Now is the time for Photodynamic therapy.
Photodynamic therapy ( PDT ) is a very effective treatment for pre-cancerous lesions (actinic keratosis) which if left untreated can turn into skin cancer (squamous cell carcinoma). The procedure is done in office, the patient’s skin is cleaned and prepped with acetone or alcohol and then a topical photo sensitizer called Levulan (aminolevulinic acid) is painted on the face. ALA is a natural substance found throughout the body and when it is applied to the face it is not uncomfortable for the patient. The ALA is left on the skin to incubate for up to two hours. The skin is then cleaned and the patient is placed under a blue light for about 17 minutes. The ALA is activated by this blue light to essentially destroy any atypical cells.
Photodynamic therapy (blue light) is also a great treatment for acne, acne-rosacea and patients with sebaceous gland hyperplasia. PDT has been shown to kill the p.acnes which is the bacteria that causes acne and shrink the sebaceous glands. Adding the levulan increases overall efficacy. Most patients notice an improvement in skin texture, pore size, reduced pigmentation from sun damage and fewer fine lines.
Who is NOT a candidate for ALA-PDT?:
- Pregnant or breastfeeding women.
- If you have been on isotretinoin within 3 months If you have an active cold sore If you have an open sore or active infection on the area to be treated.
- If you have a pacemaker or internal defibrillator If you are tanned or have recently been exposed to the sun in the area to be treated.
How many treatments are necessary?
- When treating sun damaged skin. Current recommendations suggest 1 to 2 treatments. Depending on the severity your provider may recommend more treatment spaced at least 5 weeks apart and may propose a plan to use other forms of treatment in combination with the PDT-ALA.
- Acne and acne-rosacea are chronic conditions and therefore will require maintenance treatments. Blue light treatment without levulin done once weekly for a certain amount of time (usually 5 to 6 subsequent treatments) in combination with the regimen given to you by the provider can drastically reduce acne.
What should the patient expect during the treatment?
- Expect to be in the office for up to 2 and half hours at most. Bring reading material or anything to keep you busy! You will be required to stay in a specific room as you cannot be exposed to any sunlight or other light during this time.
- While the levulan is applied and incubating the skin will feel tight but no discomfort.
- While under the blue light your skin will feel hot and may burn or sting. We will provide you with a fan and do whatever it takes to keep you comfortable.
What to expect post treatment with PDT-ALA:
- Burning, itching and stinging are common side effects and generally last up to 24 hours after treatment and then subside.
- Redness and swelling may occur for up to 4 weeks Peeling and crusting may occur especially in areas where there are atypical (precancerous cells) Uncommon side effect include: blistering, fluid under the skin or open sores. If this occurs notify the provider immediately.
- The patient will be sent home a gentle cleanser and topical moisturizer and SUNSCREEN. It is very important that the patient avoids direct sun exposure for up to two weeks post treatment.
- When it comes to treating actinic keratosis there are lesion directed treatments such as cryotherapy and field directed treatments such as PDT-ALA versus topical agents. Field directed treatments are always a more attractive option for me as they address both the clinical and subclinical lesions. In other words, field treatment will treat the precancerous lesions that are visible to the human eye as well as those that may not be. Often times a provider may recommend a protocol combining both treatment modalities for patients with severe sun damage and multiple AK’s. Most importantly it is an in office treatment so efficacy is much higher when compared to other field treatments that patients have to do at home. Patient compliance becomes a major concern when treating with patient-administered therapy. PDT-ALA will also give the patient a better cosmetic result when compared to other treatment options.
- The blue light alone without levulin is great for acne. In my experience having the patient come in to the office once or every two weeks when starting a acne regimen will drastically help improve the patients acne. I have also seen that it helps the patient efficacy of their at home regimen. It is an excellent option for maintenance therapy when combined with facials alternating with peels.
Noel Ferrer PA-C