and at the same time completely remove those infected with the virus. An advantage is the coagulation (cauterization) of blood vessels, which reduces the risk of bleeding. [ 14 ]

An interesting option for thermocoagulation is electrocoagulation. In this case, there is no contact between the metal and the skin, which significantly reduces the risk of infection. The growth is cauterized using high-frequency currents. This somewhat reduces pain, makes it possible to regulate the depth of penetration, and reduces the procedure time. The wart scar will only be noticeable if the growth area is large. The disadvantages include a fairly long wound healing period, the risk of damaging healthy tissue, and limited use for large warts and on exposed parts of the body. [ 15 ]

Cryodestruction does not use thermal action, but the opposite effect. The neoplasm is not cauterized or cut out, but frozen using liquid nitrogen. Applicators of different sizes are used for the procedure, which reduces the risk of damaging healthy tissue. The duration of exposure to nitrogen is extremely short (1-2 minutes), so the entire procedure takes no more than 5 minutes. Painful sensations usually occur in people with a low sensitivity threshold, who are offered anesthesia. Good indicators are also a low risk of infection and a high rate of recovery of damaged skin, as well as a low risk of bleeding and a small proportion of cicatricial changes.

Radio wave therapy is a non-traumatic method of combating neoplasms, which does not involve contact incisions, cauterization or freezing of the skin. There is no contact of the skin with the electrode. The wart is destroyed under the influence of high-frequency radio waves, which seem to evaporate its structures from the inside. The risk of infection and bleeding is minimal, there is no pain, healthy cells remain virtually unaffected. Wounds heal quickly, rarely leaving behind traces of scars. The disadvantage of the method is its low prevalence and high cost, so a person usually has to choose between other methods. [ 16 ]

Laser removal of various neoplasms on the skin and mucous membranes is a relatively new, but already well-established direction in modern cosmetology and medicine (surgery, gynecology). By adjusting the laser power, it is possible to treat the human body, make surgical incisions or remove neoplasms by cutting out or drying them out and sealing the vessel to avoid bleeding. [ 17 ]

Laser exposure also involves disinfection of the tissues of the wound formed at the site of the removed wart, which reduces the risk of suppuration and scarring. With laser exposure, the risk of wound infection during the procedure is minimized. Complications can only arise in the case of improper care of the skin of the affected area after the procedure.

Is it painful to remove warts with a laser? It all depends on the sensitivity threshold. There is no strong pain sensation, but such sensations are subjective. People with a low sensitivity threshold are usually offered anesthesia, but it is not at all necessary. Anesthesia can also be administered to people who are not psychologically prepared to tolerate pain, or rather, are afraid of it. [ 18 ]

Having considered various methods of combating the manifestations of the papillomavirus and age-related changes, we can decide what is the best way to remove a wart: with a laser or nitrogen, radio waves, a metal loop, current, a surgical knife or folk remedies? Considering the advantages and disadvantages of the methods, we can conclude that the most effective and justified are radio wave therapy, electrocoagulation, cryodestruction and laser wart removal. But given that radio wave removal of neoplasms is offered by a limited number of clinics, we will choose between three methods. [ 19 ]

What is the best way to remove warts: with a laser or electrocoagulation? In both cases, we are talking about cauterizing the growth, but it is believed that laser exposure is less traumatic and leaves fewer marks on the skin. With laser removal, the pain is noticeably weaker, and with its help, warts can be removed in any place and of different sizes.

When choosing between laser surgery and liquid nitrogen wart removal, it is worth paying attention to the body's reaction to cold. Often, patients complain of tissue swelling for several days after the procedure, redness of the skin around the wound, although there is no talk of infection. With a large wart area, especially if it is located on the palms or soles, it is very difficult to calculate the depth of penetration, so it is easy to damage the vessels of nearby healthy tissues, which is fraught with the formation of painful hematomas. [ 20 ]

Another disadvantage of cryodestruction is that it may take 3 to 5 procedures to completely remove a wart. [ 21 ] Laser treatment involves complete and permanent removal of a wart in one short procedure. The cost of both methods of combating warts will be approximately the same.

