Enhanced Efficacy of Photodynamic Therapy with Methyl 5-Aminolevulinic Acid in Recalcitrant Periungual Warts After Ablative Carbon Dioxide Fractional Laser: A Pilot Study

BACKGROUND Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been used to improve recalcitrant periungual warts, but most lesions achieved complete remission after more than four sessions, and some lesions did not respond to the method. In this pilot study, the potential for synergistic effects of the combination of ablative carbon dioxide (CO2) fractional laser and methyl 5-ALA (MAL)-PDT for the treatment of recalcitrant periungual warts was examined. MATERIALS AND METHODS Twelve Korean patients (8 women and 4 men aged 20-45, mean age 27.9) with a total of 40 periungual warts were enrolled in the present study. The lesions were treated using an ablative CO2 fractional laser. Immediately after each fractional treatment, MAL was applied on the periungual warts, and 3 hours later, such areas were illuminated with a red light at a dose of 50 J/cm2 for 15 minutes. RESULTS After a mean of 2.2 treatments per wart, a mean clearance of 100% was achieved in 36 (90%) warts. Two warts (5%) had 50% clearance, and two (5%) showed no response after three treatments. There were no recurrences of the warts that had achieved 100% clearance during the follow-up period of 6 months. Most of the treatments had no severe side effects during or after their administration. CONCLUSION A potential for enhanced clinical results when using combined ablative CO2 fractional laser and MAL-PDT for the treatment of periungual warts was shown in this pilot study. The authors have indicated no significant interest with commercial supporters.