Successful treatment of periungual warts with topical cidofovir

Periungual warts represent a treatment challenge because of its high recurrence rate and recalcitrance. These are benign lesions produced by the human papilloma virus (HPV) that often do not respond to habitual treatment. Cidofovir is a potent antiviral drug that acts inactivating viral DNA polymerase. Topical cidofovir for the treatment of HPV‐related cutaneous and mucous lesions is becoming increasingly common. Our aim was to assess the efficacy and safety of cidofovir cream for the treatment of viral periungual warts. We undertook a retrospective observational study of patients with periungual warts who received treatment with topical cidofovir between January 2010 and December 2013 at the Dermatology Service of the Hospital Costa del Sol, Marbella, Spain. Data were recorded about the rate of treatment response, the adverse effects and recurrences, as well as the characteristics of the patient cohort. We identified 41 patients who had received some previous treatment. The concentration of cidofovir was 3% in all cases, usually applied twice a day (in 37 of the 41 cases). A greater or lesser response was noted in 35 cases. There were six recurrences in the follow‐up period. Topical cidofovir seems to be a useful alternative for the therapeutic management of recalcitrant periungual common warts that fail to respond to usual treatment. Our experience with the use of this antiviral agent has been satisfactory, although in our opinion, it should be reserved for specific cases as its economical cost represents an important limitation.     

23例面部扁平疣的光动力治疗

目的：评价5-氨基酮戊酸光动力治疗扁平疣的疗效。方法：23例扁平疣患者采用5-氨基酮戊酸光动力阶梯治疗,对治疗效果和不良反应进行了评价。结果：23例患者中20例第1次治疗后痊愈,3例显效;第2次治疗后,2例痊愈,1例显效;所有患者在光动力治疗后2-3天均出现红斑、结痂等急性不良反应,5例患者治疗后1个月,仍有明显色素沉着,所有患者3个月色素沉着消退。结论：5-氨基酮戊酸光动力阶梯治疗扁平疣效果好,但少数患者可出现暂时眭色素沉着。     

Pain induced by photodynamic therapy of warts

BACKGROUND: Photodynamic therapy with topical 5-aminolevulinic acid (ALA), followed by irradiation with red light (ALA-PDT), is used for non-melanoma skin cancer and other dermatological diseases. Pain during and after light exposure is a well-known adverse advent that may be a limiting factor for treatment, particularly, in viral warts. METHODS: To assess the pain induced by ALA-PDT, we asked 45 patients enrolled in a randomized, placebo-controlled trial with six consecutive ALA- and placebo-PDT treatments for recalcitrant foot and hand warts to fill in questionnaires about pain immediately and 24 h after each treatment. RESULTS: Immediately and 24 h after each of the six treatments, pain intensity was significantly higher in warts treated with ALA-PDT than in warts treated with placebo-PDT (P<0.028). Severe or unbearable pain was reported from a median of 17% (6-31%) of the ALA -treated warts and from a median of 2% (0-15%) from the placebo-treated warts immediately after the treatments. With increasing treatments, no significant change in pain intensity was observed and no significant relation was found between the pain intensity and the relative change in wart area. The pain was primarily characterized as burning and shooting. The pain lasted about 30 h (range: 1-96 h). CONCLUSION: We conclude that pain induced by ALA-PDT is of such intensity in about one-fifth of the warts that pain relief is indicated.     

Successful treatment of lymphomatoid papulosis with photodynamic therapy

A 40-year-old woman presented with a prolonged history of recurrent crops of erythematous papules and nodules on her abdomen, arms and legs. Histological examination of a cutaneous biopsy revealed Type A lymphomatoid papulosis. Over a 3-year period, some of the patient's lesions had proven to be resistant to treatment with topical and intralesional corticosteroids and systemic agents including methotrexate, tetracycline and nicotinamide. These resistant lesions were treated with two sessions of methyl aminolevulinate photodynamic therapy given 1 week apart. Review 11 months post-photodynamic therapy demonstrated complete clinical clearance at the treatment site. While photodynamic therapy is considered a standard non-surgical treatment option for non-melanoma skin cancers and has been described in a number of non-oncological indications, this is the first report of its use in lymphomatoid papulosis.     

Successful treatment of cutaneous sarcoid by photodynamic therapy with minimal discomfort using a fractionated dosing regime

We report the case of a 42-year-old lady with an 8-year history of a persistent tumid plaque on her forehead. Investigations and presentation were consistent with cutaneous sarcoid with no systemic involvement. Multiple topical and oral treatments had been ineffective. She received seven sessions of 5-aminolaevulinic acid photodynamic therapy (PDT) over the course of 16 months. Each treatment was delivered in discontinuous and fractionated time intervals. Improvement was seen after the first treatment and continued with subsequent treatments. She found the treatment almost painless and was pleased with the cosmetic outcome. We conclude that PDT is a useful therapy in the treatment of facial cutaneous sarcoid. Fractionated exposure may allow the treatment to be less painful and therefore better tolerated.     