Be that as it may, we can only give our reader information about the different options for removing warts and papillomas. We have no right to dictate the final decision. Each person should choose treatment methods based on their capabilities, health condition (different methods have their own contraindications), and wishes. [ 22 ]

Preparation

Our goal is to introduce the reader to one of the most effective and popular methods of combating skin neoplasms. This is the removal of warts and papillomas with a laser. This method has become widespread for a reason. It is easy to use, affordable, and does not require special training.

And yet, like other methods, laser therapy has certain contraindications, even if not absolute. Therefore, before coming for the procedure, it is worth making sure that you do not have any. When choosing a method for removing warts, you must be sure to read the list of contraindications and consult a doctor about this. [ 23 ]

The laser therapy procedure is usually performed on an outpatient basis. No one will ask the patient for blood and urine test results, instrumental examination forms (ultrasound, ECG, etc.), but this does not mean that the patient's condition at the time of the procedure should not be taken into account. Any ailment can be considered an obstacle to instrumental removal of warts.

The psychological attitude is very important. If a person is afraid, his nervous system and receptors are in a state of heightened readiness, so even minor pain is strongly felt. In addition, sudden movements and twitching during an operation that requires high precision can negatively affect its outcome. If you cannot pull yourself together, you should take a sedative or reschedule the procedure for another time. [ 24 ]

Since the removal of warts involves exposure to human skin, it is clear that thorough hygiene procedures should be carried out the day before, despite the fact that immediately before removing the wart on the skin, the wart itself and the area around the growth will be pre-treated with an antiseptic. [ 25 ]

Another important element of preparation is determining the patient's sensitivity threshold. Testing is performed using a laser, which will be used to remove warts. If the patient is calm during the tests, he or she can do without anesthesia during the procedure. For people with a low sensitivity threshold, the tests cause noticeable discomfort, so they are offered local anesthesia. In this case, it is worth clarifying the tolerance of anesthesia.

Some clinics offer a short (20-minute) diagnostic examination of warts (dermatoscopy) as a preparation, which allows one to determine the nature of the growths on the body and their tendency to degenerate into a malignant tumor.

Technique laser wart removal

The procedure for removing warts with a laser is not difficult. After treating the surface of the skin or mucous membrane with an anesthetic, either pain relief is administered or the procedure is started immediately. [ 26 ]

General anesthesia is not advisable in such cases, because the pain is not so strong, and the operation is generally bloodless. It is enough to reduce the sensitivity of the area near the wart as much as possible. This is possible in two ways:

• injection into the base of the wart (usually popular anesthetics are used: lidocaine or novocaine),
• application of a special cream or gel with an anesthetic to the skin (often used for anesthesia in children).

When the sensitivity of the skin in the area of the wart has decreased sufficiently, a laser beam is directed at it, which heats and burns the tissue of the wart, in place of which a brown crust forms.

It should be said that different salons and clinics may use different types of laser, so it is worth inquiring about this issue in advance. The fact is that different types of laser may have a different effect from others, which determines the effectiveness and safety of their use on different parts of the body.

Having inquired about what laser is used to remove warts in different clinics, we received different answers. Laser is a collective term that denotes a device used to remove warts. But the structure and operating principle of such devices may differ.

