# Pulsed dye versus neodymium-doped yttrium aluminum garnet lasers for refractory warts: a systematic review and meta-analysis

## TL;DR

This study compares two laser treatments for stubborn warts and finds they work equally well, but one causes fewer bleeding issues.

## Contribution

The study provides a systematic review and meta-analysis comparing PDL and Nd:YAG lasers for refractory warts, highlighting their efficacy and safety differences.

## Key findings

- PDLs and Nd:YAG lasers showed similar complete clearance rates for refractory warts.
- PDLs had significantly fewer hemorrhagic complications compared to Nd:YAG lasers.
- Single-arm studies showed wide variability in clearance rates for both laser types.

## Abstract

Refractory cutaneous warts often persist despite conventional treatments. Pulsed dye lasers (PDLs) and long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are commonly used in clinical practice. However, comparative data on refractory cases remain limited.

Following PRISMA 2020 guidelines, PubMed, Embase, Scopus, and Cochrane Library were searched through October 11, 2025, for studies evaluating PDL or Nd:YAG treatment for refractory warts. Head‑to‑head studies were meta-analyzed using Inverse Variance fixed‑effect odds ratios (ORs), whereas single‑arm evidence was summarized narratively following the SWiM guidelines. The primary outcome was complete clearance, with hemorrhagic complications as the key safety outcome.

Fifteen studies met the inclusion criteria: three head‑to‑head (n=224; 115 PDLs and 109 Nd:YAG lasers) and 12 single‑arm series. Complete clearance was similar between PDLs and Nd:YAG lasers (OR, 1.29; 95% confidence interval [CI], 0.66–2.50; I²=0%). Hemorrhagic complications occurred less frequently with PDLs (OR, 0.23; 95% CI, 0.07–0.74; I²=22%). Single-arm studies indicated broad clearance ranges (PDL, 5.1%–89.0%; Nd:YAG, 9.1%–100%).

PDLs and Nd:YAG lasers demonstrated comparable efficacies in treating refractory warts, and PDLs conferred a safety advantage for hemorrhagic events. The lesion site, thickness, bleeding tolerance, and patient context should be considered when selecting the treatment modality.