Yes Graeme the Erbium family of lasers helps alot with these lesions but a diode in combination will penetrate much deeper after the laser bandaid has been placed.

Erbium is quite superficial and my experience has been more positive when combining both wavelengths for treatment. Erbium first for some superficial treatment of the area and then the diode for deeper penetration of the area.

Great post Graeme

Glenn

hello
I want to speak about a new tchnique than I use with my patients
First of all I use Kavo HealOzone for the first step
40 seconds on the lesion
After that I use Diode 980  LLL (low level therapy)  at 1 Watt for 300 seconds with a 1000um fiber
If we  have a very important lesion I repeat next day

we have excellent results with that technic

Graeme your not being lazy.

Absence of human papillomavirus DNA in the plume of erbium:YAG laser-treated warts.

Hughes PS, Hughes AP.

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.

It could be your just being smart. I have not seen any studies like this for a diode. I have seen the studies using the CO2 and they do not look so hot.
At this point might we say the Er laser is the safest laser to treat this with until further studies can be done using the diode?

Yep and thats why I use the Er to tx herpetic lesison instead of getting up and draging over the diode form the farside of the office , forgetting the Rose colored saftery glasses, dropping the stripper and finding a place to set it up.

David

My technique is similar to Glenn’s. I use the 980 first, 2W painting the surface to the periphery, with air coolant and HVE, and just beyond until the patient is asymptomatic. I then paint the lesion with my erbium. Great results so far.

Ron, i am in Germany now and the keys on the keyboard are all different so i will make this quick.

Awesome photos there and really nice treatment. i will be back in 6 days and will be able to chip in a little bit more but great photos……..

Glenn

Ron,

Wow, great pictures !! Thanks for posting them. I understand better visually with this posting especially with the great followup photos.

I am hearing Bob Gregg’s voice in my head about retreating if the vessicles reappear or contuniue. A point of clarification: You have dramatically altered the course of this infection spaning the vermillion border of the lower lip. And with at great magnification I think I see at day four and beyond, the slight appearance of vessicles.

Do you think it is just residual? Better yet, is it significant? They do not seem to be breaking down.

So to try and answer my own question, the recurrence of vessicles might not be an under threshold lasing by any instrument, but an undeveloped lesion which developes outside the treated area.

Is there a magic formula as to how much is enough?

Congrats and welcome to the laser fraternity. Good question. I have only a handful of pts that make it in at the prodromal stage, most don’t until some vesicles have erupted. In my experience, with high mags (scope) there seems to be a slight difference in surface texture. But the patient needs to guide me a little (ie symptoms subsiding…).
Good luck.

Whatever laser you use to treat the lesion, consider prescribing Valtrex 2g(500mgX4 with three refills) as well as Denavir ointment, one tube plus three refills. Tell the patient as soon as they feel the prodrome, take four Valtrex and begin applying Denavir to the outbreak area (if extraoral) and get to your office ASAP for laser treatment. Instruct them to continue the Denavir qid after laser treatment for at least 3 days. If the outbreak is intraoral, the Denavir use is moot.

Patients can’t always get into the office during the prime treatment time (prodrome/vesicular stage). Having Valtrex and Denavir on hand gives them gead start on knocking the virus load down ASAP until they can get in to see you. I have also started recommending to some patient that they pony up $239 and purchase a 50mw 532nm green laser (AND SAFETY GLASSES) from laserglow.com; these are very effective at reducing the pain and patients get a kick out treating themselves; however I think having the Valtrex and Denavir is more important.