The action of one group of lasers, which includes carbon dioxide (CO2 laser), [ 27 ] erbium and neodymium devices, is based on the absorption of laser radiation by water in our tissues:

• Carbon dioxide laser is a long-wave (up to 11 thousand nm) high-power gas device, rarely used in cosmetology rooms. It can work in two positions: a focused beam (used instead of a scalpel or a surgical knife) and unfocused radiation (the action is based on the coagulation of the vessels that feed the wart). It is useful for removing warts in hard-to-reach places (for example, under the nail plate), on rough skin, and warts of a large area. When using a focused beam, the pain is higher, and the wound healing rate is slower.
• Erbium laser (Er: YAG laser) is a solid-state laser with a wavelength of 2940 nm. It is based on yttrium aluminum garnet activated by erbium ions. Its wavelength is significantly lower, due to which the absorption of rays by water increases. The effectiveness of the procedure with an erbium laser is even higher, and the thermal radiation of such a device is less traumatic, so the risk of scarring is lower. [ 28 ]
• The neodymium laser (Nd: YAG laser) is also a solid-state device and is based on the same principle as the Er YAG laser, but neodymium ions act as an activator. The wavelength is 1064 nm, which further increases the absorption of laser radiation by water. Like the erbium laser, it coagulates blood vessels and disrupts the nutrition of warts. It acts gently, leaving virtually no scars. [ 29 ]
• The 980 nm diode laser is one of the most efficient converters of electrical energy into laser light. Diode lasers can be used for coagulation, evaporation and welding. Ultrapulse diode lasers have found application in dentistry, urology, gynecology, dermatology and vascular medicine. [ 30 ]

Removal of warts with a neodymium laser is practiced in many beauty salons where the cosmetic effect is of primary importance. It is well suited for clearing warts from exposed parts of the body, including the face and neck.

The second group of devices includes pulsed lasers (liquid devices), which use dyes that are absorbed not by water, but by oxyhemoglobin. They promote capillary gluing, which also disrupts the nutrition of the wart. The positive side of such lasers is the almost complete absence of discomfort during the procedure and scars on the body. Their action in its effectiveness is similar to cryodestruction, but the scope of application is usually limited to flat juvenile warts. For other types of neoplasms, a pulsed laser is less effective. [ 31 ]

Removing plantar warts with a laser requires a special approach, because the procedure in this case is more painful. There is no point in using a pulsed laser, and a gas laser, although it makes it possible to get rid of a growth that penetrates deep inside, requires serious anesthesia. When using other types of laser, they often resort to a step-by-step (layer-by-layer) removal of the wart, which also gives a good effect. [ 32 ]

Features of laser wart removal for children

Benign neoplasms called warts can appear in a person at any age. Often, not knowing about the presence of infection in their body, mothers pass it on to their children during childbirth. Subsequently, a baby with unstable immunity may develop warts on the face, hands and body (in rare cases on the mucous membranes of the mouth and larynx).

Despite the fact that children come into contact with condylomas in the birth canal, they rarely develop these types of growths. At least, we are not talking about genital warts. They usually appear when a teenager begins to have sex. Before this time, common or filiform (on a thin stalk) warts are found, and during puberty - flat ones. [ 33 ]

And it's not about the notorious frogs. The myth that warts on the body appear after contact with these amphibians has no basis. The true cause of the appearance of cosmetic defects in children is the papillomavirus, which has no age preferences. [ 34 ]

Children are extremely active little people, which is why their bodies are often covered with multiple wounds and scratches, through which a virus transmitted from other children or adults can easily penetrate. Often, it is contact with a wart that triggers a pathological process in a child's body. Do not assume that these neoplasms are safe for others.

It is up to the child's parents to decide whether to remove warts from a small child. But it is necessary to take into account the high risk of injury to neoplasms that rise above the skin surface. And this means bleeding, infections, the spread of the virus to nearby tissues and the growth of the wart. It is also worth noting the possibility of a benign growth degenerating into a malignant tumor if there is a predisposition, i.e. there were cancer patients in the family. [ 35 ]

When the child goes to school, other problems will arise. This is hostility towards the child from classmates, who will be afraid to even shake hands during greeting or at the teacher's request, they may tease, etc.

