Who is a candidate?

Anyone with sun damaged skin, actinic keratoses (pre-skin cancers), acne, inflammatory rosacea, hidradenitis suppurativa, and other less common conditions who understand what to expect is a good candidate

If you are pregnant or have been on Accutane within the past 6 months, you will have to wait to have this treatment until you are no longer pregnant or it has been at least six months since your last does of Accutane.

If you are taking aspirin or blood thinners, you may experience some bruising that can take up to two weeks to resolve.  If you are tanned or have recently been exposed to the sun in the area you are having treated, you may be more susceptible to potential side effects such as blisters or crusts and/or your treatments may need to be reduced in intensity or postponed until the tan fades.

What is Photodynamic Therapy like?

You will arrive 30-60 minutes before your treatment and your skin will be thoroughly cleansed.  Then the Levulan will be applied.  It is a clear solution in an applicator stick with a foam end and it is sponged onto your skin.  You will be asked to sit in our cosmetic locker room for 30-60 minutes while the solution is absorbed into your skin.  Feel free to bring along work or a book.  It will then be washed off thoroughly and you will receive your laser or light treatment.  If the light is used, the light is a blue light that you will sit under for approximately 10 minutes.  If the laser is used, a cool gel will be applied to the skin and then the laser will be applied to the skin, which feels much like a rubber band snap which most people find tolerable.  We well then apply sun block to the affected area.  You should avoid sunlight COMPLETELY for 48 hours.  If you have to drive, you should bring a hat and lower your visor.  If you are a passenger, you should turn the affected area away from the windows or cover completely.  The photosensitization persists for 2 days even though the solution has been removed.

How does Photodynamic Therapy work ?

The photosensitizing solution, made up of a normal human protein found in a small amount in our cells, is absorbed much more by abnormal cells and oil glands than by other skin cells.  These cells metabolize the Levulan into another normal human protein proporhyrin IX (PPIX).  When the affected area is illuminated with blue or visible light, the PPIX absorbs most of the light.  This yields chemicals in the cell that damage the cell.  Hence, we can selectively target the cells we want to damage or destroy, leaving the others surrounding it intact and without harm.  This will actually kill off pre-cancerous or sun damaged cells as well as reduce oil gland cell number, reducing the side of the glands.

What type of equipment is used?

We use only Levulan Kerastick, manufactured by DUSA Pharmaceuticals and sold directly to us.  For our light sources, we use the Aurora SR/SRA (ELOS device), manufactured by Syneron Corp, the Coolglide Xeo (intense pulsed light), manufactured by Cutera, and the Blu-U blue light source, manufactured by DUSA.  These are high-technology pieces of equipment that may be utilized only by appropriately trained medical personnel.

What desired results can be expected?

Actinic Keratoses usually require 1-2 treatments, one month apart.  There is a >80% response rate in the medical literature as well as in our experience.  Any spots that didn’t respond will require re-treatment, treatment with another modality, or biopsy.  Actinic keratoses represent “field cancerization.”  This means that all of the area may be affected and not just where the lesions are.  Thus we will treat the entire area and not just the spots.  This may result in prevention of skin cancer in the treated area.  Typically one treatment a year may be necessary for maintenance.

Acne usually requires three treatments, two to three weeks apart.  This should result in 70% reduction (average improvement) three months after the last treatment.  Occasionally there are resistant cases that need more treatments.  Single maintenance treatments will probably be necessary two to four times a year.

Treatments for hidradenitis suppurativa usually require monthly treatment until controlled and variable maintenance treatments.

Are there any negatives?

If you do not have multiple actinic keratoses, this treatment will not be covered by your insurance. 

