Work

Combined cryotherapy and photodynamic therapy for recurrent generalized giant plantar warts: A case report

Year: 2025

Type: article

Abstract: • The use of combining cryotherapy with Photodynamic Therapy enhances photosensitizer absorption by disrupting the hyperkeratotic surface, not only improving treatment outcomes and reducing relapse rates,but also minimizing scar formation and the risk of infection. • The new combination treatment is a highly effective and reliable strategy in recalcitrant plantar warts. • It is noteworthy that surgical excision is not recommended for extensive HPV-related plantar warts, as it may promote recurrence. Plantar warts, caused by human papillomavirus(HPV),often present therapeutic challenges due to high recurrence rates and deep tissue infiltration. Traditional modalities like cryotherapy, CO 2 laser, and surgery show limited efficacy for large or recurrent lesions. To evaluate the clinical efficacy of cryotherapy combined with photodynamic therapy (PDT) and immunomodulatory agents in treating refractory giant plantar warts. A 25-year-old male with a 3-year history of recurrent, painful giant plantar warts (largest lesion: 3.5×5.5 cm) underwent a multimodal regimen: (1) Liquid nitrogen cryotherapy (3 cycles, 30–40 seconds per cycle); (2) 20 % 5-aminolevulinic acid (ALA)-mediated PDT (635 nm wavelength, 100 J/cm², 20 min irradiation, weekly for 5 sessions); (3) Systemic immunomodulation (thymosin enteric-coated tablets, 20 mg tid; BCG polysaccharide nucleic acid injections, 0.1 mg biweekly) and topical recombinant human interferon alpha-2b gel. After 5 PDT sessions, complete resolution of warts was observed, with residual surgical scars.Significant improvement occurred after the third session, with near-complete epithelialization by the fifth session. No recurrence from prior treatments was noted during 2-year follow up visit. Pain resolved, and mobility fully recovered. Our case demonstrates that multimodal therapy combining liquid nitrogen cryotherapy with photodynamic therapy (PDT) achieves complete and durable clearance of extensive, hyperkeratotic plantar warts, with no recurrence observed over a two-year follow-up.The combination of cryotherapy, PDT, and immunomodulation demonstrates superior efficacy for recalcitrant giant plantar warts compared to conventional therapies. This approach minimizes recurrence, reduces scarring, and enhances tissue repair, offering a promising first-line strategy for complex cases.

Source: Photodiagnosis and Photodynamic Therapy

DOI: 10.1016/j.pdpdt.2025.104762

Authors: Qinghu Zheng, Jie Yu, Xianpeng Lun, Weiyao Wang, Zhenxiang Chen

Institution: The 988th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army

Language: English

Topic: Photodynamic Therapy Research Studies

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,610