title: Combination of immunotherapy and photodynamic therapy in the treatment of Bowenoid papulosis.
abstract: OBJECTIVE
  To investigate the feasibility and efficacy of combination of imiquimod and 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) for the treatment of genital Bowenoid papulosis (BP).
  
  
  METHODS
  A total of 27 BP patients were randomized into two groups. Fifteen (12 male and 3 female, age 22-56 years old) were treated with topical application of 5% imiquimod cream (three times a week) and ALA-PDT (100J/cm(2) at 100mW/cm(2), once a week) for 1-4 times. For comparison, other 12 (6 male and 6 female, age 29-58 years old) were treated with CO2 laser vaporization as a control. Patients were followed up for 3-12 months. Biopsies were taken from BP lesions prior to treatment and tested for HPV-16 and HPV-18 DNA.
  
  
  RESULTS
  In combined therapy group, 60% (9/15) patients showed complete remission and only one recurred (11.1%) during follow up. Local side effects included mild erythema, edema, erosion and burning and/or stinging sensation. No systemic side effect was found. In CO2 laser vaporization group, 83.3% (10/12) patients showed complete remission. However, recurrence occurred in six patients (60.0%). Local side effects included mild to moderate edema, erosion, ulceration, delayed healing, prolonged pain and scarring. The difference of recurrence rate between two groups was statistically significant (P<0.05).
  
  
  CONCLUSIONS
  Topical application of imiquimod cream and ALA-PDT is safe, effective and associated with low recurrence and less side effect.
authors.affiliation: Shanghai Skin Diseases and STD Hospital, Shanghai 200050, PR China.
authors.forename: Xiu-Li
authors.initials: XL
authors.lastname: Wang
authors.affiliation: Shanghai Skin Diseases and STD Hospital, Shanghai 200050, PR China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Wang
authors.affiliation: Shanghai Skin Diseases and STD Hospital, Shanghai 200050, PR China.
authors.forename: Ming-Xia
authors.initials: MX
authors.lastname: Guo
authors.affiliation: University of Colorado at Denver and Health Sciences Center, Aurora, CO, USA.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Huang