Evaluation of Chlorophyllin – IPL Mediated Photodynamic Therapy in Treatment of Periungual and Subungual Warts

Abstract Background Periungual and subungual warts are warts that develop around the nail plate in the form of epithelial thickening and fissures that cause pain and may extend below the nail plate and affect the nail matrix and cause permanent nail deformity. They are caused by human papilloma virus. Frequent nail trauma as in nail biters and immune suppression are the main predisposing factors. Treatment of periungual and subungual warts presents a great challenge due to their site and high risk of recurrence. Many treatment methods have been tried as physical destruction by cryocautery, electro cautery and lasers, chemical destruction by salicylic acid, Antimitotics as bleomycin and 5-fluorouracil, Retinoids and immune therapy as intralesional candida antigen, vitamin D derivatives and zinc. However, these methods may be difficult to apply in periungual warts and also may cause severe destruction of the nail. Photodynamic therapy is a promising, effective, easy and safe line of treatment for warts. It works through interaction between the photosensitizer, light source and oxygen causing cell damage and apoptosis of the infected cells. There are several photosensitizers used in photodynamic therapy like ALA, MAL and methylene blue. Chlorophyllin is a novel photosensitizer that have been experimented in PDT in dermatological and in non-dermatological fields and showed promising results. Aim The aim of this study is to assess the efficacy and safety of chlorophylline-IPL mediated PDT in periungual and subungual warts. Patients and Methods This is a randomized controlled clinical trial. Sixty patients with periungual and subungual warts were recruited, examined and evaluated at dermatology outpatient clinic of Dermatology, Venereology and Andrology Department, Ain Shams University Hospitals. They were divided into two groups: Methylene blue group (30 patients) received MB/IPL/PDT sessions for 5 sessions maximum and chlorophylline group (30 patients) received chlorophyllin/IPL/PDT sessions for 5 sessions maximum. Each pateint was evaluated and photographed clinically and dermoscopically before the start of the study and 2 weeks after the end of sessions and response was assessed by clinical and dermoscopic score (poor, good, very good and excellent according to reduction in size of warts in mm). Pateints were also evaluated for pain and satisfaction at the end of the study. Results In MB group: (44.4%) showed poor response,(14.8%) showed good response,(25.9%) showed very good response and (14.8%) showed excellent response, while in chlorophylline group : (63%) showed poor response,(33.3%) showed good response and (3.7%) showed excellent response. These results denoted statistically significant decrease in size of warts in the two groups, the results were better in the methylene blue group. satisfaction score of patients which was (mean±SD:4.52 ± 1.87) in methylene blue group versus (mean±SD:3.41 ± 1.53) in chlorophyllin group with statistically significant difference showing higher satisfaction in methylene blue group. Conclusion Methylene blue and chlorophylline are effective photosensitizers in photodynamic therapy of periungual and subungual warts. However, Methylene blue is more effective than chlorophylline. Further studies for chlorophyllin are needed.