In adolescence, flat and common warts become the cause of isolation and low self-esteem. However, there is no need to rush to remove them. Most often, with the normalization of hormonal levels, adolescent warts, like acne, disappear on their own. But if they really do greatly affect the psycho-emotional background of a teenager, leading to neuroses and depression, it is worth taking care of cleansing the skin.

Most parents try to remove warts from children using folk methods, which are more affordable and, as they think, have no contraindications, unlike instrumental methods used in cosmetology and medicine. Some do not understand the seriousness of the situation, believing that children's warts cannot be viral in nature. This means that we are talking about removing "excess" skin, and not the source of the virus, which, if approached incorrectly, can spread to other parts of the body.

Others do not want to admit that folk remedies may have even more contraindications than in the case of wart removal with a laser or radio wave method. And some popular methods cannot be called safe. The same celandine, which parents often use to cauterize warts on their children and themselves, is actually a rather toxic plant. It may kill the virus, but, penetrating into soft tissues and blood, it also poisons the body of a small person. [ 36 ]

Many instrumental methods are also not recommended for children. Painful surgical removal, thermal method and electrocoagulation are not the best choice, although quite affordable. Cryodestruction, which is slightly painful in adulthood, can be frightening and uncomfortable in childhood. Children's skin is more delicate, thin and sensitive. Extremely low temperature during freezing and the risk of damaging healthy tissue (it is difficult to calculate the depth of penetration) make the procedure unpopular in childhood.

The safest methods are considered to be laser therapy and radio wave method. At the same time, laser wart removal is considered more accessible. With no age contraindications, the method allows you to get rid of warts in just one procedure. This is very important, since any manipulations by people in white coats, especially if they are accompanied by even the slightest discomfort, are psychological trauma for children (even if mild). It is incredibly difficult for children to endure and wait, especially since they do not yet fully understand the need to remove neoplasms. Laser treatment allows you to get rid of warts quickly and reliably, which is very important in this situation. [ 37 ]

Laser radiation does not have a negative impact on the child's body, especially considering that we are talking about a local effect on the defect. At the same time, the risk of damage to healthy tissues is very small, scars on the skin remain extremely rarely, because the wound heals very quickly and with proper care is not accompanied by inflammation and tissue swelling.

As for the painfulness of the procedure, the pain experienced by children is rarely stronger than a mosquito bite. However, to avoid sudden movements, crying and whims, children are most often given local anesthesia. And even when it is administered, the baby does not feel pain, because an injection is not required if there is a gel that is simply applied to the skin of the wart, making the area insensitive, and the laser wart removal procedure painless.

Features of laser wart removal during pregnancy

Pregnancy is a happy and at the same time very restless period in a woman's life. It is characterized by the restructuring of various functions and systems of the body, carried out with the assistance of sex hormones. The woman's hormonal background changes, and along with it, the protective function of the body undergoes changes.

Any fluctuations in hormonal levels can be considered a blow to the immune system, which is good for a viral infection. It can lie dormant in a woman's body for a long time, but a weakened immune response provides fertile ground for the virus to become active. It is not surprising that expectant mothers so often complain about the appearance of warts during this period. Previously, before conception, they were only virus carriers, but now they have become a source of active infection, which has very specific external manifestations.

Moreover, warts can have a wide variety of locations and appearances (except for senile keratomas, which are age-related neoplasms). Whether or not to remove them during pregnancy is a difficult question, because everything depends on the location of the defects and their degree of safety in terms of injury. [ 38 ]

Common warts on the skin surface are a defect that is unpleasant only for the woman herself and her surroundings. They cannot affect either the development of the fetus or the process of the baby passing through the birth canal, because such growths are dangerous only when in contact with the skin (in the case of large or microdamages on the skin). You can take your time removing them if they do not cause psychological discomfort and are not subject to frequent injury.

