To investigate the feasibility and efficacy of combination of imiquimod immunotherapy and 5-
aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) for the treatment of genital bowenoid papulosis
(BP). A total of twenty seven BP patients were randomized into two groups: (I) fifteen
patients (12 male and 3 female, age 22-56 years old) were treated with topical application of 5% imiquimod cream
(three times a week) and ALA-PDT (100 J/cm2 at 100 mW/cm2, once a week) for 1-4 times in one week interval.
(II) Twelve patients (6 male and 6 female, age 29-58 years old) were treated with CO2 laser vaporization as a control.
Patients were followed up for 3 to 12 months. Results: In combined therapy group, 60% (9/15) patients showed
complete remission and only one recurred (11.1%) during follow up. Local side effects included mild erythema,
edema, erosion and burning and/or stinging sensation. No systemic side effect was found. In CO2 laser vaporization
group, 83.3% (10/12) patients showed complete remission. However, recurrence occurred in 6 patients (60.0%).
Local side effects included mild to moderate edema, erosion, ulceration, delayed healing, prolonged pain and
scarring. The difference of recurrence rate between two groups was statistically significant (P < 0.05).
Topical application of imiquimod cream and ALA-PDT is safe, effective and associated with low recurrence and less
side effect. Its true clinical value needs to be further investigated by a long-term follow-up of large scale trial.