Treatment of condyloma acuminatum using the combination of laser ablation and ALA-PDT
Introduction
Papilloma viridae is an ancient and ubiquitous virus. More than 200 species of human papilloma virus (HPV) are identified and divided into 16 genera. The differentiated human squamous epithelium is susceptible to Papilloma viridae and almost anybody’s skin can be infected [1]. Risk factors include sex, public bathrooms and immune suppression [2].
The traditional treatment methods of genital warts or condyloma acuminatum (CA) include: topical medications (trichloroacetic acid and imiquimod), and surgical therapy (cryotherapy, carbon dioxide (CO2) laser, surgical excision, foreskin removal) [3]. However, the recurrence rate of CA remains very high [4]. Each method has some limitations and no single therapy can achieve complete cure and prevent relapse [5]. HPV latent and subclinical infections continue to exist, which is a major factor of recurrence in CA [6,7]. There is a need to develop more effective approach to treat CA.
Ross et al. demonstrated in 1997 that CA could selectively accumulate protoporphyrin IX (PpIX) after topical application of prodrug 5-aminolaevulinic acid (ALA) [8]. This implicates a potential of ALA/PpIX-based photodynamic therapy (ALA-PDT) for the treatment of CA. Topical ALA-PDT has been approved for the treatment urethral CA in China in 2007. As recommended in the Chinese Guideline of condyloma acuminata treatment (2014), ALA-PDT should be used in conjunction with laser ablation [9]. In general, ALA-PDT is applied after the removal of visible warty lesions using laser [10].
In this study, the combination of CO2 laser and ALA-PDT was used to treat CA of adult patients of both sexes. Treatment outcomes were evaluated 3-month after the treatment. Our data suggest that the combination of laser ablation and ALA-PDT is feasible and effective in the treatment of CA.
Section snippets
Study design
This was a randomized single-arm prospective single-hospital study of newly diagnose CA of both sexes. The primary goal of the study was to evaluate the clinical outcomes of combining laser ablation and ALA-PDT treatment.
Patient collection
A total of 100 consecutive patients from the First Affiliated Hospital of Harbin Medical University participated in this study between January 2014 and January 2016. All patients were diagnosed with CA with the confirmation from pathological biopsy or typical clinical
Patient demographic data
Amongst 100 selected patients 98 of them completed the study. Their demographic data are listed in Table 1. Lesions mainly located in the urethra orifice, underneath pubic hair and around the anus in male patients and in both the inner and outer labia and around the anus in female patients.
Clinical outcomes
Laser ablation and ALA-PDT were well tolerated. Mild burning and/or pain could occur in the illuminated area. At day one and day two after treatment, mild swelling might occur at the treated area, which was
Conclusion
The combination of laser ablation and ALA-PDT is feasible and effective in the treatment of CA. Although a high cure rate can be obtained, it should be recognized that certain longer latency infections around the treated area might develop into warty lesions and their treatment warrants further improvement.
Acknowledgements
This work was supported by the Natural Science Foundation of Heilongjiang Province [grant numbers H201432], the postdoctoral foundation of Heilongjiang Province [grant numbers LBH-Z14222], the First Affiliated Hospital of Harbin Medical University [grant numbers 2017Y010], and a joint project with Gaitianli Co.
References (28)
Diseases associated with human papillomavirus infection
Virology
(2013)Laser treatment of genital human papillomavirus infections in the male patient
Obstet. Gynecol. Clin. North Am.
(1991)- et al.
Aminolevulinic acid (ALA)-assisted photodynamic diagnosis of subclinical and latent HPV infection of external genital region
Photodiagn. Photodyn. Ther.
(2008) Subclinical papilloma viral infection of male genitalia
Urology
(1985)- et al.
Photodynamic therapy with endogenous protoporphyrin IX: basic principles and present clinical experience
J. Photochem. Photobiol.
(1990) - et al.
5-Aminolevulinic acid-mediated photodynamic therapy for oral cancers and precancers
J. Dent. Sci.
(2012) - et al.
5-aminolaevulinic acid-photodynamic therapy for the treatment of cervical condylomata acuminata
Chin. Med. Sci. J.
(2009) - et al.
The combination of CO2 laser vaporation and photodynamic therapy in treatment of condylomata acuminate
Photodiagn. Photodyn. Ther.
(2014) - et al.
Antibody persistence and evidence of immune memory at 5years following administration of the 9-valent HPV vaccine
Vaccine
(2017) - et al.
Warts (non-genital)
BMJ Clin. Evid.
(2014)
Randomized clinical comparative study of cryotherapy plus photodynamic therapy vs cryotherapy in the treatment of multiple condylomata acuminata
Photodermatol. Photoimmunol. Photomed.
Management of genital warts
Am. Fam. Phys.
Selectivity of protoporphyrin IX fluorescence for condylomata after topical application of 5-aminolaevulinic acid: implications for photodynamic treatment
Br. J. Dermatol.
Chinese Medical Doctor Association Dermatology Branch Sexually Transmitted Diseases Subcommittee. Condyloma acuminata treatment guide (2014)
Chin. J. Dermatol.
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Shaoshan Hu, Yun Yang and Bingbing Jiang are the co-first authors.