Annalisa Patrizi

Camilla Loi

Elena Cleopatra Burtica

Federico Bardazzi

Michela Magnano

English

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Journal of Dermatological Treatment. 2013; 24: 137–138LETTER TO THE EDITORPhotodynamic therapy with 5-methylaminolevulinic acid in thetreatment of multiple warts of the faceELENA CLEOPATRA BURTICA, MICHELA MAGNANO, CAMILLA LOI,FEDERICO BARDAZZI & ANNALISA PATRIZIDepartment of Internal Medicine, Geriatrics and Nephrology, Division of Dermatology, University of Bologna, ItalyKey words: facial warts, 5-methylaminolevulinic acid, photodynamic therapySirs,The facial flat wart is caused by human papillomavirus and these lesions may be observed on the face,dorsal hands and shins. Although different therapies,such as keratolytic agents, topical immunomodulatorsand radical measures, have been used for multiplewarts of the face, the results may be troublesome (1).In fact, all these treatments may be painful, notsuccessful and there are numerous relapses. Photo-dynamic therapy (PDT) with topical photosensitizerapplication followed by irradiation with red light hasbeen recently proposed for the treatment of viralwarts. Side effects of this therapy are few: patientscomplained of moderate pain or burning sensation,and subsequent scars are usually not observed (2).We describe one case of multiple facial warts suc-cessfully treated with this method.A22-year-oldman(Fitzpatrickphototype3) came toour attention for recalcitrant andmultiple viral warts ofthe face lasting 1 year. He presented multiple warts,most of them situated on the beard area (Figure 1). Hehad developed few lesions after sun exposure, andsubsequently the number of warts had increased.He did not have a history of immunodeficiency.After a month of the use of 80% trichloroacetic acidand 0.05% isotretinoin solution to reduce the thicknessof lesions, we used MAL-PDT: we applied the MALwith occlusive dressing technique for 2 h and then useda red light source (630 nm, 37 j/cm2 – Aktilite CL128LED) for 8 min. The lamp-to-skin distance was 5 cm.After the first session, the patient showed a clearance ofthe 60% of warts. The second session of PDT wasperformed after a month with the same modalities.After two sessions of PDT, the patient achieved acomplete clearance of the warts (Figure 2). We didnot notice any severe reaction or side effect, excepttransient local erythema. The patient complained onlymild burn sensation, moderate pain and some pus-tules. A biopsy performed 1 month after this treatmentdid not show any sign of wart.After a year of follow-up, he did not presentrecurrences.The PDT consists in the topical application of the5-aminolevulinic acid (ALA) or its methyl ester(5-methylaminolevulinic acid or MAL), followed byirradiation with red light: this process results in thecreation of free radicals able to destroy diseasedtissues (2). PDT is a method usually employed forthe treatment of non-melanoma skin tumors, in par-ticular actinic keratosis, superficial basal cell carci-noma and Bowen disease, and some inflammatorydermatoses (3). The use of PDT for facial plane wartshas been reported in three studies (1,4,5), but in thesestudies the photosensitizer was ALA and this drugrequires a longer incubation period (3–6 h) (1,5) anda longer time exposure (20 min) (5) to red light.Correspondence: Michela Magnano, Department of Internal Medicine, Division of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy.E-mail: michela_magnano@virgilio.it(Received 22 April 2011; accepted 26 May 2011)ISSN 0954-6634 print/ISSN 1471-1753 online  2013 Informa Healthcare USA on behalf of Informa UK Ltd.DOI: 10.3109/09546634.2011.595773Moreover, just one patient achieved the completeclearance after only two sessions of ALA-PDT (5).Our patient responded completely and rapidly toMAL-PDT. He did not present scars or other sideeffects and there were not observed recurrences after1 year of follow-up.We propose the MAL-PDT as a good treatment forthe plane warts of face, because of its good cosmeticresults and low rate of recurrences. Other treatments,such as surgery or cryotherapy are more painful, maycause visible scars, particularly hypopigmentedmacules in patients with high phototypes such ours,and relapses are frequently observed.We can conclude that the MAL-PDT should beconsidered an effective and safe therapy to treat facialplane warts.References1. Lin MY, Xiang LH. Topical 5-aminolevulinic acid photody-namic therapy for recalcitrant facial flat wart in Chinese sub-jects. J Dermatol. 2008;35:658–661.2. Ericson MB, Wennberg AM, Larko O. Review of photody-namic therapy in actinic keratosis and basal cell carcinoma.Ther Clin Risk Manag. 2008;4:1–9.3. Babilas P, Szeimies RM. The use of photodynamic therapyin dermatology. G Ital Dermatol Venereol. 2010;145:613–630.4. Lu YG, Wu JJ, He Y, Yang HZ, Yang YD. Efficacy oftopical aminolevulinic acid photodynamic therapy for thetreatment of verruca planae. Photomed Laser Surg. 2010;28:561–563.5. Mizuki D, Kaneko T, Hanada K. Successful treatment oftopical photodynamic therapy using 5-aminolevulinic acid forplane warts. Br J Dermatol. 2003;149:1087–1088.Figure 2. Complete clearance of the warts and acneiform papulesafter two sessions of MAL-PDT.Figure 1. Flat-topped papules and some acneiform lesions on thebeard area before the topical and MAL-PDT treatment.138 E. C. Burtica et al.Copyright of Journal of Dermatological Treatment is the property of Taylor & Francis Ltd and its content maynot be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express writtenpermission. However, users may print, download, or email articles for individual use.

Photodynamic therapy with 5-methylaminolevulinic acid in the treatment of multiple warts of the face.

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Photodynamic therapy with 5-methylaminolevulinic acid in the treatment of multiple warts of the face.

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