Comparison of Efficacy of Carbon Dioxide Laser Therapy with Cryotherapy for the Treatment of Palmoplantar Viral Warts

Abstract

Background: Palmoplantar viral warts are common human papillomavirus-associated cutaneous lesions for which several destructive treatment modalities are available, but comparative evidence regarding the efficacy of carbon dioxide (CO₂) laser therapy and liquid nitrogen cryotherapy remains limited. This study compared the efficacy of CO₂ laser therapy with cryotherapy for the treatment of palmoplantar viral warts.

Methods: This randomized controlled trial included 100 patients aged 18–60 years with palmoplantar viral warts presenting to the Dermatology Outpatient Department of DHQ Hospital, Faisalabad. Participants were allocated equally to CO₂ laser therapy (n=50) or liquid nitrogen cryotherapy (n=50). The CO₂ laser group received ablative continuous-wave treatment at 4–8 weeks per lesion, while the cryotherapy group underwent two freeze-thaw cycles using liquid nitrogen, with treatment continued weekly until clearance or for a maximum of eight weeks. Efficacy was defined as complete clinical clearance of warts. Quantitative variables were summarized as mean ± standard deviation, categorical variables as frequencies and percentages, and treatment efficacy was compared using the chi-square test, using SPSS v.26.0 and the statistical significance set at p<0.05.

Results: The mean age was 32.42 ± 11.15 years in the CO₂ laser group and 35.22 ± 12.09 years in the cryotherapy group. Overall, 64% of participants were male. Complete clearance was achieved in 44/50 patients (88.0%) treated with CO₂ laser therapy compared with 27/50 (54.0%) treated with cryotherapy (p<0.001). The direction of the treatment difference was maintained across the prespecified strata of age, sex, lesion site, disease duration, and number of warts, although the comparison among patients with disease duration greater than six weeks did not reach statistical significance.

Conclusions: CO₂ laser therapy achieved a higher rate of complete clinical clearance than liquid nitrogen cryotherapy in patients with palmoplantar viral warts. These findings add randomized comparative evidence supporting CO₂ laser therapy as an effective treatment option, although larger multicenter studies with longer follow-up are required to evaluate recurrence, adverse effects, durability of response, and patient-reported outcomes.