title: Treatment of a vulvar Paget's disease by photodynamic therapy with a new light emitting fabric based device.
abstract: The non-invasive vulvar Paget's disease is an intra-epidermal carcinoma with glandular characteristics. It appears like an erythematous plaque. The main symptoms are pruritus and pain. The standard treatment is surgical excision in depth. This treatment is complicated with a severe morbidity and photodynamic therapy can be an alternative choice. However, the pain experienced during the photodynamic treatment of vulvar lesion is intense and leads to a premature interruption of the treatment. The light emitting fabric is a part of a device under clinical evaluation for the treatment of actinic keratosis with photodynamic therapy. We report the observation of a vulvar Paget's disease treated by this device with a satisfactory result and an excellent tolerance.
  
  
  
  The patient has been diagnosed with non-invasive vulvar Paget's disease for 25 years. The disease recurred constantly despite several imiquimod applications, LASER treatments and conventional photodynamic therapy. These procedures were complicated with intense pain. To improve the tolerance, we performed three PDT sessions a month apart using a 16% methyl-aminolevulinate cream (Metvixia® Galderma, Lausanne, Switzerland) with the light emitting fabric at low irradiance (irradiance = 6 mW/cm2-fluence = 37 J/cm2) with a satisfactory result and an excellent tolerance.
  
  
  
  There are no controlled trials evaluating the efficacy of photodynamic therapy in the treatment of vulvar Paget's disease. The treatment and follow-up protocols in the literature are heterogeneous. Pain is the most common side effect with greater intensity for perineal locations where photodynamic therapy is impractical outside of anesthesia or hypnosis.
  
  
  
  We report the case of a multirecidivant non-invasive vulvar Paget's disease treated with a satisfactory result and an excellent tolerance by the new light emitting fabric device. A specific study is required but the light emitting fabric could be indicated for the treatment of Paget disease of perineal location. Lasers Surg. Med. 49:177-180, 2017. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Clinic of Dermatology, Lille University Hospital, Lille, France.|ONCO-THAI, INSERM U1189, Lille, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Vicentini
authors.affiliation: Clinic of Dermatology, Lille University Hospital, Lille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Carpentier
authors.affiliation: ONCO-THAI, INSERM U1189, Lille, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Lecomte
authors.affiliation: ONCO-THAI, INSERM U1189, Lille, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Thecua
authors.affiliation: Clinic of Dermatology, Lille University Hospital, Lille, France.|ONCO-THAI, INSERM U1189, Lille, France.|Lille University, Lille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mortier
authors.affiliation: ONCO-THAI, INSERM U1189, Lille, France.|Lille University, Lille, France.
authors.forename: Serge R
authors.initials: SR
authors.lastname: Mordon
mesh_terms: D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008875:Middle Aged; D010145:Paget Disease, Extramammary / Q000188:drug therapy* / Q000473:pathology; D010778:Photochemotherapy / Q000295:instrumentation*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D014846:Vulvar Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid
keywords: light emitting fabric; photodynamic therapy; vulvar Paget's disease