Rest is important for a pregnant woman, and wart removal can be considered a stress factor. Pain that appears to varying degrees, the need to prepare for the procedure, fear of complications - all this throws the expectant mother off track and affects the course of pregnancy, so doctors do not recommend treatment during this period unless absolutely necessary. [ 39 ]

But on the other hand, the presence of pointed genital warts is already a problem that is unsafe for the baby. While the fetus is in the womb, nothing threatens it. But after a certain time, the child will ask to be born, and passing through the birth canal will become a risk factor for him to become infected with the papillomavirus. In this case, the gynecologist will even insist on removing the warts.

Since there is no particular hurry, because condylomas are not dangerous for the child before the birth, it is not worth taking risks by removing neoplasms in the early stages of pregnancy. Considering the localization of genital warts and their proximity to the baby's temporary residence, the woman's greater sensitivity to negative factors and the increased risk of termination of pregnancy before placentation, gynecologists insist on waiting and removing neoplasms no earlier than 28-30 weeks of pregnancy. But you should not wait until the last minute, the mucous membrane needs time to recover to avoid complications during childbirth. [ 40 ]

When choosing a method for removing warts, it is important to understand that in most cases pain is present to some extent, but the possibilities of anesthesia are limited. If when removing skin growths you can resort to gels and ointments with anesthetic (however, in the area of the hardened sole they are of little help), then when removing warts on the mucous membrane, it is not so easy to provide anesthesia, and the proximity to the uterus suggests that this is undesirable. [ 41 ]

In any case, it is better for the expectant mother to avoid the effects of chemicals on the body. And this can be done by choosing less painful methods of combating neoplasms, for example, laser wart removal, which can be done without anesthesia, because the pain is not very strong. Neodymium, erbium and pulse lasers can cope with neoplasms without causing severe pain.

Speaking about the safety of laser treatment, it should be noted that such an impact will cause much less trouble than taking antiviral drugs and immunostimulants during pregnancy. The latter affect the immune system, and it is difficult to predict how it will react to the fetus. The safety of many folk remedies is also in doubt, especially since most of them are not suitable for combating genital warts. [ 42 ]

It turns out that laser wart removal is the best option for treating manifestations of the human papillomavirus (HPV) during pregnancy. But even in this case, some caution is required. Before removing condylomas, it is necessary to conduct a study of the growth (biopsy and histological analysis of the biopsy) to determine the type of HPV and the degree of its oncogenicity.

The fact is that after removing warts with a laser, there is no material left for such a study, and in the case of incomplete removal of a highly oncogenic type of virus, there is a risk of the condyloma degenerating into a cancerous tumor. This is dangerous both for the woman herself and for her child, who may receive such a dangerous "gift" from his mother at the time of birth.

Often, when a highly oncogenic type of virus is detected, a cesarean section is performed, and condylomas on the internal genital organs are removed (surgically or with a laser) after childbirth, prescribing the woman special antiviral treatment, and, if necessary, chemotherapy and radiation therapy. [ 43 ]

The earlier a pathological formation with a high risk of malignancy is detected, the easier it is to prevent dangerous consequences. And even if degeneration has occurred, in the early stages of the disease, tumor removal gives quite decent results. However, the removal of individual warts cannot be considered a full-fledged treatment, so a person with a highly oncogenic type of virus will have to be careful, maintaining immunity at a high level, throughout life, taking into account the possible presence of inactive virions biding their time.

Contraindications to the procedure

As we have already understood, pregnancy and childhood are not contraindications to removing warts using laser radiation. It is just that during these periods it is especially important to take into account some features of the human body and the processes occurring in it.

