Abstract: Objective: To preliminarily investigate the clinical efficacy and safety of blunt dissection combined with 5-ALA-PDT in the treatment of refractory subungual and periungual warts. Methods: A retrospective analysis was conducted on 8 patients with subungual and periungual warts resistant to conventional therapies admitted between March 2021 and May 2023. All patients underwent one session of blunt dissection followed by 1-2 sessions of ALA-PDT. Treatment-related pain was assessed using the Visual Analog Scale (VAS). Patients were followed up for 6 to 12 months to observe lesion clearance, nail plate regeneration, recurrence and adverse reactions. Results: Complete clearance of warts was achieved in all 8 patients with a clinical cure rate of 100%. No recurrence was observed during the follow-up period. All patients had satisfactory nail plate regeneration without nail bed scarring or permanent nail deformity. The pain VAS scores during treatment ranged from 3 to 5, which were tolerable after symptomatic management. Conclusions: Blunt dissection combined with ALA-PDT in the treatment of refractory subungual warts and periungual warts can completely clear the warts, protect the nail unit structure, and effectively reduce the recurrence rate.

Key words: subungual warts, periungual warts, blunt dissection, 5-ALA-PDT