Abstract
Dear Sir,
Verrucous Epidermal Nevus (VEN) and Inflammatory Verrucous Epidermal Nevus (ILVEN) are usually difficult to treat, and patients often seek treatment due to cosmetic concerns. 1,2 Laser offers a promising role due to its ability to ablate tissues with controlled scarring and shorten recovery. 3 -5 We performed a systematic review to determine the clinical outcomes, efficacy, and associated complications of laser treatment of verrucous epidermal naevi.
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed to perform this systematic review (Supplemental Figure 1). A P value of < .05 was considered statistically significant.
A total of 30 studies with 204 patients were analyzed (Supplemental Tables 1 and 2). There were 39% (n = 68) males and 61% (n = 104) females. The mean age was 20 (range 3-61) years and mean follow-up was 27 months. The most common laser used was CO2 laser (n = 112) followed by Er:YAG (n = 50). Other laser types included the Argon laser (n = 23), Nd:YAG (n = 8), Pulse Dye Laser (n = 5), Er:YAG and CO2 (n = 2), UV 308 nm Excimer lasers (n = 2), CO2 and PDL (n = 1) and Q Switch Alexandrite laser (n = 1). The most common regions treated were the head and neck (40.6%) and trunk (23.4%).
Complications were reported in 68% (n = 140) with no incidence of major complications (Supplemental Table 2 and Supplemental Figures 2-8) The total incidence of scarring in all patients was 24% (n = 49) and was seen in patients treated with Argon laser (35%, n = 8) followed by CO2 laser (31%, n = 35). No statistically significant difference in scarring was found between different laser types (P = .50). Total incidence of recurrence was 24% (n = 48). The highest incidence of recurrence was seen in patients treated with Er:YAG laser (36%, n = 18) followed by CO2 laser (24%). Again, rates of recurrence in different lasers were statistically not significant (P = .327). Pigmentary change was seen in 48% (n = 71) and with CO2 laser having significantly lower rate of incidence of pigment change (P = .017). The total incidence of positive outcomes was 77% (n = 158) and no statistical significance was identified between different laser types (P = .891). Patients treated for VEN had marginally better results with a recurrence rate of 24% (n = 40) and a positive outcome in 78% (n = 138). Interestingly, the rate of scarring in VEN lesions was higher (27%, n = 47) than in ILVEN lesions (7%, n = 2). Logistic regression analysis demonstrated high probability of scarring in patients with VEN after laser treatment (OR 4.4, P = .054). This review is limited by the quality of evidence with most of the studies reviewed being either case reports or case series and highlights the need for future research comparing different lasers and their efficacy, ideally through a randomized control trial. Despite the presence of heterogenous data and lack of studies with robust designs, the review is valuable as it synthesizes practical evidence which both clinicians and patients will find useful.
The laser treatment for verrucous skin lesions can be effective but with a high risk of minor complications. This review will allow patients and physicians to make an educated risks-benefit analysis when considering to treat epidermal naevi electively.
Supplemental Material
Table S1 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Table S1, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Table S2 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Table S2, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S1 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S1, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S2 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S2, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S3 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S3, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S4 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S4, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S5 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S5, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S6 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S6, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S7 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S7, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Figure S8 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Figure S8, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Supplemental Material
Online supplementary file 1 - Supplemental material for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review
Supplemental material, Online supplementary file 1, for Laser Treatment of Verrucous Epidermal Naevi: A Systematic Review by Wajeeha Khan, Abdullah Ibrahim, Anton Alvaro, Jake Willet, Nabil Ponnambath, Richard Goodwin and Muhammad Umair Javed in Journal of Cutaneous Medicine and Surgery
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
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