Stender I-M, Borgbjerg F Molke, Villumsen J, Lock-Andersen J, Wulf H-C
Department of Dermatology, H:S Copenhagen University, Copenhagen, Denmark.
Photodermatol Photoimmunol Photomed. 2006 Dec;22(6):304-9. doi: 10.1111/j.1600-0781.2006.00259.x.
Photodynamic therapy with topical 5-aminolevulinic acid (ALA), followed by irradiation with red light (ALA-PDT), is used for non-melanoma skin cancer and other dermatological diseases. Pain during and after light exposure is a well-known adverse advent that may be a limiting factor for treatment, particularly, in viral warts.
To assess the pain induced by ALA-PDT, we asked 45 patients enrolled in a randomized, placebo-controlled trial with six consecutive ALA- and placebo-PDT treatments for recalcitrant foot and hand warts to fill in questionnaires about pain immediately and 24 h after each treatment.
Immediately and 24 h after each of the six treatments, pain intensity was significantly higher in warts treated with ALA-PDT than in warts treated with placebo-PDT (P<0.028). Severe or unbearable pain was reported from a median of 17% (6-31%) of the ALA -treated warts and from a median of 2% (0-15%) from the placebo-treated warts immediately after the treatments. With increasing treatments, no significant change in pain intensity was observed and no significant relation was found between the pain intensity and the relative change in wart area. The pain was primarily characterized as burning and shooting. The pain lasted about 30 h (range: 1-96 h).
We conclude that pain induced by ALA-PDT is of such intensity in about one-fifth of the warts that pain relief is indicated.
外用5-氨基酮戊酸（ALA）光动力疗法，随后用红光照射（ALA-PDT），用于治疗非黑素瘤皮肤癌和其他皮肤病。光照期间及之后的疼痛是一种众所周知的不良反应，可能是治疗的限制因素，尤其是在治疗病毒性疣时。
为评估ALA-PDT引起的疼痛，我们让45名参加了一项随机、安慰剂对照试验的患者填写问卷，该试验对顽固性手足疣进行连续6次ALA-PDT和安慰剂-PDT治疗，询问每次治疗后即刻及24小时的疼痛情况。
在6次治疗中的每次治疗后即刻及24小时，ALA-PDT治疗的疣体疼痛强度显著高于安慰剂-PDT治疗的疣体（P<0.028）。治疗后即刻，ALA治疗的疣体中，中位数为17%（6%-31%）报告有严重或无法忍受的疼痛，安慰剂治疗的疣体中这一比例中位数为2%（范围0%-15%）。随着治疗次数增加，未观察到疼痛强度有显著变化，且疼痛强度与疣体面积的相对变化之间未发现显著关联。疼痛主要表现为灼痛和刺痛。疼痛持续约30小时（范围：1-96小时）。
我们得出结论，ALA-PDT引起的疼痛在约五分之一的疣体中强度较大，表明需要缓解疼痛。
