Class IV Laser Therapy for Verrucae

What is Class IV laser therapy?

Verrucae are caused by the human papillomavirus (HPV) and can sometimes persist despite the body's natural immune response or previous treatments.

At The Podiatry Clinic, we use a medical Class IV diode laser using 810 nm and 980 nm wavelengths.

Laser energy is delivered directly to the verruca using controlled treatment parameters selected by your podiatrist.

The aim is to create a controlled therapeutic effect within the affected tissue while limiting unnecessary treatment of the surrounding healthy skin.

Laser treatment does not guarantee that a verruca will disappear immediately. The treated tissue and your body's response continue to develop following treatment.

Why has laser therapy been recommended?

Class IV laser therapy may be considered for verrucae that are:

• persistent or longstanding
• painful or troublesome
• spreading or multiple
• resistant to previous treatments; or
• suitable for a laser-based treatment approach following clinical assessment.

One advantage is that treatment can be accurately directed at the affected area and usually does not require local anaesthetic.

Your podiatrist will have considered the location, size and number of verrucae, previous treatments and your general health before recommending laser therapy.

What happens during treatment?

Your podiatrist will first examine the verruca and review its response to any previous treatment.

Where appropriate, overlying hard skin will be carefully reduced or debrided. This allows better access to the affected tissue.

Protective laser eyewear will be provided and must be worn during treatment.

The Class IV laser is then applied to the verruca using treatment settings selected according to the size, depth, location and response of the lesion.

Where you have several verrucae, all appropriate lesions can normally be treated during the same appointment.

Local anaesthetic is not normally required.

What does laser treatment feel like?

During treatment you are likely to notice warmth or heat within the treated area.

Some areas may feel more sensitive than others and you may experience brief discomfort, particularly when treating deeper or more sensitive verrucae.

Your podiatrist will monitor your response throughout the treatment and adjust the application where appropriate.

Treatment should always remain controlled. Please tell your podiatrist if the sensation becomes unexpectedly uncomfortable.

How many treatments will I need?

Verrucae respond differently between patients.

At The Podiatry Clinic, a course of approximately 6 laser treatments is commonly recommended.

Appointments are generally spaced approximately 2–4 weeks apart, depending on the appearance of the verruca, the response of the skin and your individual treatment plan.

Your podiatrist will review progress throughout the course and may alter the interval or number of treatments depending on your response.

Research into laser treatment for plantar verrucae has shown encouraging results, including for persistent verrucae. However, different studies have used different types of laser, wavelengths and treatment protocols, and there is currently no single laser protocol that guarantees clearance.

As with all verruca treatments, complete clearance cannot be guaranteed.

What happens after treatment?

Most patients can walk normally and continue their usual daily activities following treatment.

The treated area may feel warm, tender or mildly sore for a period afterwards.

Depending on the intensity of treatment and how the verruca responds, you may notice:

• temporary redness
• tenderness
• darkening or changes in the appearance of the verruca
• drying of the treated tissue; or
• gradual reduction in the size or thickness of the verruca.

Your podiatrist will provide specific aftercare instructions if required.

Avoid picking, cutting or attempting to remove treated tissue yourself.

What are the potential benefits?

Potential advantages of Class IV laser therapy include:

• precise treatment of the affected area
• ability to treat persistent or resistant verrucae
• treatment of multiple appropriate verrucae during the same appointment
• no local anaesthetic in most cases
• relatively little interruption to normal activities; and
• an alternative treatment approach when simpler treatments have not produced an adequate response.

Clinical research supports the use of laser technologies as an option for persistent verrucae, and more recent research specifically involving diode lasers has also produced encouraging results.

However, outcomes vary between patients and between different laser technologies.

What are the possible side effects and risks?

Class IV laser treatment is generally well tolerated when appropriately performed, but all treatments have potential side effects and risks.

Temporary effects may include:

• warmth or discomfort during treatment
• tenderness or soreness afterwards
• redness
• swelling
• temporary changes in the appearance or colour of the treated tissue; and
• local sensitivity.

Less commonly, a stronger tissue response may result in:

• blistering
• superficial skin damage
• a small wound
• delayed healing
• infection
• changes in skin pigmentation; or
• scarring.

There is also a possibility that the verruca may not completely clear, may recur following treatment or may require further or alternative treatment.

Protective eyewear is required during treatment because high-powered laser energy can cause serious eye injury if appropriate laser safety precautions are not followed. The clinic follows appropriate laser safety procedures during treatment.

Is Class IV laser therapy suitable for everyone?

Laser therapy is not appropriate for every patient or every verruca.

Your podiatrist will consider factors including:

• your medical history
• circulation and sensation
• medications
• healing ability
• the condition of the surrounding skin
• pregnancy where relevant; and
• the location and appearance of the verruca.

Particular care may be required where there is poor circulation, reduced sensation, impaired wound healing or certain medical conditions or medications.

Treatment in children and young people is considered individually, taking into account their age, medical history, the location of the verruca and their ability to comfortably tolerate treatment.

If your health, medication or the condition of your foot changes during your treatment course, please tell your podiatrist before your next treatment.

What are the alternatives?

There are several approaches to managing verrucae and no single treatment is appropriate for everyone.

Depending on your individual circumstances, alternatives may include:

• monitoring the verruca without active treatment
• appropriate home or topical treatments
• Verrutop
• CryoPen cryotherapy
• Swift microwave therapy; or
• verruca needling (Falknor's needling).

Your podiatrist can discuss these options with you if your verruca does not respond as expected or you would like to reconsider your treatment.

How much does Class IV laser treatment cost?

Class IV laser treatment: £85 per session

Course of 6 treatments: £450

The number of treatments required varies between patients. Your podiatrist will review your progress during the treatment course and advise whether further treatment is appropriate.

When should I contact the clinic?

Some temporary warmth, tenderness or change in the appearance of the verruca can occur following treatment.

Please contact the clinic if you experience:

• significant or worsening pain
• excessive blistering
• unexpected skin breakdown
• increasing redness or swelling
• discharge or signs of infection
• delayed healing; or
• any other reaction that concerns you.

Please also tell us about any significant change in your health or medication before your next treatment.

Your next step

If you have already booked your laser treatment

There is normally nothing further you need to do.

Please read this information before attending. Your podiatrist will review the verruca and confirm that laser therapy remains appropriate before treatment.

If you have any questions or concerns, please discuss these with your podiatrist before treatment begins.

If laser therapy has been recommended but you have not yet booked

You can book your Laser Therapy – Verruca – Follow-Up appointment when you are ready to proceed.

£85 per treatment | Course of 6 treatments £450

Important information

This information sheet is intended to support the discussion you have had with your podiatrist and help you make an informed decision about treatment. It does not replace individual clinical advice.

Treatment outcomes vary between patients and complete clearance cannot be guaranteed.

Before treatment, your podiatrist will confirm that Class IV laser therapy remains appropriate for you and you will have the opportunity to ask questions or discuss any concerns before deciding whether to proceed.

The Podiatry Clinic