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Medical Lasers; Engineering, Basic Research, and Clinical Application
76
Verruca Plana Successfully Treated with a 2790-nm Erbium:
Yttrium-scandium-gallium-garnet Laser
Verruca plana is a cutaneous infection caused by the human papilloma
virus. Although various treatment methods are currently available, most
have limitations due to the risk of complications such as hyper-
pigmentation, edema, and scarring. Moreover, as the infection tends to
spread easily, new verrucae can potentially develop, and treatment
procedure times tend to be lengthy. Thus, novel treatment methods are
required. The 2790-nm wavelength erbium:yttrium–scandium–gallium–
garnet (Er:YSGG) laser is a superficial resurfacing laser. Here, we
present a case of a 25-year-old woman with multiple verrucae treated
using a 2790-nm Er:YSGG laser. Compared to traditional methods, this
novel laser is convenient, produces better cosmetic outcomes, and is
less time-consuming; it is therefore suitable for the treatment of facial
verruca plana.
Key words
Verruca plana; Er:YSGG Laser
Su Jung Park1
Kui Young Park1
Seong Jun Seo1
Ji Yeon Hong2
1Department of Dermatology, Chung-Ang
University College of Medicine, Seoul, Korea
2Department of Dermatology, Seoul National
University Hospital, Seoul, Korea
Received March 9, 2020
Accepted March 30, 2020
Correspondence
Ji Yeon Hong
Department of Dermatology, Seoul National
University Hospital, 101 Daehak-ro, Jongno-gu,
Seoul 03080, Korea
Tel.: +82-2-2072-3171
Fax: +82-2-742-7344
E-mail: caudrjyhong@gmail.com
C
Korean Society for Laser Medicine and Surgery
CC
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Med Laser 2020;9(1):76-78
https://doi.org/10.25289/ML.2020.9.1.76
pISSN 2287-8300ㆍeISSN 2288-0224
Case Report
Verruca Treatment with Er:YSGG Laser
Su Jung Park, et al.
VOLUME 9 NUMBER 1 June 2020 77
Case Report
INTRODUCTION
Verruca plana is a cutaneous infection caused by hu-
man papillomavirus (HPV), mainly types 3 and 10.1,2 Ver-
ruca mainly affects exposed body areas in young adults,
and the members of this demographic are particularly
sensitive to their appearance.3 Verruca plana presents as
multiple and grouped flat-topped hyperkeratotic papules,
which are of normal skin or brown color.1
Many treatment options exist for verruca plana, in-
cluding topical retinoids, imiquimod, cryotherapy, ci-
metidine, immunotherapy, pulsed dye laser, CO2 laser,
erbium:yttrium–aluminum–garnet (Er:YAG laser), and
photodynamic therapy (PDT).3,4 However, treatment has
its own limitations, such as the potential for hyper or
hypopigmentation and scarring. Moreover, multiple and
recalcitrant verruca plana that fail to resolve after previ-
ous treatments is challenging to treat. Therefore, a novel
treatment with less downtime, a satisfactory safety pro-
file, and good cosmetic results is still needed.
CASE REPORT
A 25-year-old woman presented with multiple flat-
topped papules on her cheek that had been present
since 2 years (Fig. 1A). Clinical examination revealed
erythematous to skin colored flat-topped papules with
a verrucous surface. A skin biopsy showed epidermal
hyperkeratosis and acanthosis with infected koilocytes,
which correspond to the diagnosis of verruca plana (Fig.
2). The patient was treated with oral ranitidine and a
combination of cryotherapy and intralesional injections
of MMR (measles, mumps, rubella vaccine) at 2-week
intervals for 2 months; however, the lesions did not re-
spond to treatment. As the lesions were widely distributed
over the cheek and chin and occupied a large area, we
decided to use an erbium:yttrium–scandium–gallium–
garnet (Er:YSGG) laser (Cutera®, Brisbane, CA, USA). The
treatment parameters used with the Er:YSGG were 2.2 J/
cm2 with a 400-µs pulse duration. Local anesthesia was
applied before treatment to reduce pain. Laser treatment
was performed every 4 weeks. After three repeated ses-
sions of the laser treatment, most of the lesions were
resolved, without erythema or pigmentation (Fig. 1B).
DISCUSSION
Er:YSGG lasers with a 2790-nm wavelength are abla-
tive resurfacing lasers and used to treat acne scars and
epidermal dyschromia. The Er:YSGG laser has a medium
water absorption coefficient, between that of a CO2 laser
and an Er:YAG laser, which means it induces less thermal
damage, thereby creating minimal scarring compared to
a CO2 laser and provides improved remodeling compared
to a Er:YAG laser.5 Histopathologically, verruca plana
shows hyperkeratosis and acanthosis of the epidermis
and koilocytes in the upper epidermis.6 Ross et al. re-
ported that biopsies taken from the area irradiated by a
Er:YSGG laser showed a zone of vacuolated and coagu-
lated epidermis.5 Therefore, the mechanism of action is
thought to be induction of damage to the infected kerati-
nocytes in the epidermis as a result of resurfacing.
Er:YSGG lasers have two benefits compared to previ-
ous treatment options. First, they can be used to treat
a large area of lesions in a shorter period of time than
A B
Fig. 1. (A) Before treatment: remarkable verrucous lesions on the
cheek. (B) After treatment: significant improvement of the verrucous
lesion after three repeated sessions.
Fig. 2. Histopathologic findings of lesion consistent with verruca
plana, showing hyperkeratosis and acanthosis with definite
koilocytosis (H&E, ×100).
Medical Lasers; Engineering, Basic Research, and Clinical Application
78
conventional techniques, as Er:YSGG lasers deliver ther-
mal damage to a large surface area per treatment unit.
This advantage of Er:YSGG provides convenience to the
operator as well as to the patient. PDT can also treat a
large area per irradiation; however, its prolonged incuba-
tion period (2-6 hours) is a limitation.1 Second, Er:YSGG
lasers create less pain and scarring than CO2 lasers be-
cause they deliver a lower thermal load.7 As the face is an
area of major cosmetic concern, treatments that induce
scarring and hyperpigmentation are not appropriate ap-
proaches to treat facial verruca. Therefore, an Er:YSGG
laser may offer an alternative treatment option with a
shorter operating time, less downtime, and fewer side ef-
fects.
Our case suggests that Er:YSGG laser treatment may
be an effective therapy for verruca plana because of its
short time duration and convenience, in addition to its low
incidence of side effects. Further studies in a larger popu-
lation are required to determine the optimal regimen for
recalcitrant verruca plana.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
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How to cite this article: Park SJ, Park KY, Seo SJ, Hong JY.
Verruca plana successfully treated with a 2790-nm erbium:
yttrium-scandium-gallium-garnet laser. Med Laser 2020;9:76-78.
https://doi.org/10.25289/ML.2020.9.1.76