But are there any obstacles to using a laser to remove warts, if this procedure is allowed even in such sensitive periods of life? You can find information on the Internet that laser treatment has many contraindications. In fact, everything is not so categorical, because in most cases we are not talking about diseases, but temporary conditions of the body. In such cases, we talk about relative contraindications that occur for a limited time. [ 44 ]

Relative contraindications include:

• elevated body temperature,
• the presence of infectious diseases in the acute stage, including colds of viral and bacterial etiology
• general malaise of unknown origin,
• exacerbation of herpes infection, which can appear on the lips, in the corners of the mouth and nose, on the genitals (the activation of the virus is indicated by the appearance of external symptoms in the form of a blistering itchy rash),
• increased blood pressure the day before the procedure (this may be due to anxiety),
• inflammation of the tissues around the wart or the growth itself (preliminary examination required),
• unstable mental state of the patient.

These contraindications are temporary and are intended to avoid deterioration of the person's condition. They also help to make the wart removal procedure effective and safe, to avoid inaccuracies resulting from the anxiety of both the patient and the specialist performing the procedure.

It should be said that the above conditions are an obstacle not only for the procedure using a laser. They are common to all methods of instrumental removal of neoplasms. They should be taken into account when resorting to folk recipes. [ 45 ]

The only absolute contraindication to laser wart removal can be considered changes in the blood composition. Most often, doctors pay attention to the ability of the blood to clot. If it is impaired, the risk of bleeding increases during the procedure, which will be difficult to stop. With hemophilia, this is almost impossible to do. [ 46 ]

Caution should also be exercised when removing warts in people with diabetes. Only in this case, we are not talking so much about complications that may occur during the procedure, but about unpleasant consequences.

The fact is that with elevated blood sugar, there are problems with the healing of any wounds. They take a long time to heal, so the risk of tissue infection, the development of purulent and purulent-necrotic processes increases. In this case, very careful care of the wound is required. In addition, it is recommended to remove only those warts that are already prone to injury, cause severe discomfort (for example, interfere with movement) or are capable of degenerating into a malignant tumor. [ 47 ]

Sometimes you can see information that laser wart removal is not recommended for oncological diseases. It is important to understand that the laser beam itself does not change the biochemical properties of the cells around the affected area, removing only those affected by the virus. Infrared treatment used in lasers, unlike sunlight, is not capable of provoking active malignancy of the tumor; on the contrary, laser tumor removal is becoming increasingly popular. But it is possible only after a biopsy and special studies to assess the depth and prevalence of the pathological process. In addition, such an operation can only be performed in special clinics for cancer patients, but not in a cosmetology room. [ 48 ]

If we are talking about removing warts that do not consist of malignant cells in patients with oncology, then there are no obstacles at all, because we are talking about a local effect that does not affect abnormal cells and cannot affect their behavior in any way.

Consequences after the procedure

One of the important advantages of the laser method of removing neoplasms is the low risk of wound infection. Pre-treatment with an antiseptic, the absence of direct contact of the device or the doctor's hands with the patient's skin, as well as significant heating of the tissue in the area of the wart do not leave the infection and the slightest chance. But it is quite logical that after removing the wart with a laser (especially if it was large), a wound will remain, the condition of which will depend on the correct care of it. [ 49 ]

For a long time, the wound will be covered with rough necrotic tissue. A crust after laser wart removal forms almost immediately and can last from 5 to 14 days. Everything depends on the size of the wound and compliance with the doctor's (cosmetologist's) requirements. The wound heals directly under the crust, which is typical for any burn, and this is how the skin is affected by a laser, electric current, a hot loop, and even a radio wave knife.

It is impossible to give a clear answer to the question of how long it takes for a wound to heal after laser removal of a wart, mole or other neoplasm. Wounds can have different locations, sizes, and healing conditions. For example, in the air, in low humidity conditions, the wound dries up and heals faster, which is not possible for postoperative erosions on the mucous membrane in the genital area. If the crust is torn off prematurely or the erosion is covered with a dense material that prevents air access, healing will be delayed. [ 50 ]

Usually, you can expect a wart wound to be completely healed within a couple of weeks after the procedure. Large wounds, more than one centimeter in diameter, can take a month or more to heal. If an infection occurs, treatment can take several months, often ending in scarring.

