BI31 Daylight photodynamic therapy as an effective treatment for extensive verrucae vulgares in a renal transplant recipient

Abstract

Verrucae vulgares are benign cutaneous lesions caused by human papillomavirus. They commonly affect immunosuppressed patients, particularly organ transplant recipients, who often present with extensive disease that is refractory to conventional treatment. Photodynamic therapy (PDT) is licensed in the UK for treatment of precancerous skin conditions and superficial nonmelanoma skin cancers. There is a growing body of evidence demonstrating the efficacy of PDT in treating refractory verrucae vulgares (Caucanas M, Gillard P, Vanhooteghem O. Efficiency of photodynamic therapy in the treatment of diffuse facial viral warts in an immunosuppressed patient: towards a gold standard. Case Rep Dermatol 2010; 2: 207–13). A 49-year-old man with skin phototype VI presented with multiple verrucous lesions involving the scalp, neck, chest, shoulders and dorsal hands. His past medical history included type 1 diabetes and a renal transplant in 2013. His medications included tacrolimus 5 mg twice daily and mycophenolate mofetil 500 mg twice a day. Skin biopsy confirmed verruca vulgaris. An initial treatment course with imiquimod 5% for 30 applications had minimal therapeutic effect. Given the limited response to conventional treatment and significant degree of disease burden, off-label treatment with 5-amino­levulinic acid photodynamic therapy (ALA-PDT) was commenced, initially to the scalp and dorsum of both hands. Treatment was well tolerated. Clinical review at 3 months showed complete resolution of warts on the scalp and marked improvement on the hands. In view of this excellent treatment response, a further treatment course to other affected areas was planned. This case demonstrates the clinical efficacy of a single treatment with ALA-PDT in treating extensive verrucae vulgares in a renal transplant recipient. Further studies are warranted to evaluate its efficacy, optimal protocol and long-term safety in the immunocompromised population.