IPL for Warts: Not Recommended as Monotherapy
IPL alone is not effective for treating warts and should not be used as a standalone treatment. The highest quality randomized controlled trial found no significant difference between paring followed by IPL versus paring alone for recalcitrant hand and foot warts, while causing significantly more pain 1.
Evidence Against IPL Monotherapy
A 2010 randomized controlled trial of 89 patients with recalcitrant hand and foot warts found that paring followed by IPL achieved complete or partial clearance in only 22% and 12.2% of patients respectively, compared to 13.5% and 10.8% with paring alone—a difference that was not statistically significant 1.
IPL monotherapy caused moderate pain intensity that was significantly higher than paring alone (p<0.0005), without providing additional therapeutic benefit 1.
The British Association of Dermatologists 2014 guidelines do not recommend IPL as a treatment option for cutaneous warts, notably excluding it from their comprehensive treatment algorithm that covers plantar, plane, facial, pediatric, and immunosuppressed patient populations 2.
IPL Combined with Photodynamic Therapy: Limited Evidence
When IPL is combined with photosensitizing agents (ALA or methylene blue), there is modest evidence of efficacy, but this represents photodynamic therapy (PDT), not IPL alone.
A 2021 randomized controlled trial showed that intralesional methylene blue followed by IPL (MB/IPL/PDT) achieved clinical and dermoscopic clearance in 43.3% of patients with a cure rate of 40.9%, compared to 20% clearance and 23.4% cure rate with IPL alone 3.
The 2008 British Journal of Dermatology PDT guidelines note that ALA applied with IPL illumination showed improved response compared to IPL alone in small studies, but this is PDT treatment, not IPL monotherapy 2.
PDT for viral warts (using various light sources including IPL) is noted to be "a relatively painful therapy option, with outcomes dependent on adequate paring and the use of a keratolytic agent pre-PDT" 2.
Recommended Treatment Algorithm
Follow the British Association of Dermatologists evidence-based approach:
First-Line Treatment
- Salicylic acid 15-40% topical paints or ointments applied daily after paring, continued for 3-4 months 2.
- Cryotherapy fortnightly for 3-4 months as an alternative first-line option 2.
Second-Line Treatment
- Combination of salicylic acid and cryotherapy with more aggressive regimens, though care is needed due to worse side-effects 2.
Third-Line for Refractory Cases
- Pulsed dye laser (PDL) has significantly better evidence than IPL, with clearance rates of 95-100% for simple warts and 44-56% complete response for facial flat warts 4, 5, 6.
- PDT using ALA or MAL with appropriate light sources (not IPL alone) showed 75-88% clearance rates for plantar warts in controlled trials 2.
- Contact immunotherapy, intralesional bleomycin, or other destructive methods 2.
Critical Caveats
Location matters: Plantar warts have lower cure rates at all sites due to thicker cornified layer and poorer treatment penetration 2. The 2010 RCT showing IPL inefficacy treated predominantly plantar warts (92.1%) 1.
Pain without benefit: IPL causes significant treatment-related pain without demonstrated efficacy advantage 1.
PDT is not IPL: Studies showing benefit with "IPL" for warts almost universally involve photosensitizing agents (making it PDT), not IPL monotherapy 2, 3.
Avoid in children: Painful treatments like IPL should be avoided in young children, as warts in children are often short-lived and likely to clear within 1-2 years 2.
Cost-effectiveness: IPL requires specialized equipment and multiple sessions without proven benefit over inexpensive first-line treatments like salicylic acid 2, 1.