It is inconvenient to have to avoid sunlight and other intense light sources completely for 48 hours.  The majority of people will have mild redness and minimal discomfort but about 5% will experience “sunburn” like reaction in which they are uncomfortable for 24 hours and the skin looks red and peeled for 2-3 days.  <1% experience a very severe reaction resulting in redness and peeling for 1 week and very rarely longer.  Complete healing does take place even in these cases and no scarring has been reported.  Avoidance of this reaction can be greatly enhanced by COMPLETELY AVOIDING ANY SUNLIGHT FOR 48 HOURS.  If any exposure is necessary, covering up with scarves, hats, and thickly applying zinc oxide to the treated area is advised.

In addition to peeling and redness, other side effects although uncommon are also possible.  Bruising is also uncommon, although the risk increases if you take aspirin or are on blood thinners.  Bruises are temporary and resolve within 1-2 weeks.

Uncommonly, a skin wound such as superficial blisters and scabs can occur, which heal within 2 to 14 days.  Use of antibiotic ointment on a regular basis usually results in uneventful healing.  There is a <0.5% possibility of a skin wound leaving behind a permanent scar.  It is also rare for an infection to occur since the skin is usually not broken.

Another risk is a possibility of hypo (too little) or hyper (too much) pigmentation that is very uncommon.  Usually treatable with prescription creams, chemical peels, or further laser treatments, there is a <1% possibility that the pigmentation could be permanent. There is an increased risk of this on tanned or naturally dark skin.  You may need extra treatments than those required by others if your skin is dark in order for use to be more conservative (gentler with initial and subsequent treatments) due to this increased risk.  It is also important that you let any tanning lotions fade and do not seek artificial tanning treatments for 3-4 weeks prior to the procedure.

What happens after Photodynamic Therapy?

Pure zinc oxide should be applied to the treated area or it should be covered with clothes, hats, or scarves for 48 hours.  Do not expose the area to sunlight even briefly during this time.  You may experience slight redness and/or peeling.  You may resume your normal skin care after the peeling stops or immediately if there is no peeling.  Make up may be applied immediately after your treatment.  Normal skincare can be resumed after 24 hours unless otherwise directed by your provider.

Is there another way to get the same effect?

Alternative treatments for actinic keratoses include topical creams that kill precancerous cells, liquid nitrogen treatments, and surgical removal.

Alternative treatments for acne include oral and topical antibiotics and retinoids, isotretinoin (Accutane), other lasers, and chemical peels.

Photodamage may be treated with photorejuvenation without Levulan, Fraxel® Laser Treatment, laser resurfacing, chemical peels, and topical prescription or cosmeceutical creams.

How is this different than other procedures?

Photodynamic Therapy (PDT) for actinic keratoses (AKs) is different from topical therapies in that it is done here in the office as opposed to by you at home.  Also it usually results in less time that you appear red and scaly from the treatment.  For PDT it is usually at most a couple of days, whereas for topical therapies it can be done in 3-6 weeks.  By the medical literature, they are equally effective, giving 80-90% improvement.  Freezing AKs is fast and effective.  We do it at your visit, it is somewhat uncomfortable but only for a few minutes and you do not have to mess with creams or come in for a procedure.  However, it can leave behind white scars that are permanent.  Also, if you have a lot of AKs, it is more appropriate to choose a treatment that will not only treat what you have but any abnormal cells that may not be visible.

For acne, you may be able to avoid using topical and/or oral therapies.  Also, you may be able to have PDT and not need Accutane, which is a drug with many potential side effects.

For hidradenitis suppurativa, it works better than most other therapies.  It also allows you to avoid having to have swollen areas lanced which leaves scars and is uncomfortable.

Can this be combined with other treatments?

Photodynamic Therapy may be combined with traditional photorejuvenation, chemical peels, SonoPeels, and other therapies dependent upon which condition is being treated.

What is the cost of Photodynamic Therapy?

In some cases, such as for the treatment of actinic keratoses, we may be able to submit treatment to your insurance if we are contracted with them.  Treatments for conditions such as acne, rosacea, and sun damage are at this time not covered by insurance.  Please schedule an office visit where your provider will evaluate a treatment plan specific for your skincare goals.