Our objective was to determine the feasibility of selective photosensitization of vulvar condylomata using topical application of 5-aminolevulinic acid (ALA). In vivo fluorescence was assessed and biopsies of condylomata were taken for fluorescence microscopy in 24 patients at different time points after application of 2.5% ALA-ointment or 20% ALA-cream. Both in vivo fluorescence imaging and fluorescence microscopy showed selective fluorescence of condylomata of the labia minora and vestibule only within short time intervals. In non-hair-bearing skin, lesional fluorescence remained highly selective. Fluorescence microscopy showed that peak selectivity in epithelial lesional fluorescence was significantly higher using 2.5% ALA-ointment than it was using the 20% cream. Selective fluorescence of vulvar condylomata acuminata can be induced by non-selective topical ALA application. Studies evaluating selective photodynamic destruction of condylomata are justified.
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