| Abstract |
Condylomata acuminata consist the most common sexually transmitted viral disease. A big percentage of the sexually active population is infected by one or more Human Papilloma Virus (HPV) types. However, the number of patients presenting with clinically overt lesions represent only the tip of the iceberg, since most genital tract HPV infections are subclinical or latent. Consequently, clinical examination underestimates the extent of HPV infection, whereas in vitro diagnostic methods are expensive and time consuming. HPV16, 18 and other HPV types have been detected frequently in carcinomas of the cervix, vulva, penis and anus. Although condylomata acuminata represent a great epidemiological problem, there is still no gold-standard therapy, since all treatment modalities have moderate response rates and relatively high recurrence rates. In addition, all therapeutic modalities aim to the destruction of clinically overt disease, since eradication of HPV is impossible. The aim of this study was the in vivo detection and staging of HPV infection of anogenital area by quantitative assessment of the acetic acid-induced temporal and spatial alterations in the light-scattering properties of HPV-infected skin. For this reason an imaging system has been employed, which performs time-lapse imaging and enables the calculation and display of the kinetics of the provoked alterations in any point within the examined area. Lesions of anogenital area with clinical diagnosis of condylomata acuminata were studied. The evaluation of acetic acid-tissue interaction kinetics revealed quantitative parameters, containing information about the magnitude and duration of the provoked alterations. The histology evaluation and polymerase chain reaction performed, showed that the method contains specific diagnostic information, since it enables the differentiation between subclinical lesions, clinical condylomata acuminata and squamous cell carcinomas developing on condylomata. It also allows the exact localization of lesions and delineates their borders. Photodynamic therapy efficacy in condylomata acuminata after topical application of δ-aminolevulinic acid (ALA) was also assessed. ALA-induced protoporphyrin IX (PpIX) fluorescence kinetics were studied, in order to select for PDT suitable lesions that show selective accumulation of PpIX. The optimal time of illumination was determined, so as to improve PDT efficacy by individualizing the procedure. The overall cure rate was 72.9% 12 months after treatment, indicating that ALA-PDT is a potential effective treatment for condylomata acuminata.
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Φωτοδιάγνωση και φωτοδυναμική θεραπεία HPV λοιμώξεων του δέρματος και δερματο βλεννογονίων περιοχών