Removing the crust just because it contains wart particles is illogical. The virus cannot exist in dead cells and does not pose a danger outside of the cells. In other words, there is no active virus in the crust, but it is an excellent protection of the open wound from negative external influences, blocking the path of infection. [ 51 ]

A good sign is spontaneous peeling of the crust, from under which no ichor or pus oozes. When the skin falls off, tender young pink skin will be visible underneath. Subsequently, it will become lighter in color than the surrounding skin, and over time, it will become almost indistinguishable. Sometimes a depression remains at the site of the wart, which gradually smooths out, as does the skin color.

Complications after the procedure

Laser wart removal may be a more gentle procedure compared to some other methods, but it also involves skin trauma. A scar of tissue burn remains in the place of the wart, in the form of a wound covered with a crust. And like any wound, this place may hurt for a while. As it heals, the pain subsides, and the wound becomes less noticeable.

The most painful both "during life" and during removal are plantar warts, which have roots deeper than usual. And even after laser removal of a wart, complaints are common that the heel, on which the neoplasm was previously located, hurts and it is difficult to lean on it when walking or standing. Pain in the first days after the procedure is quite normal, because tissue injury occurred and time is needed for their recovery. [ 52 ]

If the pain persists for more than a month, it may be a relapse of the wart. If after the wart was removed it reappears, this indicates low immunity or the cause was incomplete removal of the neoplasm. In the latter case, the specialist who performed the procedure was unprofessional.

Skin trauma in natural conditions is often accompanied by redness and swelling. This does not necessarily indicate the introduction of an infection. If swelling around the wound occurs after laser wart removal, it is likely that this is the body's reaction to the injury, but if a finger or a large area of the body around the wound is swollen, this can no longer be called a normal reaction. Especially if such swelling persists for more than a day, is accompanied by dull pain and a local (or general) increase in temperature. [ 53 ]

A general increase in temperature most often indicates sepsis (blood poisoning), while a local increase indicates a wound infection. But don't rush to blame the doctor for this. The laser wart removal procedure itself practically eliminates infection. Usually, the cause lies in postoperative care or an allergic reaction to the healing agents used.

When a wound becomes infected, an inflammatory process occurs, which, depending on the pathogen, can become purulent. The longer the inflammation lasts, the more healthy cells die, thereby increasing the size of the wound. Moreover, a long-term inflammatory process is considered one of the main reasons for the appearance of cicatricial changes, which are not typical for laser treatment. [ 54 ]

The second reason for the appearance of unsightly scars is an individual feature of the body's functioning. In this case, removing warts by any means will leave visible traces. To reduce such consequences, you can apply drugs to the skin that accelerate wound healing and prevent the formation of foci of coarse fibrous tissue (Baneocin, Contractubex).

If it is still not possible to avoid scar formation (for example, the wart was too large or the wound became infected), you can again resort to laser removal and resurfacing of scars and cicatrices, which gives an excellent cosmetic effect. [ 55 ]

Care after the procedure

How quickly the erosion heals after laser wart removal depends on the correct implementation of postoperative wound care requirements, which include the following recommendations:

• During the first 3 days after wart removal, try not to wet the wound or treat it with alcohol solutions. To prevent infection, antiseptics (brilliant green solution, iodine solution or potassium permanganate) are applied to the skin around the wound. What else can be used to treat a wound after wart removal with a laser? As a preventive measure to prevent inflammation of wound tissue, you can use water infusions of chamomile and calendula, chlorhexidine and miramistin solutions. Additionally, the doctor may prescribe creams with an anti-inflammatory effect.
• Can I swim after laser wart removal? After 3 days, if there are no complications, I am allowed to take a shower, trying to prevent soapy water from getting into the wound. It is recommended to take a bath after the crust has fallen off, i.e. not earlier than 2 weeks later. It is better to postpone baths, saunas, swimming in pools and public showers for a month or more, focusing on the complete restoration of damaged tissue. Swimming in open water bodies with questionable water quality is especially dangerous if the wound has not healed.
• When removing warts in the warm season with active sun, you need to make sure that young sensitive skin does not come under direct sunlight. Under the influence of laser radiation, the sensitivity of nearby tissues increases, which can easily get burned, so you should not stay in the sun for a long time, especially in the first days and months after the procedure.
• An open wound can easily become infected, so many patients try to protect themselves by covering the wart with a bandage. This should not be done, because air penetrates under the bandage with great difficulty, creating a humid atmosphere around the wound, which slows down healing. If the wound has already become infected, it will multiply more actively in humid conditions.
• If the warts were located in areas with increased sweating, the wound in their place should be covered with special plasters with an absorbent surface. Such plasters should be changed once a day, allowing the skin to breathe if possible.
• The wound should also be covered if it is on the foot or hands, which come into contact with dust and other sources of infection. It is better to apply a bandage that allows air access and remove it every time you rest. Ideally, you should refrain from work and active movement for the first few days, allowing the wound to dry out in an uncovered state.
• The crust on the wound should not be removed independently until it is completely healed, but it can be easily touched, exposing the wound surface. You should try to avoid such accidental injuries. If the wart was on the foot, you should pay attention to shoes that should not rub the area of the former wart. The same applies to clothing.

If the wart was on the face or under the arms, when shaving you should try to avoid this area so as not to accidentally touch the crust and cause an infection. [ 56 ]

• As for cosmetics, and especially decorative cosmetics, they should not be used until the wart wound has completely healed.

It is very important that during the healing and restoration of the skin, i.e. for 1.5 months or more after the laser wart removal procedure, the sensitive skin in the area of the procedure is not exposed to aggressive external influences. Be it cold water, rubbing with clothes or a towel after bathing, or too active cosmetics (especially with abrasive particles).

Reviews

Most of those who have experienced the laser wart removal procedure on themselves confirm the information about the effectiveness of this procedure. Usually, the wart disappears after a single exposure, i.e. repeated procedures are not required. At the same time, the duration of the laser removal of neoplasms can vary from 10 to 30 minutes depending on the number of elements removed (up to 10 warts can be removed in one session), their size and location.

The most difficult to burn are plantar and palmar warts - growths on rougher and thicker skin, going deep into the epidermis. Any wart involves layer-by-layer tissue removal, but in this case there are a lot of layers, so the procedure is longer. And the pain during the session is higher. The pain when removing common and flat warts is insignificant, most people can tolerate it without anesthesia.

Many patients write that after removing warts, a trace remains. But this is quite understandable, at the site of any wound there is a weakly pigmented area for some time, and here we are still talking about a skin burn. You need to be patient for several months and the trace will become almost invisible. If the wart was large, then no method can remove it without a trace.

Perhaps, the wound after a laser burn heals longer than after cryodestruction, but the possibilities of using a laser are wider. It can be used to remove warts of any location, size and depth. It is used to remove warts in children and expectant mothers. In this case, repeated procedures are not necessary, and the risk of relapse is usually lower, as is the likelihood of damage to healthy tissue.

Some are 100% satisfied with the result, others complain about the appearance of new pathological elements, without taking care to maintain immunity, others point out the possibility of scars, without understanding what reasons could have caused them, and whether this is related to the use of a laser. There are always people who like this method, and those who are dissatisfied. And this pattern can be traced regardless of the devices and methods used. Until a person tries the chosen method on himself, he is unlikely to receive objective information about its effectiveness without a touch of someone else's subjective opinion.

Laser wart removal is a procedure whose effectiveness is confirmed by the popularity of this method among cosmetologists, doctors and patients. Otherwise, people would turn to other, cheaper methods of combating neoplasms. But the laser method has three big advantages: effectiveness, availability and safety. These are the main factors influencing a person’s choice.