Superficial shaving combined with photodynamic therapy for treating verrucous epidermal nevi: A case report

Verrucous epidermal nevi is a refractory skin disease. Photodynamic therapy is considered a third-line treatment for verrucous epidermal nevi due to its unstable efficacy and high recurrence rate, mainly because of its limited depth of penetration. In this case, we conducted a successful treatment using superficial shaving combined with photodynamic therapy to treat verrucous epidermal nevi and gained a satisfactory efficacy. Before photodynamic therapy treatment, the epidermis in situ of each lesion in the tissue is removed with superficial shaving. Removal of the epidermal layer by intentional in situ injury improves the diffusion and absorption of topically applied photosensitizers and enhances the efficacy of photodynamic therapy. Our results show that photodynamic therapy combined with superficial shaving maybe is a safe and effective treatment for verrucous epidermal nevi.

Efficacy of the combination of superficial shaving with photodynamic therapy for recalcitrant periungual warts

BACKGROUND

Periungual warts are a viral infectious disease that occurs in a particular location. It is difficult to eliminate completely, and recurrence is common. Photodynamic therapy (PDT) as an option that has been widely recommended to treat viral warts. However, there are always a few patients with poor efficacy after PDT treatment. We have considered that the reason is the limitation of PDT penetrating deep into tissue. Thus, we combined superficial shaving with PDT to treat recalcitrant periungual warts.

METHODS

Twenty-three patients had a total of 61 periungual wart lesions. All patients had recalcitrant periungual warts that had failed to respond to various treatments that had poor curative effects. After local injection of anesthesia, the lesions were shaved in situ, and PDT was performed immediately. A total of three sessions of PDT were applied for each patient after only one superficial shaving. The overall clinical response rate, recurrence rates, cosmetic outcomes, adverse events, patient satisfaction and quality of life were assessed. The potential risk factors have also been recorded.

RESULTS

We achieved a 96% success rate (defined as more than 50% on clearance) in our 23 patients using combination superficial shaving with PDT after treatment for 3 months. At the 12-month follow-up, 21 patients (91%) had excellent cosmetic outcomes. All patients had satisfactory therapeutic effects and significant improvement in the quality of life. Pain during the illumination process was the main adverse event, but all patients were able to tolerate it. We also found that frequent or continuous hand activity, such as playing Mah-jong, may be a potential risk factor for periungual warts.

CONCLUSION

Our results offer promise for combining superficial shaving with PDT as an effective and safe therapy for patients with periungual warts, especially for those periungual warts that are recurrent, have multiple lesions, and thickness corneum stratum of lesions. For nails that are not suitable for routine surgery, combined superficial shaving with PDT is recommended.