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Incomplete efficacy of 5‐aminolevulinic acid (5 ALA ) photodynamic therapy in the treatment of widespread extramammary P aget's disease
Author(s) -
Al Yousef Abdullah,
Boccara Olivia,
MoyalBarracco Micheline,
Zimmermann Ute,
Saiag Philippe
Publication year - 2011
Publication title -
photodermatology, photoimmunology and photomedicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.736
H-Index - 60
eISSN - 1600-0781
pISSN - 0905-4383
DOI - 10.1111/j.1600-0781.2011.00635.x
Subject(s) - photodynamic therapy , medicine , dermatology , extramammary paget's disease , actinic keratosis , surgery , sex organ , disease , basal cell , chemistry , organic chemistry , biology , genetics
Summary Photodynamic therapy ( PDT ) using 5‐aminolevulinic acid (5‐ ALA ) is an effective treatment for several conditions such as B owen's disease, subsets of basal cell carcinomas and actinic keratosis. Surgical resection is the first‐choice therapy for extramammary P aget's disease ( EMPD ), but extensive resection is highly invasive and recurrences are frequent. We report two cases of genital EMPD treated by PDT with partial efficacy. The first patient, a 78‐year‐old male, suffered from pubic and scrotal P aget's disease for 6 years despite numerous treatments. The second patient, a 78‐year‐old female, had vulvar involvement for 2 years that was resistant to multiple treatments. The disease was recurrent and chronic with important pruritus and significant impact on the quality of life. Methyl 5‐aminolevulinate was applied for 3 h, and irradiation was applied with red light (630 nm) using a total light dose of 37 J/cm 2 for a period of 10 min. The patients were treated every 2 to 4 weeks for a total of at least three treatments. Both patients experienced a partial transient reduction in their symptoms. One patient had a partial transient remission (< 50% reduction of the involved surface), whereas in the other patient, PDT failed to reduce the surface area of the lesions.