PhotoDynamic Therapy™ (PDT)
What is PhotoDynamic Therapy™?
PhotoDynamic Therapy™ (PDT) is a special treatment performed with a topical photosensitizing agent called Levulan® Kerastick® (5-aminolevulinic acid or ALA) that is activated with the correct wavelength of light. This is also known as “ALA/PDT treatment”. These treatments remove sun damaged pre-cancerous zones and pre-cancerous lesions called actinic keratoses. Sun damage, fine lines, and blotchy pigmentation are also improved because of the positive effect of Levulan® and the light treatment. ALA/PDT treatment also has the unique ability to minimize pores, reduce oil glands, and kill bacteria, effectively treating stubborn acne vulgaris, acne rosacea, and improving the appearance of some acne scars. No oral medications are required.
Levulan® is a naturally occurring photosensitizing compound. It has been approved by the FDA to treat pre-cancerous skin lesions called actinic keratosis, as well as for the treatment of moderate inflammatory acne vulgaris. When activated by Intense Pulse Light (IPL), cosmetic results are more dramatic. Levulan® is applied to the skin and subsequently “activated” by specific wavelengths of light. This process of activating Levulan® is to improve the appearance of and reduce acne rosacea, acne vulgaris, sebaceous hyperplasia, brown sun spots, decrease oiliness of the skin, and improve texture and smoothness by minimizing pore size. Any pre-cancerous lesions are simultaneously treated. The improvements of these skin conditions (other than actinic keratoses and acne vulgaris) are considered an “off label” use of Levulan®. The activation with IPL is also off label, but gives a better cosmetic result.
How is the procedure performed?
The skin is cleaned and prepped with microdermabrasion and acetone. The Levulan is then applied, and the patient rests for about one hour to allow for the chemical to penetrate. The Levulan is washed off and then activated with the Intense Pulse Light.
Is it painful?
Most patients complain of mild burning or stinging, and a sensation similar to rubber bands snapping against the face. If needed topical anesthestic cream can be applied to minimize discomfort.
How much improvement can I expect?
Patients with severely sun damaged skin manifested by actinic keratoses, texture, and tone changes, including mottled pigmentation and skin laxity, may see excellent results with 75%-90% of cases being placed in remission. You may also see improvement of large pores and pitted acne scars. Active acne can improve dramatically, and topical treatment can help maintain these effects.
How many treatments will it take to the see the best results?
To achieve maximum improvement of pre-cancerous (actinic keratoses) sun damage, skin tone, texture, and acne, a series of three treatments 2 – 4 weeks apart is the most effective. Some patients with only actinic keratoses are happy with just one treatment. More treatments can be done at periodic intervals in the future to maintain the rejuvenated appearance of the skin. Acne patients generally require 1-2 treatments per year.
What are the disadvantages?
Following PDT™, the treated areas can appear red with some peeling for 2 – 7 days. Some patients have an exuberant response to PDT™ and experience marked redness of their skin. Temporary swelling of the lips and around your eyes can occur for a few days. Darker pigmented patches, called liver spots, can become temporarily darker and then peel off, leaving normal skin. This usually occurs over 7 – 10 days. These side effects are rare, and most patients experience little to no downtime. Repeat treatments may be necessary. Sun must be avoided for 48 hours, and sunscreen with zinc oxide and a hat must be worn during the healing process.