Breaking the Therapeutic Depth Barrier: Single-session Intralesional ALA-PDT versus Topical ALA-PDT Combined with CO2 Laser for Refractory Verruca Vulgaris —A Randomized Controlled Pilot Study

Background: Topical photodynamic therapy (PDT) exhibits suboptimal efficacy in the management of proliferative cutaneous diseases.
Objective: To evaluate the efficacy of single-session intralesional 5-aminolevulinic acid PDT (iALA-PDT) for refractory verruca vulgaris.
Methods: Eligible participants were randomly assigned to the following two groups. iALA-PDT group: 10% ALA saline solution was administered via intralesional injection. tALA-PDT + CO₂ laser group: Superpulsed CO₂ laser was used to ablate the wart before 10% ALA cream applied topically. All lesions were irradiated with a 633-nm LED red light after a 2-hour incubation. The primary outcome measure was the Total Wart Volume Regression Rate at Week 16 post-treatment, whereas the key secondary outcome measure was the Complete Subject Cure Rate.
Results: A total of 40 verruca vulgaris were included. The median Total Wart Volume Regression Rate in the iALA-PDT group was 100%, which was significantly higher than the 41.7% in the tALA-PDT + CO₂ laser group (p < 0.1). The Complete Subject Cure Rate was 55% in the iALA-PDT group, also significantly superior to the 20% in the tALA-PDT + CO₂ laser group (p < 0.1).
Limitations: Pilot study lacking big sample size.
Conclusion: iALA-PDT is an effective therapeutic modality for refractory verruca vulgaris.