Genital warts treated by photodynamic therapy

Area of Science:

• Dermatology
• Photomedicine

Background:

• Genital condylomata acuminata (CA) are a common sexually transmitted infection caused by human papillomavirus.
• Conventional treatments including cryotherapy, topical agents (podophyllin, imiquimod), and antiviral therapies often have limited efficacy or significant side effects.
• Recalcitrant cases of CA may require alternative therapeutic strategies.

Observation:

• A 30-year-old male patient presented with extensive genital CA resistant to multiple conventional treatments.
• Immunological examination revealed lower lymphocyte levels, reduced IgM, and C4 complement, but HIV testing was negative.
• Photodynamic therapy (PDT) with 20% aminolevulinic acid (5-ALA) gel was administered, followed by red light irradiation.

Findings:

• PDT involved applying 5-ALA gel under occlusion for 3 hours, followed by irradiation with red light (580-680 nm).
• The treatment was repeated 10 times at 2-week intervals due to persistent fluorescence.
• Complete resolution of CA without scarring or pigmentation was observed 22 weeks after PDT initiation, with no recurrence at 6-month follow-up.

Implications:

• PDT with 5-ALA represents a promising therapeutic option for managing treatment-resistant genital condylomata acuminata.
• The treatment was well-tolerated, with only mild, transient burning reported.
• Further research into PDT for refractory CA is warranted to establish optimal protocols and long-term efficacy.