Topical 5-aminolaevulinic acid-photodynamic therapy for the treatment of urethral condylomata acuminata.
BACKGROUND
Electrocoagulation and laser evaporation for urethral condylomata acuminata have high recurrence rates and can be associated with urethral malformations.


OBJECTIVE
To investigate the effect of photodynamic therapy (PDT) with topical 5-aminolaevulinic acid (ALA) on urethral condylomata acuminata and to examine the histological changes in lesions of condylomata acuminata after ALA-PDT.


METHODS
Patients with urethral condylomata (n = 164) were given topical ALA followed by intraurethral PDT through a cylindrical fibre. Patients included 11 individuals with 16 penile or vulval condylomatous lesions which were biopsied before or after treatment; the histological changes were then evaluated by light microscopy and electron microscopy.


RESULTS
The complete response rate was 95% and the recurrence rate was 5% after 6-24 months of follow-up. Light microscopy revealed keratinocytes in the middle and upper layers of the epidermis showing marked vacuolation and some necrocytosis 1 and 3 h after PDT. Necrosis in all layers of the epidermis was noted 5 h after PDT. Electron microscopy of keratinocytes revealed distinct ultrastructural abnormalities of mitochondria and the endoplasmic reticulum, and membrane damage. Apoptotic bodies were detected 3 h after PDT and a large number of keratinocytes exhibited necrosis 5 h after PDT.


CONCLUSIONS
Results suggest that, compared with conventional therapies, topical ALA-PDT is a simple, effective, safe and well-tolerated treatment for urethral condylomata acuminata that is associated with a low recurrence rate. The mechanism might be the triggering of both apoptosis and necrosis by ALA-PDT in human papillomavirus-infected keratinocytes.
Wang
X L
XL
Department of Dermatology and Venereology, Shanghai Dermatosis and STD Hospital, Wuyi Road, Shanghai 200050, China. xiuliwang2001@yahoo.com.cn
Wang
H W
HW
Wang
H S
HS
Xu
S Z
SZ
Liao
K H
KH
Hillemanns
P
P
D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D017209:Apoptosis; D003218:Condylomata Acuminata / Q000188:drug therapy* / Q000473:pathology; D004817:Epidermis / Q000473:pathology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015603:Keratinocytes / Q000648:ultrastructure; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010409:Penile Diseases / Q000188:drug therapy; D010778:Photochemotherapy / Q000379:methods*; D012008:Recurrence; D014522:Urethral Diseases / Q000188:drug therapy* / Q000473:pathology; D014845:Vulvar Diseases / Q000188:drug therapy
D000622:Aminolevulinic Acid