title: Treatment of perianal condyloma acuminate with topical ALA-PDT combined with curettage: outcome and safety.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the treatment outcome and safety of topical photodynamic therapy (PDT) with aminolevulinic acid (5-ALA) combined with surgical curettage for perianal condyloma acuminata.
  
  
  BACKGROUND
  Condyloma acuminata is the most common sexually transmitted disease, with a high relapse rate, especially in the perianal area. The outcomes of many treatment methods for perianal genital warts are not satisfactory.
  
  
  METHODS
  In this study, 40 cases of perianal condyloma acuminata were treated with topical aminolevulinic acid photodynamic therapy (ALA-PDT) combined with curettage. First, the warts were removed with the patient under local anesthesia. The depth of the ablation and curettage reached the dermal layer. Then, the first session of PDT was performed after 2 days. Ten percent 5-ALA cream was applied to lesional skin with occlusive dressing for a 3-h incubation period and the lesions of warts were irradiated for 10 min by using a 635-nm laser beam of 177 mW/cm(2) intensity. The ALA-PDT was repeated after 1 and 3 weeks. Follow-up evaluation was performed at our outpatient clinic at 1 and 3 months after completion of therapy. Before treatment and at each follow-up visit, the lesions were photographed; the treatment outcome was evaluated as recurrence rate, and patient satisfaction was surveyed.
  
  
  RESULTS
  After three PDT sessions following surgical curettage, all 40 patients were cured and there was no recurrence at 1 month off treatment. At 3 months off treatment, six cases relapsed, corresponding to a recurrent rate of 15%. The satisfaction rate of patients was 100% at 1 month and 95% at 3 months after treatment.
  
  
  CONCLUSIONS
  Combination of surgical curettage and topical PDT has been proven to be a safe and effective procedure, and may offer a wide clinical application for the treatment of perianal condyloma acuminata.
authors: Plastic and Cosmetic Surgery Department, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China. skin515@163.com
authors: Yuan-gang
authors: YG
authors: Lu
authors: Ya-dong
authors: YD
authors: Yang
authors: Jin-jin
authors: JJ
authors: Wu
authors: Xia
authors: X
authors: Lei
authors: Qiong-hui
authors: QH
authors: Cheng
authors: Yang
authors: Y
authors: He
authors: Wen
authors: W
authors: Yang
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000622:Aminolevulinic Acid / Q000627:therapeutic use*; D001003:Anal Canal / Q000473:pathology*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003218:Condylomata Acuminata / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery*; D003475:Curettage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid