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

Background: Acral 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. Objectives: to 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 methods: 68 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. Results: 48 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. Conclusion: PDT 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.