Comparative Study of Aminolevulinic Acid Photodynamic Therapy Plus Pulsed Dye Laser versus Pulsed Dye Laser Alone in Treatment of Recalcitrant Viral Warts

Background: Recurrent recalcitrant warts are likely to increase gradually, and require more aggressive and effective treatment for remedy. According to recent foreign research materials and literature, aminolevulinic acid photodynamic therapy (ALA-PDT) is reported to prove to show high curative performances, but there has been little relevant research in Korea to date. Objective: This study will evaluate the efficiency and side effects of ALA-PDL and PDL in treating recalcitrant viral warts. Methods: 120 warts from 44 people were selected and sorted by their locations such as hand, foot, and periungual area, and then randomly divided into 2 groups: ALA-PDL group and PDL group. The ALA-PDL group used 20% 5-ALA as a photosensitizer, and PDL for the light-source, the other group used PDL. The setting of PDL being used in both groups is as follows: wavelength of 585 nm, spot size of 7 mm, and energy density of 7.0∼10 J/cm2. Results: After 3 treatment sessions, the complete clearance of ALA-PDL and PDL groups was 44/59 (74.6%), 18/61 (29.5%), partial clearance-good was 8/59 (13.6%), 20/61 (32.8%), partial clearance-poor was 7/59 (11.9%), 21/61 (34.4%) and no response was 0/59 (0%), 2/61 (3.3%). The average treatment sessions were 2.32 and 2.97 times. ALA-PDL group showed pain in 27/59 (45.8%) for the first and second treatment sessions, and postinflammatory hyperpigmentation (PIH) in 11/59 (18.6%). The PDL group showed only PIH in 3/61 (4.9%). Conclusion: PDT is an efficient treatment modality in recalcitrant viral warts. Especially in the case of periungual warts, it is very safe and cosmetically satisfactory without serious side effects such as nail deformity. (Korean J Dermatol 2008;46(8):1020∼1027)