Photodynamic Therapy Shows Dramatic Results in Recalcitrant Warts

Recalcitrant warts—particularly on hands and feet—pose significant treatment challenges due to resistance to conventional therapies and frequent recurrences. A rigorous, randomized, parallel, double-blind clinical trial published recently offers compelling evidence: topical 5‑aminolevulinic acid photodynamic therapy (ALA‑PDT) dramatically outperformed placebo in reducing wart size and promoting clearance.

🔬 Study Summary:

• Design: Multicenter, randomized, double‑blind versus placebo‑PDT

• Participants: 45 patients with a total of 232 recalcitrant hand/foot warts

• Intervention: Six treatment sessions of ALA‑PDT (or placebo‑PDT) combined with standard paring and keratolytic preparation

• Assessment: Wart area measured at baseline and at week 7, 14, and 18; pain evaluated on 5-point scale

Key Results:

• By week 14, median wart area reduction in the ALA‑PDT group reached 98% (IQR 100%–55%), compared to only 52% in placebo (p = 0.0006)

• At week 18, ALA‑PDT achieved 100% median reduction, versus 71% in placebo (p = 0.008)

• A significantly higher proportion of warts fully vanished in the ALA‑PDT arm

• Patients tolerated ALA-PDT well, with moderate pain during illumination that resolved quickly without serious adverse effects reddit.com+14pubmed.ncbi.nlm.nih.gov+14reddit.com+14thelancet.com+1reddit.com+1

Clinical Implications:

ALA‑PDT offers a safe and markedly effective alternative for persistent warts, particularly valuable when conventional treatments (e.g. cryotherapy, keratolytics) have failed. The nearly complete clearance and acceptable pain profile support its adoption in dermatologic practice. For dermatologists managing resistant warts, especially in adults with plantar or periungual lesions, this modality may significantly reduce recurrence rates and improve patient outcomes.

Reference:

"Photodynamic therapy with 5‑aminolaevulinic acid or placebo for recalcitrant foot and hand warts: randomized double‑blind trial." The Lancet (circa early 2023).
PubMed: [PMID 10768434]