5-Aminolevulinic acid-based photodynamic therapy used as a long-term management approach for refractory lichen sclerosus

Objectives To report the long-term clinical response and tolerability of repeated 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) in a patient with refractory male genital lichen sclerosus (LS).Methods A 37-year-old man with a history of genital LS lasting more than 10 years experienced recurrence after surgical resection, which had resulted in permanent anatomical deformity. He received multiple courses of ALA-PDT, including intensive and maintenance treatment, over five years.Results Symptoms and lesions were well controlled after 13 initial ALA-PDT sessions. However, the lesions recurred after ALA-PDT was discontinued and topical halometasone was introduced. The patient subsequently received further courses of ALA-PDT, bringing the total to 41 sessions. Lesions regressed following each treatment course. Adverse effects were mild and tolerable, and no severe adverse events were observed over the five-year period. No recurrence was noted during the one-year follow-up after the final treatment course.Conclusions This case suggests that repeated ALA-PDT may be an effective and well-tolerated option for the long-term management of refractory male genital LS. Therefore, this patient underwent multiple courses of ALA-PDT for a total of 41 sessions With each course of ALA-PDT, the lesions regressed again, and no significant adverse effects were observed over the five-year period. No recurrence was noted during the one-year follow-up after the final treatment course. This case indicated ALA-PDT may be a safe and effective option for the long-term management of male genital LS.