Conventional versus daylight photodynamic therapy for recalcitrant hand warts: Efficacy, safety and recurrence

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BackgroundAcral warts appear as skin-colored, verrucous, hyperkeratotic papules most located on the dorsal hands, distal fingers, subungual skin, and feet. Conventional photodynamic therapy (C-PDT) has shown a good efficacy and safety profile in patients with viral warts, in both adults and children, with a good cure rate and excellent cosmetic results in front of few and light side effects. The efficacy of daylight photodynamic therapy (DL-PDT) has not yet been evaluated. Objectivesto investigate and assess the short- and long-term efficacy of PDT using 10 % aminolevulinic acid (ALA) in the treatment of multiple verrucae vulgaris of the hands. The second endpoint was to compare the efficacy and safety of C-PDT versus DL-PDT. Materials and methods68 patients (38 males and 30 females) aged between 6 and 80 years, affected by hand warts, were divided into two arms: group A was treated with C-PDT, and group B was treated with DL-PDT. Patients underwent treatments three times at 1-month intervals. The response was assessed 3 months after the last session (W24) and 1 year after the last session (W52) and scored as excellent (75–100 % reduction of total wart count), partial (74−25 % reduction), and none (< 25 % reduction or no response). Any adverse events occurring during or after ALA application or irradiation as well as pain intensity were recorded at each visit. Results48 patients (70.6 %) achieved excellent response at W24, while 6 patients (8.8 %) had a partial response and 14 (20.6 %) were resistant to treatment. Patients treated with DL-PDT were less likely to have an excellent response (66.7 %) than patients treated with C-PDT (73.7 %), although not statistically significant. Among patients with excellent or partial response (n=54), 37 % (n=20) had warts relapse at W52. Both treatment modalities were well tolerated, with transient pain as the main side effects. ConclusionPDT is effective in the treatment of verrucae vulgaris of the hands. An overall response rate of 70.6 % of excellent response was achieved. While C-PDT showed a trend towards better outcomes, DL-PDT offered a more patient-friendly approach, particularly in terms of comfort and compliance.