Condyloma Acuminatum of the Tongue Treated with Photodynamic Therapy

To the Editor—A 27-year-old, otherwise healthy female was referred for treatment of a white, exophytic, and verrucous lesion on the left side of the tongue (figure 1A). Personal history revealed heterosexual oral intercourse during past years. The detection of epithelial acanthosis with atypical koilocytosis on histological examination, as well as the finding of human papillomavirus 6 by in situ DNA hybridization, confirmed the diagnosis of condyloma acuminatum. Routine serological testing for other sexually transmitted infections, including human immunodeficiency virus, yielded negative results. A, White verrucous lesion on the left side of the tongue. B, Clinical resolution 1 month after photodynamic treatment with 5-aminolevulinic acid. After obtaining signed, informed consent, a gel containing 16% 5-aminolevulinic acid was applied topically and covered with a polyethylene dressing. After 3 h, the application site was irradiated with 120 mJ/cm2/s of red light at a peak emission of 630 nm delivered using a PTD–CLD 100 device (E.P.E.M. s.r.l. Italia). No significant adverse effects were reported, but the patient noticed an intense sensation of burning during and immediately after light exposure. Follow-up visits occurred 15 days and 1 (figure 1B), 3, 6, and 12 months after treatment; no relapses were registered. Topical photodynamic therapy with 5-aminolevulinic acid has been demonstrated to be an effective and safe treatment for human papillomavirus–induced anogenital lesions, including condylomata acuminata [1, 2]. Such lesions may sometimes be localized on extragenital mucous membranes, including the lingual one [3], but there are no reports on the treatment of these lesions with photodynamic therapy with 5-aminolevulinic acid. We describe here the first case, to our knowledge, of condyloma acuminatum of the tongue ever treated by topical photodynamic therapy with 5-aminolevulinic acid. We suggest that photodynamic therapy with 5-aminolevulinic acid may represent an effective and safe option for the treatment of human papillomavirus–induced lesions affecting extragenital mucous membranes. Potential conflicts of interest. All authors: no conflicts.