👨⚕️ Case Presentation A 70‑year‑old gentleman presented with a long history of multiple senile warts (seborrheic keratoses) on the face. The lesions first appeared at the age of 50 and gradually increased in number, reaching approximately 40 by the time of consultation. Clinically, the warts were well‑circumscribed, verrucous, and pigmented plaques ranging from light brown to dark brown. Their surfaces were rough, with a “stuck‑on” appearance typical of seborrheic keratosis. Over time, the lesions became thicker, more elevated, and cosmetically distressing to the patient.
🔬 Clinical Description of Lesions
- Morphology: Hyperkeratotic papules and plaques, some pedunculated, with a waxy or verrucous surface.
- Distribution: Predominantly on the temples, and cheeks.
- Color: Varied from tan to dark brown, with progressive deepening of pigmentation over the years.
- Symptoms: No pain or pruritus, but significant cosmetic concern.
- Differential Diagnosis: Ruled out pigmented basal cell carcinoma and melanoma through clinical examination and dermoscopy.
💡 Treatment The patient underwent CO₂ laser ablation of all 40 lesions. The procedure was performed under local anesthesia for comfort. The laser was applied in a controlled manner to vaporize the keratotic tissue layer by layer, ensuring complete removal while minimizing damage to surrounding skin.
🩺 Post‑operative Course
- Immediate outcome: Minimal bleeding, with superficial wounds at the treated sites.
- Healing: All wounds healed uneventfully within 2 weeks, with re‑epithelialization and no evidence of infection.
- Pigmentary changes: Post‑inflammatory hyperpigmentation (PIH) was noted initially but resolved spontaneously within 2 months.
- Cosmetic result: Excellent, with smooth skin and no hypertrophic scarring.
📊 Discussion Senile warts are benign epidermal tumors, but their cosmetic impact can be significant, especially when numerous and pigmented. CO₂ laser therapy offers several advantages:
- Precise tissue ablation with minimal collateral damage
- Reduced bleeding compared to surgical excision
- Faster healing and lower risk of scarring
- High patient satisfaction due to improved cosmetic outcomes
This case highlights the effectiveness of CO₂ laser in managing extensive facial seborrheic keratoses. The rapid healing and resolution of PIH underscore the safety and reliability of this modality in elderly patients.
✅ Conclusion CO₂ laser removal is a safe, effective, and cosmetically favorable treatment for multiple senile warts. In this patient, complete clearance was achieved with excellent healing and resolution of pigmentary changes, reinforcing the role of CO₂ laser as a first‑line option for cosmetically significant seborrheic keratoses.f 50. The number of lesion increased and the colour of the lesion deepened. I did co2 laser removal of these warts for him and recovery was good. All the wounds healed within 2 weeks and the PIH resolved after 2 months.
臨床文章：二氧化碳激光去除多發性老人疣
👨⚕️ 病例介紹 患者為一名 70 歲男性，自 50 歲起面部逐漸出現多發性老人疣（脂溢性角化症）。病灶數量隨年齡增加而逐步增多，至就診時約有 40 個。臨床表現為邊界清楚的隆起性斑塊，呈褐色至深褐色，表面粗糙或呈疣狀，具典型「貼附於皮膚表面」的外觀。隨時間推移，病灶顏色加深，厚度增加，對患者外觀造成明顯困擾。
🔬 臨床特徵描述
- 形態：呈乳頭狀或疣狀的角化性丘疹或斑塊，部分呈蠟樣或疣狀表面。
- 分布：主要位於顳部（太陽穴）及雙頰。
- 顏色：由淺褐色逐漸加深至深褐色或黑色。
- 症狀：無疼痛或瘙癢，但因數量多及顏色深，患者有顯著美容困擾。
- 鑑別診斷：臨床及皮膚鏡檢排除黑色素瘤及基底細胞癌等惡性病變。
💡 治療過程 患者接受 二氧化碳激光汽化治療，在局部麻醉下逐層汽化病灶組織，直至完全去除。操作過程中出血極少，周圍正常皮膚損傷有限。
🩺 術後經過
- 即時效果：治療後形成淺表創面，無明顯出血。
- 癒合情況：所有創口於 2 週內完全癒合，無感染跡象。
- 色素變化：術後早期出現輕度炎症後色素沉著（PIH），於 2 個月內自行消退。
- 美容結果：皮膚平整，無肥厚性瘢痕，患者對外觀改善非常滿意。
📊 討論 老人疣雖屬良性，但在數量多、顏色深或位於顯眼部位時，常造成患者心理及美容困擾。二氧化碳激光治療具有以下優勢：
- 精準汽化病灶，對周圍組織損傷小
- 出血少，術後恢復快
- 癒合良好，瘢痕風險低
- 美容效果佳，患者滿意度高
此病例顯示，CO₂ 激光在治療多發性面部老人疣中安全有效，且術後色素沉著可在短期內自然消退，適合用於追求美容效果的患者。