Condyloma acuminatum is one of the common venereal diseases and is mainly transmitted through direct sexual contact. However, a small percentage of patients can be infected indirectly, such as may be related to sanitary utensils or supplies, local use of sexual massage health appliances contaminated by the patient, etc. Warts are caused by human papilloma virus (HPV) infection of the skin mucosa. Chen Fang, Department of Dermatology, Yueqing People’s Hospital
Traditional treatment methods are: 1 local cryotherapy; 2 local carbon dioxide laser treatment (or electrocautery, electrocautery treatment); 3 local topical drug treatment; 4 other adjuvant treatment. Cryotherapy is less expensive (50-100 yuan), and the treatment is superficial, fast healing and less likely to have scarring, but the recurrence rate is greater than 50%. Carbon dioxide laser is much more expensive than cryotherapy ($100-$1,000) and requires local anesthesia. Although topical topical medication can eliminate the need for a hospital visit, it often causes local redness and swelling due to the method of use or improper selection of medication. The cost is high, and the effectiveness of treatment varies greatly from person to person, and some treatments are controversial.
I. Photodynamic therapy principle.
The photosensitizer is input into human body, and after a certain period of time, the lesion is irradiated with specific wavelength of light. Through a series of photochemical and photobiological reactions, monomorphic oxygen and/or free radicals are generated with the participation of molecular oxygen, which oxidize and destroy various biological macromolecules in tissues and cells, causing irreversible damage to the abnormal proliferating active cells, and finally causing cell death to achieve the treatment purpose.
Photodynamic therapy indications.
1. pre-cancerous skin diseases and skin malignant tumors, such as solar keratosis, basal cell carcinoma, squamous carcinoma.
2. Treatment of non-malignant tumor skin diseases, such as: condyloma acuminata, vascular malformation, acne vulgaris.
III. Steps of photodynamic therapy
1. The fresh medicinal solution will be prepared by the medical staff for use in the treatment.
2, fresh solution wet compress the affected area for 3 hours, and according to the specific circumstances of the corresponding local sealing package.
3, red light irradiation lesion local, irradiation time is usually 20 minutes.
Fourth, the adverse effects of photodynamic therapy
The most common adverse reaction is localized pinprick-like pain when illuminated, which can be tolerated by most patients, or will be relieved later on their own, generally without special treatment. Patients should be instructed not to be overly nervous, and for those with obvious pain, topical application of “compound lidocaine cream” may be used or the doctor should be notified for further special treatment.
V. Treatment cost
1, the cost of drugs: aminoglutaric acid hydrochloride (Ala, ALA) each drug more than 700 yuan.
The general area is not very large condyloma acuminata patients, each treatment using 1. The area is large then increase the dosage.
2, the cost of treatment; each 300-400 yuan / spot
The general local light time is 20 minutes
3, usually treated once a week, about half a day; 3 times for a course of treatment.
Six, photodynamic therapy precautions.
1, special parts of the condyloma acuminata (such as warts occurring in the urethra, urethra, vulva around the opening of the glands) can be directly selected photodynamic therapy, good efficacy, less recurrence.
2, after local carbon dioxide laser or freezing treatment, repeated recurrence of patients, local photodynamic therapy is recommended 2-3 times.
3. After conventional traditional treatment, you can choose photodynamic therapy for 2-3 times to consolidate treatment and prevent recurrence.
4, for larger warts, it is recommended to use carbon dioxide laser or freezing methods to remove the large warts, and then choose photodynamic therapy, which can reduce the cost of treatment, but also to shorten the treatment time.
5, any kind of treatment currently can not absolutely prevent the recurrence of condyloma acuminata, generally photodynamic therapy after 3 times, the wart recurrence rate is less than 10%.
The advantages of photodynamic therapy is different from the traditional surgery, radiotherapy and chemotherapy three major means of treatment of tumors, it is selective to the target tissue and the degree of damage, can reduce the damage to normal tissue. Compared with conventional treatments such as surgery, chemotherapy and radiotherapy, photodynamic therapy has the following important advantages
(1) Minimal trauma: With the help of optical fiber, endoscope and other interventional techniques, laser can be guided deep into the body for treatment, avoiding the trauma and pain caused by open-chest and open-abdomen surgery.
(2) Low toxicity: The photosensitive drug entering the tissue will trigger photodynamic reaction and kill tumor cells only when it reaches a certain concentration and is irradiated by sufficient amount of light, which is a local treatment method. The part of human body that is not irradiated by light does not produce such reaction, and the organs and tissues in other parts of human body are not damaged, nor does it affect the hematopoietic function, so the toxic side effects of photodynamic therapy are very low.
(3) Good selectivity: The main target of photodynamic therapy is the lesion tissue in the light irradiated area, and the damage to the normal tissue around the lesion is slight, this selective killing effect is difficult to achieve by many other treatments.
(4) Good applicability: Photodynamic therapy is effective for different cell types of cancer tissues and has a wide range of applicability; while the sensitivity of different cell types of cancer tissues to radiotherapy and chemotherapy can vary greatly and the application is limited.
(5) Repeatable treatment: Cancer cells are not resistant to photosensitive drugs, and patients will not increase toxic reactions due to multiple photodynamic treatments, so treatment can be repeated.
(6) Palliative treatment: For patients with advanced tumors, or tumor patients who cannot receive surgery due to advanced age, cardiopulmonary, hepatic and renal insufficiency, or hemophilia, photodynamic therapy is a palliative treatment that can effectively relieve pain, improve quality of life, and prolong life.
(7) It can cooperate with surgery to improve the efficacy: for some tumors, surgical resection first, followed by photodynamic therapy can further destroy residual cancer cells, reduce the chance of recurrence and improve the thoroughness of surgery; for some other tumors, it is possible to do photodynamic therapy first to shrink the tumor before resection, which can expand the indications for surgery and improve the success rate of surgery.
(8) Eliminate hidden cancer lesions: clinically, some tumors, such as bladder metastatic cell carcinoma, may have scattered microscopic cancer nests invisible to the naked eye outside the main lesion, and conventional treatment can only remove the main lesion, but it can do nothing for the hidden cancer nests.
(9) Protecting appearance and important organ functions: For skin cancer of face, oral cancer, penile cancer, cervical cancer, retinoblastoma, etc., the application of photodynamic therapy may effectively kill cancer tissues while minimizing the damage to epithelial structure and collagen scaffold of the developing organ, so that the appearance will be less affected and the organ shape and normal physiological functions will be kept intact after wound healing.
The application of photodynamic therapy is very promising. In recent years, great progress has been made at home and abroad in the application of photodynamic therapy for the treatment of non-tumor diseases, such as acanthosis, nevus, fundus macular degeneration, rheumatoid arthritis, psoriasis, atherosclerotic plaques, and post-angioplasty restenosis. In particular, the new topical photosensitizer’s – Aminoketovaleric Acid Hydrochloride (Aila, ALA) was marketed and creatively used for the treatment of acromegaly, pushing the photodynamic treatment of acromegaly with Aminoketovaleric Acid Hydrochloride to clinical research for the first time in the international arena. The results of clinical trials showed that ALA-photodynamic therapy for intra-urethral warts had a wart clearance rate of 95% and was well tolerated by patients; for extra-urethral warts, the wart clearance rate was 98.42%. The recurrence rate is only 10.77%. At the same time, the safety is high: no scars, the incidence of adverse reactions is only 7.67%. The experts agree that Ira photodynamic therapy will be the first choice for intra-urethral warts and the first line of treatment for extra-urethral warts.