Genital warts treated by photodynamic therapy

The patient, a 30-year-old man with numerous genital condylomata acuminata (CA), has had unsuccessful treatment with liquid nitrogen, 20% podophyllin, and repeated 0.5% podophyllotoxin solution with 5% imiquimod (Figure 1). Before the appearance of CA, he experienced acute orchiepididimitis and a Candida infection. The patient was immunologically examined, and the lower level of lymphocytes, slightly reduced level of IgM, and C4 complement were revealed. Results from a human immunodeficiency virus examination were negative. After the therapeutic failure mentioned above, photodynamic therapy (PDT) was initiated using 20% aminolevulinic acid (5-ALA) in a gel. The photosensitizer was applied to lesions and 10 mm of surrounding skin in a 1-mm-thick layer under occlusive dressing for 3 hours and then removed with saline and nonwoven gauze. The site was immediately irradiated with noncoherent red light with an emission spectrum of 580 to 680 nm wavelength (Medeikonos PDT-Model 200, Medeikonos AB, Sweden). The total light dose was 50 J/cm(2); light intensity ranged from 70 to 90 mW/cm(2). Because of persistent fluorescence during photodynamic therapy, the treatment was repeated 10 times in 2-week intervals with a follow-up of 1, 3, and 6 months after its completion. After the last PDT treatment, the persistent fluorescence disappeared completely. The absence of fluorescence corresponded with a healed clinical finding without scarring and pigmentation (Figure 2). The period from the initiation of PDT to the consolidation of CA was 22 weeks. During PDT treatment, the patient felt only mild burning, which disappeared after the illumination stopped. Six months after the therapy, there were no signs of recurrent disease.