Comparative Study of Aminolevulic Acid Photodynamic Therapy plus Pulsed Dye Laser versus Pulsed Dye Laser Alone in Treatment of Viral Warts

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Abstract
Objective and Background: A number of scientific publications describe the removal of viral warts using photoselective laser destruction with pulsed dye laser (PDL) or photodynamic therapy (PDT). Although both methods represent an enormous improvement in therapy, the results are not sufficiently consistent to consider these methods as the "gold standard" for therapy. Methods: With a view to further improvement we combined a photoselective dye laser (595 nm, 20 J.cm−2) with photodynamic therapy using aminolevulic acid. The results of this method were compared against traditional laser photodestruction (of identical physical parameters) and against traditional photodynamic therapy (of similar parameters). Results: After combined therapy (PDT + PDL) of 86 warts in 24 patients, 100% were cured, with an average of 1.96 therapeutic sessions. Therapy with PDT alone failed in 3 of 76 warts even after 5 sessions (96%), with an average of 2.54 therapeutic sessions. Therapy with PDL alone failed in 21 of 112 warts even after 5 sessions, with an average of 3.34 therapeutic sessions. Conclusions: All three therapeutic methods are able to cure infectious warts with high probability (>80%). However, a combination of PDT and PDL is the most effective and the most favored therapy. If other investigators also confirm results near or equal to 100% success, this therapy could become a treatment of choice for this indication.