Recalcitrant hand and foot warts successfully treated with photodynamic therapy with topical 5-aminolaevulinic acid: a pilot study

Abstract

The purpose of this pilot study was to determine if photodynamic therapy with topical application of 5-aminolaevulinic acid followed by irradiation with incoherent filtered and unfiltered light (ALA-PDT) is an effective therapy for recalcitrant hand and foot warts. In 30 patients with recalcitrant warts, 49 regions with a total of 250 warts were randomized to one of the following five treatments: (i) ALA-PDT with white light applied three times within 10 days (W3); (ii) ALA-PDT with white light applied once (W1); (iii) ALA-PDT with red light applied three times within 10 days (R3); (iv) ALA-PDT with blue light applied three times within 10 days (B3), and (v) cryotherapy applied up to four times within 2 months (CRYO). The ALA-PDT treatment modality was repeated in case of partially responding warts. Significantly more warts were completely healed after W3 and W1 than after R3, B3 and CRYO (P < 0.01): 73% of the warts treated with W3 were completely healed, 71% after W1, 42% after R3, 23% after B3 and 20% after CRYO. No scars were observed in the ALA-PDT treated areas and patients treated for foot warts were all able to walk after the treatment. No recurrences in completely responding ALA-PDT treated warts were observed after 12 months of follow-up. In conclusion, photodynamic therapy with topical 5-aminolaevulinic acid followed by irradiation with white light is a promising treatment for recalcitrant hand and foot warts.

Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5‐aminolevulinic acid*

“…Lobraico and Grossweiner [30] reported on 16 patients with genital warts treated with PDT using Photofrin II: 7 patients recurred rapidly after PDT. Recently, Stender et al reported favorable results on the treatment of recalcitrant foot and hand warts using ALA-mediated PDT [17,31]. In agreement with our results, healing was without scar formation.…”

An Armamentarium of Wart Treatments

“…8,156 Photodynamic therapy has also been used to treat common warts on the hand, flat warts and plantar warts. [157][158][159][160] …”

Current Evidence and Applications of Photodynamic Therapy in Dermatology

“…123 ALA-PDT with white light (halogen lamp; 250 W Osram; delivered via slide projector) was found to be more efficacious than red or blue light and standard cryotherapy. 124 One case report demonstrated the use of fractional resurfacing to aid PDL-PDT delivery in a recalcitrant plantar wart. 125 Other virus-mediated lesions treated successfully with PDT have been reported.…”