Photodynamic therapy using methylene blue and intense pulsed light versus intense pulsed light alone in treatment of verruca: A randomized controlled study
Introduction
Warts are benign epidermal lesions caused by human papillomavirus (HPV) [1]. The National centre for Biotechnology Information (NCBI), nucleotide sequence database currently, listed more than 150 different HPV types [2]. Productive infection and induction of hyperproliferation are initiated when the virus enters proliferating basal epithelial cells [3]. Despite the relative success of papillomaviruses in evading immune responses, up to two-thirds of cutaneous warts spontaneously regress within 2 years [4].
Many therapeutic modalities are available for the treatment of warts, but no single therapy is universally effective. Warts can resolve, recur, shrink, or grow despite therapy [5]. Treatment methods are divided into the categories of home remedies, over-the-counter treatments, and office-based therapies [6]. Photodynamic therapy (PDT) is a treatment modality involving administration of a photosensitizing compound, accumulation of the sensitizer molecules in the target cells followed by selective irradiation of the lesion with visible light [7]. PDT can exert the following mechanisms which are inter-linked: direct cytotoxicity, vascular damage, inflammation, and immune host response [8].
The use of methylene blue (MB) as a photosensitizer (PS) against some viruses has been established before [9]. Also, intense pulsed light (IPL) can be used either alone or with PDT in treating warts since it can selectively destroy the superficial capillaries of the viral papillomas, as well as induce thermal damage to the human papillary virus [10].
Therefore, a combination of both would give an appropriate option for warts treatment, and hence the aim of this study was to assess the efficacy and safety of photodynamic therapy using methylene blue and IPL for the treatment of warts.
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Patients and methods
This prospective randomized controlled trial (ClinicalTrial.gov Identifier NCT04620785) was carried out on eighty patients with clinically and dermoscopically diagnosed verrucae. Patients were recruited from the Outpatient Clinic of Dermatology, Venereology, and Andrology Department, Alexandria Main University Hospital. The study was approved by the local ethical committee in accordance with the declaration of Helsinki 1975. The age was not less than 16 years. Written informed consent was
Results
Eighty patients with clinically and dermoscopically diagnosed verrucae were included in this study. Demographic and clinical characteristics of the studied groups are shown in Table 1 while dermsocopic features of studied verrucae are shown in Table 2.
By week 8, clinical and dermoscopy score 3 was achieved in 43.3% versus 20%, score 2 in 10% versus 3.3%, score 1 in 40% versus 30%, and score 0 in 6.7% versus 46.7% in groups A and B. There was a statistically significant difference between the
Discussion
Treatment for HPV infection is generally unsatisfactory. Most rely on destruction of the affected tissue. Clinically normal skin may harbor viral DNA and, thus, it is unlikely that destroying clinically visible lesions eliminates the virus [15].
PDT can destroy HPV-infected keratinocytes and inactivates non-enveloped viral particles by the possible mechanism of binding PS molecules to the viral surface glycoproteins and inhibiting early phases of viral infection [16].
Methylene blue is a widely
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2022, Photodiagnosis and Photodynamic TherapyCitation Excerpt :Only three studies had a low risk of bias, while twelve studies were identified as having an unclear risk of bias, and four studies were considered to have a high risk of bias. We conducted a meta-analysis of PDT for warts induced by HPV infection, including hand and foot warts [10–19], condyloma acuminatum [20–25] and plane warts [26–28], which were divided into groups. First, in the hand and foot wart group, as shown in Fig. 3, three subgroups were established to examine the wart clearance rate.
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