Photodynamic Therapy for Acne and Rejuvenation
What is Photodynamic Therapy (PDT)?
Photodynamic Therapy (PDT) is a special treatment performed with a topical photosensitizing agent called Levulan (5-aminolevulinic acid or ALA), activated with the correct wavelength of light. This is also known as “ALA/PDT treatment”. These treatments remove sun damaged pre-cancerous zones and spots called actinic keratosis. 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 and reduce oil glands, effectively treating stubborn acne vulgaris, acne rosacea, and improve the appearance of some acne scars.
ALA (Levulan, Kerastick) is a substance that occurs naturally in the body. When applied topically, it is selectively absorbed into fast-growing, rapidly metabolizing epidermal cells including photodamaged skin and oil glands. This specially formulated topical sensitizer enhances the skin’s response to light. First, the sensitizer is applied to the skin and allowed to absorb. Next, specially selected wavelengths of light are applied to the skin using our Palomar Starlux Intense Pulsed Light machine. The sensitizer is activated in the skin and causes an increased immune response to occur. For acne, this results in the killing of the p. acnes bacteria that help turn skin oils into toxins. For rejuvenation, this results in increased heat in the skin, further stimulating new collagen formation and the reduction of pigment, vessels and wrinkles. Often, what used to take 5-6 treatments can often be accomplished in 1-2 treatments.
How much improvement can I expect?
Patients with severe sun damaged skin manifested by actinic keratosis, texture, and tone changes including mottled pigmentation and skin laxity may see excellent results. You may also see improvement of large pores and pitted acne scars. Active acne can improve dramatically.
How many treatments will it take to see the “Best Results”?
To achieve maximum improvement of pre-cancerous (actinic keratosis) sun damage, skin tone and texture, a series of three treatments 2-4 weeks apart is the most effective. Some patients with only actinic keratosis 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.
Will I feel any discomfort during the treatment?
Although the ALA/PDT system has been designed to minimize patient discomfort, many patients do report some:
- Stinging and burning
At least 50% of patients experienced significant stinging and burning during treatment, usually plateauing by 6 minutes into treatment
- Swelling and temporary reddening
Almost all patients experienced this immediately following light treatment
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 seven to ten days.) Repeat treatments may be necessary as PDT medicine is not an exact science.
What are the advantages?
- Easier for patients than repeated topical liquid nitrogen, Efudex (5FU), or Aldara because the side effects are minimal, rapid healing, and only 1-3 treatments required.
- Reduced scarring and improved cosmetic outcome compared with cautery, surgery and Efudex. Liquid nitrogen can leave white spots on your skin.
- Levulan improves the whole facial area treated creating all one color, texture, and tone rather than just spot treating with liquid nitrogen, cautery and surgery. In summary, PDT matches the “Ideal treatment” for photodamaged skin:
- well tolerated (essentially painless)
- easily performed by a specialty clinic environment
- non-invasive (no needles or surgery required)
- excellent cosmetic outcome (particularly in cosmetic sensitive areas of the face)
- Patients who have a history of recurring cold sores (Herpes simplex type I) should start oral Valtrex 500 mg tablets, two tablets twice daily for three days – starting this prescription the morning of your PDT treatment. The prescription for this product will be ordered for you.
- Make sure your skin is clean and free of all makeup, moisturizers, and sunscreens. Bring a hat, sunglasses, and scarf when appropriate to the clinic.
- Photography will be done by the staff before the Levulan is applied.
- You must sign a consent form.
- An acetone scrub is performed. This will enhance the absorption of the Levulan and to give much more even uptake.
- Levulan is applied topically to the whole area – whole zone to be treated (such as the whole face, back of the hands, extensor part of the forearms). This is done by Dr. Schlesinger or his staff.
- The Levulan is left on for 60 minutes before any light treatment.
- The Levulan is activated with a unique spectrum of light beginning with low energy levels. This requires about 15 minutes to complete.
- Post-treatment instructions will be given to you to care for your improved skin.
What should I do after the ALA/PDT treatment?
- Be careful to avoid sun exposure, exposure to bright indoor light and exposure to the sun through a window for 48 hours.
- Avoid extremes of temperature and wind (if possible)
- Avoid hot water or other irritants
- Sunscreen will be applied to the treated area before you leave the office. You should bring a wide-brimmed hat and wear it home on the day of treatment
- You will be provided with information on the care, cleaning and maintenance of the treated areas and instructions for follow-up
A typical short contact photodynamic therapy treatment sometimes begins with a Vibradermabrasion. This technique is used to remove any dead skin cells on the surface of the face, which allows for better penetration of the aminolevulinic acid. Vibradermabrasion also builds a new layer of collagen in your skin with repeated treatments, enhancing the cosmetic outcome. The Vibradermabrasion is followed by a topical application of aminolevulinic acid, which is left in place for approximately 30 to 60 minutes. The medication is then removed using an alcohol swab, soap and water. Finally, the patient is treated with a laser or light source. Please ask your provider about Vibradermabrasion.
Photodynamic Therapy is an essentially painless procedure for the patient. While initial results may be seen as early as the first session, some patients require a series of three to five sessions to see significant results. However, it really depends on the patient and the severity of the skin condition being treated.