Introduction:

Periungual warts, caused by human papillomavirus types 1, 2, 4, 27, and 57 are particularly difficult to treat due to their location, leading to pain and nail damage. Standard treatments, such as cryotherapy, are often associated with high recurrence rates and discomfort. Photodynamic therapy, which uses 5-aminolevulinic acid activated by light to target infected cells, has emerged as a promising alternative for treatment-resistant cases.

Objective:

To describe photodynamic therapy as a treatment modality in multiple, resistant palmar warts.

Case reports:

Our 2 cases showed complete remission of periungual warts after photodynamic therapy. One patient with multiple warts achieved remission after three monthly sessions, while another achieved remission after five sessions, with additional pretreatments (5-fluorouracil and fractional carbon dioxide CO₂ formula laser) to enhance effectiveness.

Conclusions:

Photodynamic therapy is well tolerated and cosmetically favorable, though its limitations including high cost and limited availability, suggest it is best reserved for persistent cases. Pretreatments improve aminolevulinic acid absorption and cell targeting, increasing photodynamic therapy efficacy.