Factors contributing to the treatment duration of diphenylcyclopropenone immunotherapy for periungual warts

Diphenylcyclopropenone (DPCP) immunotherapy has been shown to be efficacious for the treatment of warts, especially periungual warts for which destructive techniques are limited. However, factors affecting the duration of treatment of periungual warts have not been studied. A total of 61 patients with periungual warts who were completely cured with DPCP immunotherapy were included in this study. Age, sex, disease duration, location (fingernail, toenail, or both), number of warts, diameter of the largest wart, application number for sensitization and two types of sensitization reactions, erythema and blister index (EBI), and pruritus index were evaluated. Multiple linear regression analysis was performed to find correlations of these variables with the treatment duration. Of the nine variables, application number for sensitization (regression coefficient = 3.251 and 2.428, respectively) and EBI (regression coefficient = ?9.950 and ?9.694, respectively) were independent factors significantly affecting both the total duration of treatment and the duration of treatment after sensitization (p < 0.05, respectively). The sample size was limited. A shorter sensitization period and more severe EBI of the sensitization reaction contribute to a shorter time required for a complete cure in the treatment of periungual warts with DPCP immunotherapy.     

Erosive pustular dermatosis of the scalp: a successful treatment with photodynamic therapy

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease of unknown aetiology that usually occurs in the elderly. It is characterized by sterile pustules, chronic crusted erosions, cicatricial alopecia, and skin atrophy. The histopathology is nonspecific, and its pathophysiology remains undetermined, with various types of local trauma possibly acting as the triggering factor. We describe a case of EPDS in a 75-year-old female in whom there was a marked response to photodynamic therapy with methyl 5-aminolaevulinic acid.     

5-氨基酮戊酸光动力疗法治疗面部扁平疣疗效评价

目的：评价5-氨基酮戊酸光动力（5-ALA—PDT）治疗面部扁平疣的疗效。方法：面部扁平疣患者48例,治疗组24例,采用5-氨基酮戊酸光动力疗法每周1次。对照组24例,用波长532nm的Q开关Nd：YAG激光照射皮损每周1次。疗程均为3周。治疗结束后判定两组疗效。末次观察后3个月判定两组复发率。结果：治疗组痊愈率为91．67％。3个月后随访,复发l例,复发率为4．17％;对照组痊愈率为83．33％,复发5例,复发率为20．83％,两组复发率有显著性差异（P〈0．05）。结论：5-ALA—PDT治疗扁平疣有效、复发率低。     

Pulsed dye laser vs. photodynamic therapy in the treatment of refractory nail psoriasis: a comparative pilot study

Background  Nail psoriasis is often refractory to traditional treatments, and patients with nail psoriasis usually demand a therapeutic option. Both photodynamic therapy (PDT) and pulse dye laser (PDL) have proved effective for plaque-type psoriasis, but they have not been evaluated in nail psoriasis. On the other hand, delta-aminolaevulinic acic has been shown to penetrate into the nail matrix and nail bed occluded with bioadhesive patches.
Objectives  To compare the efficacy of PDT and PDL in the treatment of nail psoriasis
Methods  We studied 61 nails treated with PDT and 60 nails treated with PDL in a group of 14 patients. The PDT used PDL as the light source. Sessions were applied monthly treating one hand with PDT and the other with PDL. The hand treated with PDT was occluded with methyl-aminolaevulinic acic (MAL, Metvix^®) for 3 h using a bioadhesive patch. The nails treated were evaluated at baseline, and after 3 and 6 months according to the Nail Psoriasis Severity Index (NAPSI) score.
Results  A decrease in NAPSI score was observed with both treatments and in both nail matrix and nail bed involvement. No statistical differences were found between PDT and PDL ( P =  0.632, P  = 0.084, P  = 0.535, at baseline, and 3 and 6 months, respectively), and between nail matrix and nail bed NAPSI scores ( P =  0.423 and P  = 0.853, respectively). The subjective impression of the patients was good, especially regarding the decrease in the pain.
Conclusions  PDL seems to be effective in the treatment of nail psoriasis and improves nail matrix and nail bed involvement. MAL does not seem to play role in the clinical response.

Conflicts of interest

None declared.     

光动力疗法联合冷冻治疗多发性甲周疣的护理

生长在甲周或甲下的寻常疣称为甲周疣或甲下疣,可使指甲、甲床破坏、指甲变形,其治疗目前多使用冷冻或CO2激光。冷冻常有治疗时疼痛、治疗周期长、且对甲沟部和甲缘部疣体的疗效差、复发率高等缺点;CO2激光治疗术后创面愈合时间长,易引起继发感染,且愈后易引起局部瘢痕形成或新甲变形[1]。     

An open pilot study of ambulatory photodynamic therapy using a wearable low-irradiance organic light-emitting diode light source in the treatment of nonmelanoma skin cancer

