Combined cryotherapy and photodynamic therapy for recurrent generalized giant plantar warts: A case report

Abstract

Background

Plantar warts, caused by human papillomavirus(HPV),often present therapeutic challenges due to high recurrence rates and deep tissue infiltration. Traditional modalities like cryotherapy, CO₂ laser, and surgery show limited efficacy for large or recurrent lesions.

Objective

To evaluate the clinical efficacy of cryotherapy combined with photodynamic therapy (PDT) and immunomodulatory agents in treating refractory giant plantar warts.

Methods

A 25-year-old male with a 3-year history of recurrent, painful giant plantar warts (largest lesion: 3.5×5.5 cm) underwent a multimodal regimen: (1) Liquid nitrogen cryotherapy (3 cycles, 30–40 seconds per cycle); (2) 20 % 5-aminolevulinic acid (ALA)-mediated PDT (635 nm wavelength, 100 J/cm², 20 min irradiation, weekly for 5 sessions); (3) Systemic immunomodulation (thymosin enteric-coated tablets, 20 mg tid; BCG polysaccharide nucleic acid injections, 0.1 mg biweekly) and topical recombinant human interferon alpha-2b gel.

Results

After 5 PDT sessions, complete resolution of warts was observed, with residual surgical scars.Significant improvement occurred after the third session, with near-complete epithelialization by the fifth session. No recurrence from prior treatments was noted during 2-year follow up visit. Pain resolved, and mobility fully recovered.

Conclusion

Our case demonstrates that multimodal therapy combining liquid nitrogen cryotherapy with photodynamic therapy (PDT) achieves complete and durable clearance of extensive, hyperkeratotic plantar warts, with no recurrence observed over a two-year follow-up.The combination of cryotherapy, PDT, and immunomodulation demonstrates superior efficacy for recalcitrant giant plantar warts compared to conventional therapies. This approach minimizes recurrence, reduces scarring, and enhances tissue repair, offering a promising first-line strategy for complex cases.