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Laser in der Therapie der Warzen

Laser treatment of warts

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Zusammenfassung

Humanpathogene Papillomaviren (HPV) führen bei ca. 5% der Bevölkerung zu einem Befall mit vulgären und bei ca. 1% der sexuell aktiven Bevölkerung zu genitalen Warzen. Obwohl über 50% der durch Virusinfektion induzierten Warzen eine spontane Regression zeigen, ist der Abheilungszeitpunkt ungewiss. Zu langes Zuwarten führt oft zu einer Progredienz und Streuung. Bewegungseinschränkungen und Schmerzen beim Gehen bei plantarem Befall sind ebenso Komplikationen wie eingeschränkte soziale Kontakte bei Warzenbeeten an den Palmae oder genital. Das therapeutische Spektrum zur Warzentherapie ist vielfältig und schließt den Einsatz von verschiedenen Lasersystemen ein. In der Gruppe der ablativen Therapiemaßnahmen fällt insbesondere der CO2-Laser auf, der in Kohorten- und Fallkontrollstudien bei Patienten mit therapieresistenten Verrucae vulgares Abheilungsraten von bis 75% erzielt. Den Abheilungsraten stehen Nebenwirkungen wie Blutung, Schmerzen und Funktionseinschränkungen über mehrere Wochen entgegen. Der gepulste Farbstofflaser führt zu einer selektiven und unblutigen, nichtablativen Zerstörung von extragenitalen und genitalen Warzen und kann sich zur Therapie der ersten Wahl entwickeln. In prospektiv randomisierten Studien konnten Abheilungsraten bei therapieresistenten Warzen von bis zu 82% bei nur geringen Nebenwirkungen erzielt werden.

Abstract

Human papilloma viruses (HPV) lead to common warts in 5% of the population and genital warts in 1% of sexually-active individuals. Although about 50% of HPV infections regress spontaneously, the course is uncertain. Expectant waiting often leads to progression and dissemination. Plantar warts may cause pain on walking, while palmar and genital warts may impair social contacts. There are many treatments for warts, including a variety of laser systems. The CO2 laser is the best ablative approach, producing cure rates of up to 75% for therapy-resistant common warts in cohort and case-control studies. Side effects such as bleeding, pain and reduced function over weeks must be weighed against the likelihood of success. Considering non-ablative approaches, pulsed dye lasers can be used for a selective, non-bloody destruction of extragenital and genital warts and may become the treatment of choice. In prospective randomized studies, they produced cure rates of up to 82% for therapy-resistant warts with few side effects.

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Authors and Affiliations

  1. Haut- und Allergieklinik, Klinikum Stadt Hanau, Leimenstraße 20, 63450, Hanau, Deutschland

    H.M. Ockenfels

  2. Laserklinik Karlsruhe, Karlsruhe, Deutschland

    S. Hammes

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  1. H.M. Ockenfels
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  2. S. Hammes
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Correspondence to H.M. Ockenfels.

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Widmung

Diese Arbeit ist Herrn Professor Dr. med. Manfred Goos mit den besten Wünschen zum 70. Geburtstag gewidmet.

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Ockenfels, H., Hammes, S. Laser in der Therapie der Warzen. Hautarzt 59, 116–123 (2008). https://doi.org/10.1007/s00105-007-1468-9

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