The Ever-Increasing Role of ALA-PDT - Q&A
Q: What kind of medical and/or cosmetic indications have you treated with ALA-PDT, and what type of results did you see?
Dr. Taub: We’ve been using ALA-PDT to treat AKs, acne, rosacea, sebaceous gland hyperplasia and hidradenitis suppurativa on the medical side. For the cosmetic side, we’ve been using ALA-PDT mainly for photorejuvenation, oily skin and pore reduction. Our results have been so beneficial with many of the mainstream dermatologic issues that we often turn to PDT as a first- pt second-line therapy now.
Q: What laser and light sources do you commonly use to activate ALA?
Dr. Taub: We use the Aurora device (ELOS – pulsed light technology with radiofrequency), the Blu-U and ClearLight systems, and the XEO (600 nm to 800 nm) IPL.
Q: Can you share some practical clinical Pearls relative to using ALA-PDT with short-contact and full-face application in your daily practices?
Dr. Taub: The most important thing I’ve learned is how ALA-PDT can really change the face of a dermatology practice. Whether a patient come in with one AK or many, ALA-PDT is the beginning of a “relationship” with that patient that revolves not only around disease treatment, but also “wellness.” Instead of destroying individual lesions with potentially scarring cryotherapy and just waiting for more AKs to occur, we can step in and take control making our patients “look” better in the process of producing healthy skin.
Q: In your experience with ALA-PDT, what kind of patient discomfort or adverse events have you seen?
Dr. Taub: About 95% of our patients have no problem – minimal and tolerable erythema and peeling. The good news is that those who have the most erythema and peeling usually have the best outcomes. About 4% to 5% have about 24 hours of discomfort, characterized as a burning sensation, with pronounced erythema. Our protocol includes NSAIDs, topical emollients and cold packs. With some reassurance, patients are usually okay. And, about 1% of patients have extreme reactions with significant exfoliation and a week of downtime. This group usually includes people who have significant sun damage and who do not comply with the warnings of strict sun avoidance.
Q: What is your rationale for adding ALA-PDT to your photorejuvenation regimen when you’ve been using lasers and light sources successfully for photorejuvenation for the past several years?
Dr. Taub: Adding ALA gives you three things you can’t get without it. It provides a degree of skin clarity that is a whole magnitude greater than that produced by photorejuvenation alone. The skin is bright, it shines and looks newer. Throw away the old concept that you can’t shrink pores, you can only make them look better. PDT does shrink pores. Finally, the ability to rid the skin of precancerous keratinocytes yields the potential of providing a health/wellness benefit that cosmetic procedures usually don’t confer. Look better, shrink pores and prevent skin cancers. It’s a win, win, win.
Q: What has been your experience in treating acne with ALA-PDT treatments?
Dr. Taub: ALA-PDT is the only modality that truly works for severe cystic acne, other than isotretinoin. Although ALA-PDT doesn’t work 100% of the time, it works in a significant number of patients. You can also see a recovery of the integrity of the skin and reductions in scarring that exceeds what you would expect from any essentially non-invasive technique.
Also, with isotretinoin becoming more regulated and fears heightening regarding the risks of systemic medications, such as long-term antibiotic use, don’t be surprised within 5 years ALA-PDT becomes a first-line therapy for acne therapy when topicals don’t work.
Q: What clinical Pearls have you learned as you’ve implemented ALA-PDT into your medical and cosmetic practices?
Dr. Taub: Start with what you know and build from there. It’s easy to start with PDT for AKs. Insurance companies reimburse it to a large degree and patients usually prefer it to topical therapy, which can leave them unsightly for weeks. Get a Blu-U, which isn’t a huge expense and doesn’t take a lot of your time. Convince yourself that it works and that it’s easy. Next, start treating acne with ALA-PDT and then move on to other procedures it can be used for. In fact, even if your don’t have a cosmetically oriented practice, you can just do a few short-contact blue light ALA-PDT treatments for mild to moderate photodamage and get similar results to what might have taken five treatments with an $80,000 laser.
—Skin & Aging