Background Photodynamic therapy (PDT) is a popular treatment for nonmelanoma skin cancer with clearance rates of between 70% and 100%. Although reported to have a superior cosmetic outcome, the inconvenience of hospital visits and discomfort during therapy are considered drawbacks. Objectives To present an open pilot study of a low‐irradiance, potentially disposable, lightweight, organic light‐emitting diode (OLED), which is an area‐emitting light source (2 cm diameter), suitable for ambulatory PDT. Methods Twelve patients with Bowen’s disease (eight) and superficial basal cell carcinoma (four) < 2 cm in diameter were recruited into the study following histological confirmation of the diagnosis. Two treatments (45–60 J cm^?2 red light, 550–750 nm, peak 620 nm, irradiance 5 mW cm^?2) were administered 1 month apart following application of aminolaevulinic acid for 4 h. Results At the 12‐month follow‐up, seven of the 12 patients remained clear, with four of the nonresponders demonstrating peripheral margin failure. Patients were scored for pain during and immediately after treatment using the numerical rating scale (NRS; 1–10). All 12 subjects scored pain as < 2 using the NRS (median score 1). In contrast, a similar cohort of 50 consecutive patients from our routine PDT clinic (Aktilite^® inorganic LED source; 75 J cm^?2, irradiance 80 mW cm^?2) scored a median of 6 on the NRS. Conclusions Pain and inconvenience are practical barriers to the use of conventional PDT. This pilot study suggests that OLED‐PDT is less painful than conventional PDT with the added advantage of being lightweight, and therefore has the potential for more convenient ‘home PDT’. These results need to be validated in larger studies.     

Photodynamic therapy using light-emitting diodes for the treatment of viral warts

Photodynamic therapy with topical 5-aminolevulinic acid is an effective and safe treatment for actinic keratosis and superficial non-melanoma skin cancer. Further, some studies have reported good efficacy when using photodynamic therapy to treat viral warts. The light-emitting diode is an incoherent, narrow-spectrum light source. The purpose of this study is to evaluate the efficacy of photodynamic therapy using a light-emitting diode for viral warts. Six patients with a total of 41 foot and hand warts were recruited in this study. They were treated with 20% 5-aminolevulinic acid cream under occlusion for 5 h. Thereafter, the treated area was irradiated with the light from a red light-emitting diode (633 ± 6 nm) with a dose of 126 J/cm². This treatment was repeated at 2- or 3-week intervals. The rate of improvement observed in patients was 68.3%. The adverse effects included mild to moderate pain and erythema, which was well-tolerated by all six patients. No patients withdrew from the study due to the adverse effects. Photodynamic therapy with topical 5-aminolevulinic acid using the light from a red light-emitting diode has the advantage of non-invasiveness, minimal associated adverse reactions, and production of good results in a significant proportion of cases: therefore, it is an alternative treatment for recalcitrant viral warts.     

Successful treatment of cutaneous leishmaniasis with intralesional aminolevulinic acid photodynamic therapy

Leishmaniasis is a protozoan infectious disease that often affects the skin and may acquire a chronic and difficult to treat course. Topical photodynamic therapy (PDT) is a novel treatment which involves the selective uptake of a photosensitizing agent. Exposure to an appropriate light source in the presence of oxygen leads to formation of reactive oxygen species and destruction of the target cells. We report on the successful treatment of a 69-year-old patient with a relapse of long-standing cutaneous leishmaniasis using intralesional aminolevulinic acid-PDT.     

Successful treatment of verrucous epidermal nevus with fractional micro-plasma radio-frequency technology and photodynamic therapy

Verrucous epidermal nevus (VEN) is a skin disorder that commonly presents at birth; it is characterized by skin-colored to brown verrucous papules in a linear distribution following Blaschko’s lines. Even though it is extremely rare, VEN has been associated with malignant transformation. VEN has been treated by different treatment modalities with varying and frustrating results. We introduce a new type of treatment. The fractional micro-plasma radio-frequency (RF) technology, which uses unipolar RF technology to provoke plasma spars, creating multiple controlled micro-perforations on the skin. Photodynamic therapy (PDT) is a type of technology for disease diagnosis and treatment, in which a photosensitizer gathers within the nidus and kills the diseased cells. In this report, we present a case of VEN that was successfully treated with fractional micro-plasma RF technology and PDT without side effects or complications; a follow-up was conducted after 24 months and no signs of recurrence were observed.     

Topical 5-aminolaevulinic acid photodynamic therapy for the treatment of skin conditions other than non-melanoma skin cancer

Topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) is used increasingly for superficial non-melanoma skin cancer (NMSC) and dysplasia. However, the relative accumulation of the photosensitizer protoporphyrin IX (PpIX) in diseased tissue is not specific for neoplastic disease, and has been shown after the application of ALA to benign proliferative skin conditions such as viral warts and psoriasis. This review appraises the quality of evidence available for the use of topical ALA-PDT in the treatment of skin conditions other than NMSC. The diseases that have been studied in most detail are recalcitrant viral warts, acne, psoriasis and cutaneous T-cell lymphoma. Publications relating to the treatment of other diseases by topical PDT are restricted to small case series or case reports. The relevant literature will be discussed and the potential for topical PDT in the treatment of several skin diseases is highlighted, although more detailed studies are required to clarify the role of PDT beyond the treatment of NMSC.