Absence of human papillomavirus DNA in the plume of erbium:YAG laser–treated warts,☆☆,,★★

*Mihashi S, Ueda S, Hirano M. Some problems about condensates induced by CO2 laser irradiation. Presented at the Fourth International Society for Laser Surgery; November 1981;Tokyo, Japan.
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Abstract

Background: The erbium:YAG laser (Continuum Biomedical, Dublin, Calif.) is a new resurfacing and ablating laser that produces minimal residual thermal damage. Laser safety requires careful attention to the hazards of the laser plume. It is important to know whether viable organisms survive in the vapors. Human papillomavirus (HPV) DNA has been detected in the vapor of carbon dioxide laser–treated and electrodesiccated human warts. The presence or absence of HPV DNA in the laser plume of erbium:YAG laser–treated warts has not been previously studied to our knowledge. Objective: Our purpose was to determine the presence or absence of HPV DNA in the laser plume of erbium:YAG laser–treated human warts. Methods: One half of clinically typical and histopathologically confirmed verrucae vulgares from five patients were submitted for HPV DNA detection with in situ hybridization. After erbium:YAG laser ablation of the remainder of the warts, the laser plume was deposited on the handpiece as an abundant fluffy material and was submitted for evaluation of HPV DNA by polymerase chain reaction with consensus primers for the HPV type detected in the wart specimens. Results: HPV2 DNA was found in all warts. HPV DNA was not detected in the erbium:YAG laser plume after ablation of these same warts. Conclusion: The absence of HPV DNA in the plume of erbium:YAG laser–treated warts is a significant safety feature of this laser. (J Am Acad Dermatol 1998;38:426-8.)

Section snippets

METHODS

Five patients with clinically typical verrucae vulgares of the extremities were selected for study. From each patient, after intradermal 1% lidocaine with epinephrine anesthesia, one half of a typical wart was removed with iris scissors and place in 10% aqueous formalin solution and submitted for histopathologic diagnosis and HPV DNA detection (HPV1 and HPV2) with in situ hybridization for HPV (Enzo Clinical Labs, Inc.). Bleeding was stopped with pressure and sometimes with 35% aqueous aluminum

RESULTS

For all five submitted specimens, the histopathologic diagnosis was verruca vulgaris, and HPV2 DNA was found in all five warts by in situ hybridization. By polymerase chain reaction with consensus primers for HPV2, HPV DNA as not detected in the erbium:YAG laser plume after ablation of these same warts.

DISCUSSION

In this study, the HPV infecting the wart was absent in the erbium:YAG laser plume. The erbium:YAG laser factors (2 mm spot size, 175 mj) used in this study were typically used in clinical practice. This absence of HPV in the erbium:YAG laser plume is in contrast to the presence of HPV DNA after wart treatment with the carbon dioxide laser7, 9 or electrocoagulation.7 The polymerase chain reaction for HPV used in the current study is more sensitive than the dot blot hybridization technique10

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In private practice, San Antonio.

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*Undergraduate student, Biomedical Engineering, Vanderbilt University, Nashville.

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