Observation On Clinical Efficacy Of Combined Therapy Of ALA-PDT,CO₂ Laser And 5% Imiquimod Cream On Condylomata Acuminataon

Background and ObjectiveCondyloma acuminatum?condyloma acuminatum CA?is a sexually transmitted disease with high incidence in recent years?STD?,due to infection of human papilloma virus?HPV?that cause the corresponding part of mucocutaneous lesions,which is more common in genitalia and anus,and leads to the formation of cauliflower or papilloma hyperplasia neoplasm.The disease has the characteristics of strong infectivity,rapid proliferation,easy to relapse after treatment,which is reported that the recurrence rate can be as high as 30%.In recent years,the incidence of this disease has been increasing year by year in both China and abroad,and most of the patients are 18³5 years old.The disease is mainly transmitted through sexual contact,and can also be transmitted vertically and transmitted through indirect objects.There are a variety of clinical methods for the treatment of this disease at present,such as freezing,laser,electrocautery,topical drugs,although these methods can remove warts,but can not remove the HPV latent infection and type of subclinical infection,so easy to relapse after treatment.Photodynamic therapy?photodynamic therapy,PDT?,which is also called Ella?acid photodynamic therapy photodynamic therapy,ALA-PDT?,is based on photosensitizer 5-aminolevulinic,at certain wavelengths of red light,photodynamic reactions destroy cells infected by the HPV virus and cause lesions to fall apart,while adjacent normal tissue is unaffected.PDT treatment of CA can not only remove warts,but also reduce the recurrence rate,and high safety,but it needs for multiple treatment that can eliminate warts.As well as limited irradiation,ALA penetration of topical ALA-PDT is limited and the penetration depth is less than 2mm in the skin tissue.Carbon dioxide?CO₂?laser,as a routine physical therapy for CA,has the characteristics of rapid removal of warts from the naked eye.But there is no therapeutic effect on the surrounding latent infection area,and can not effectively reduce the recurrence rate.Imiquimod is an immunomodulatory agent that induces a variety of immune related cytokines and stimulates the body's natural and acquired immune responses by modulating the immune response.Based on the above research background,we can combine the treatment of CA CO₂ laser to remove visible warts,increase its penetration,while application of imiquimod enhances immune responses to the virus,may effectively improve the problem of CA cure rate and recurrence rate,and relieve the pain of patients.Therefore,we can employ photodynamic three phase therapy,in the first stage,using CO₂ laser to remove dominant warts,the second stage uses ALA-PDT,and the third stage uses imiquimod.To investigate the cure rate,efficacy,recurrence rate and safety of photodynamic therapy combined with CO₂ laser and Imiquimod Cream in the treatment of CA.In accordance with the requirements of patients with condyloma acuminatum,according to the principle of randomization,divided into two groups,60 cases in each group,a total of 120 cases.The observation group was treated with three stage photodynamic therapy,and the CO₂ laser was combined with photodynamic therapy for 3 times,then continued to be used for external use of Imiquimod Cream.PDT group received photodynamic therapy 3 times.In order to provide a reasonable basis and guidance for the clinical treatment of condyloma acuminata,we compared to the two kinds of treatment methods,such as the removal rate,verrucous body clearance,curative rate of latent infection site,the recurrence rate and the adverse reaction rate.MethodsFrom November 2014 to October 2016,120 patients with CA were admitted to the Department of Dermatology of the department of dermatology of the Second Affiliated Hospital of Zhengzhou University.All are eligible for diagnosis,inclusion and exclusion criteria,that randomly divided into observation groups and control groups.The observation group?60 cases?,verrucous body by CO₂ laser;then using 20%ALA,application range of 2cm diameter,external polyethylene film tape fixed packet.After 3 h,red light was used,and the light energy density was 80 120J/ cm2.7¹0d repeated treatment 1 times,a total of 3 times,then continue to use Imiquimod Cream,3 times a week,used for 8 weeks.The control group?60 cases?was treated with ALA-PDT only 3 times,the same as the observation group.The curative effect was evaluated and the adverse reactions were observed 1 weeks after each treatment.After the end of the last treatment,the cases of complete removal of warts were included in the recurrence statistics,and the recurrence was followed up at first,4,8,12 and 24 weeks.Results1.The observed group had a higher clearance rate than the control group,the difference between the 2 groups was statistically significant?P<0.05?.2.The number of warts in the observation group was 93,and that in the control group was 79.After the last treatment,the rate of verrucous body clearance in the observation group was higher than that in the control group,and the difference was statistically significant between the two groups?P<0.05?.3.The curative rate of latent infection site in observation group was higher than that in control group,the difference between two groups was statistically significant?P<0.05?.4.After half a year follow-up,the recurrence rate of the observation group was lower than that of the control group,and the difference between the two groups was statistically significant?P<0.05?.5.The correlation between the recurrence of the two groups and the follow-up time was analyzed.The results of the two groups were not statistically significant?P>0.05?.6.There were no statistically significant differences in the rates of adverse reactions between the two groups?P>0.05?.Conclusion1.Compared with the control group,single photodynamic therapy,the observation group with photodynamic therapy in the treatment of CA,and can significantly improve the cure rate,wart removal,latent infection site the cure rate and reduce the recurrence rate of CA,better than the control group,and the safety and tolerability of relatively safe.2.Compared with the control group,the observation group was more complicated than the control group in the course of treatment,and the incidence of adverse reactions was higher,but the patients were tolerant and relieved within 1 to 5d,without affecting the treatment.