Epidermodysplasia verruciformis treated using topical 5-aminolaevulinic acid photodynamic therapy

Abstract

We describe a 65-year-old woman who had had wart-like lesions on the hands, lower arms and forehead for about 45 years. She had already had several basal cell carcinomas excised. Histological study, electron microscopy and in situ hybridization [human papilloma virus (HPV)-types 5/8/12/14/19-23/25/36] of skin biopsies confirmed a diagnosis of epidermodysplasia verruciformis (EV). Photodynamic therapy (PDT) was performed using a 20% 5-aminolaevulinic acid ointment applied for 6 h to the lesions and irradiating using an incoherent light source (lambda = 580-740 nm, 160 mW/cm2, 160 J/cm2). Following PDT, blistering and crusting of the lesions occurred, but these healed completely within 2-3 weeks without scarring, and the cosmetic result was excellent. Six months after PDT a skin biopsy was taken. In situ hybridization was positive for HPV type 8 in skin which was clinically and histologically normal. Twelve months after PDT a few lesions had recurred on the hands. Although permanent cure of EV cannot be achieved by any therapy at present and single lesions continue to appear in this patient, topical PDT might result in better control of HPV-induced lesions.

Treatment of a patient with epidermodysplasia verruciformis carrying a novel EVER2 mutation with imiquimod

“…Other treatment options include surgery, systemic retinoids, 5-fluorouracil, and 5-aminolevulinic acid photodynamic therapy for premalignant and early malignant lesions. 1,16 The antiviral agent cidofovir was not found to be effective in one report and is very expensive. 17 Treatment with radiotherapy is not recommended as this may result in the reoccurrence of skin cancers, often with aggressive growth patterns.…”

Photodynamische Therapie nichtonkologischer Indikationen

“…Bei der Epidermodysplasia verruciformis handelt es sich um eine genetisch determinierte Empfänglichkeit für bestimmte Papillomviren, infolge deren es zu flachen warzenähnlichen Hautveränderungen kommt, die maligne entarten können [37]. Bei einer 65-jährigen Patientin mit Epidermodysplasia verruciformis und multiplen flachen Warzen an den Händen, Unterarmen und im Gesicht wurde eine ALA-PDT (20% ALA für 6 h, Bestrahlung mit inkohärenter Lichtquelle mit 160 J/cm 2 und 160 mW/cm 2 ) durchgeführt.…”

Induction of apoptosis in HPV16 E7 transfected human keratinocyte by ALA-mediated photodynamic therapy

“…If surgical removal is not an option or is unsuccessful, then other approaches are necessitated [2]. The feasibility of topical photodynamic therapy (PDT) for the treatment of skin and mucosal lesions associated with HPV infection (e.g., condylomata, epidermodysplasia verruciformis and intraepithelial neoplasia) has been evaluated since the late 1990s [3][4][5]. Mounting clinical data suggest that 5-aminolevulinic acid (ALA)-mediated PDT (ALA-PDT) for condyloma and intraepithelial neoplasia appears to be as effective as conventional treatments, but with shorter healing time and excellent cosmetic results.…”