Photo Dynamic Therapy
- Used to treat: acne clearance, sun damage, sebaceous hyperplasia, and skin tone. One can sometimes see a reduction of pore size and even minimal wrinkle reduction.
- Removes precancerous cells
- Reduces oiliness of sebaceous skin and reduces sebaceous gland hyperplasia.
- Aminolevulanic acid (ALA) or Levulan is a naturally occurring substance in the skin and is applied to the prepared face.
- 20% ALA is applied to affected area
- Incubation time is variable from 30 mins to 4 hours: The advantage of a longer incubation leads to fewer treatments while the shorter incubation may need up to three treatments but each is somewhat more comfortable. The longer incubation also means a greater inflammatory reaction with increased swelling and redness. 3-4 hours seems to yield the best results
- For severe acne, follow up light treatment 2-3 times a week for a few weeks enhances the result and frequently leads to no further treatment for a few years.
- The ALA is then activated with red light or blue light for 12 to 15 minutes. When the ALA is placed on the skin and activated by the light, it is converted to Protoporphyrin IX within the skin cells and that is the active ingredient.
- Patients will experience discomfort at that time (can have water spritzed and fan on during light treatment)
- The longer the incubation the more painful the light activation is
- Patient will experience burning, flaking, peeling and photosensitivity for 48 hours after treatment.
- Patients must stay out of the sun for 5 days post treatment
- Best results are seen with 4 treatments spaced 4-6 weeks apart. Final results are seen within 1-2 months of treatment.
- Skin prep pre treatment: microderm or gentle cleansing and application of alcohol; tretinoin can be used pre-procedure
- It restores the skin integrity to a large degree, resulting in sometimes amazing improvement of not only acne but also acne scarring.
WHO IS A GOOD CANDIDATE FOR PHOTODYNAMIC THERAPY?
Patient with diffuse actinic keratosis, moderate to severe rosacea, moderate to severe sun damage, textural irregularities and/or acne are good candidates for Photodynamic Therapy with Levulan.
WHO IS NOT A GOOD CANDIDATE FOR PHOTDYNAMIC THERAPY?
If you are pregnant, have been on Accutane within 6 months, or have an active cold sore you should not have this procedure. If you are taking aspirin or blood thinners, you may experience some bruising that can take up to 2 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 treatment may need to be reduced in intensity or postponed until the tan fades. In addition, patients with pacemakers or internal defibrillators should not have this procedure.
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 be dramatically reduced.
HOW MANY TREATMENTS WILL IT TAKE TO SEE THE “BEST RESULTS”?
Achieving maximum improvement is greatly dependent on the protocol you select. With a more aggressive protocol just one or two treatments are usually required. If you select a less aggressive protocol it may require two to four treatments. Treatments are usually spaced 3 – 5 weeks apart. More treatments can be done at periodic intervals in the future to maintain the rejuvenated appearance of the skin. Alternatively, once an aggressive treatment protocol is chosen, follow up light treatments without Levulan may be recommended.
DISADVANTAGES AND RISKS OF PHOTODYNAMIC THERAPY
Every medical procedure involves certain disadvantages and risks and it is important that you understand the disadvantages and risks involved in Photodynamic Therapy. Depending on the treatment protocol (how mild to aggressive the treatment is), you may be red and have some swelling and peeling for 3–7 days. Dark pigment areas can become darker during this time, but peel off during the peeling process. The majority of patients do not experience complications. It is important that your decision to proceed with Photodynamic Therapy is based upon consideration of the alternatives to treatment as well as the risks, benefits and costs of the proposed plan. Your clinician will make sure that you fully understand the alternatives, benefits, risks, potential complications, and expected outcomes of this treatment.
REDNESS AND SWELLING
Depending on your desired outcome and length of Levulan incubation the short-term immediate risks include prolonged redness that may last from a few days to a few weeks. Swelling is common with more aggressive treatments and usually starts on day 1 and is usually over by day 3. Once the treatment has been completed we send you home with special topical products to moisturize and enhance healing.
Peeling and/or superficial crusting is an anticipated side effect of a PDT treatment and it generally occurs between days 3 – 6. Most patients are excited about the peeling process because they begin to see the new skin.
Bruising is uncommon, although the risk increases if you take aspirin products or blood thinners. Bruises are temporary and resolve in 1-2 weeks.
The sensation of heat has a lot to do with the incubation time of the Levulan. The longer incubation period (how long Levulan is on) yields a more aggressive treatment and a warmer sensation while in blue light.
SKIN WOUNDS, INFECTION, AND SCARRING
Uncommonly, a skin wound such as superficial blisters and scabs can occur, which heal within 2 days 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.
HYPOPIGMENTATION AND HYPERPIGMENTATION
Another risk is a possibility of hypo (too little) pigmentation that is very uncommon. Usually treatable with prescription creams, chemical peels or further laser treatments, there is a <1% possibility that this could be permanent. There is an increased risk of this with tanned or naturally dark skin. You may need extra treatments than those required of others if your skin is dark in order for us 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 ARE THE ADVANTAGES AND KEY POINTS OF PDT?
- Levulan is all natural and produced by your body to make hemoglobin.
- It is applied to your skin. There are no internal side effects.
- Uptake of Levulan is by abnormal cells. Levulan targets pre-cancer cells, bacteria and sebaceous glands that produce acne.
- Appropriate light wavelength activates Levulan.
- Your damaged skin then sheds leaving you with new, revitalized skin.
- Levulan cosmetically benefits the whole facial area treated with improved clarity, tone and texture.
MULTIPLE TREATMENTS AND MAINTENANCE TREATMENTS
Sometimes more than one treatment may be needed to achieve desired results. Occasionally actinic keratosis may not fully respond to laser treatments with ALA and additional treatments may be necessary. Subsequent actinic keratosis may develop over time and future treatments may be needed. Rosacea is a chronic condition, and maintenance treatments may be necessary to remain in remission. Many patients like the rejuvenated look they get and the continued improvement over a series of treatments.
You may be disappointed in the outcome as not everybody achieves every bit of improvement they desire. Although the vast majority of our patients have been happy with their results, medicine is not an exact science and results are variable. We cannot provide you with any guarantee of your final results.
POST TREATMENT CARE
You should use the skin care regimen that your consultant has provided for you. Living in the Southwest, it is important that you avoid sun exposure for the first 2 days following your treatment and then try to avoid prolonged sun exposure. DO NOT go in a tanning booth at any time either before or during these treatments. Doing so will greatly increase your risks of a side effect. If there is any blistering or breakage of the skin after the procedure, you should use an antibiotic ointment such as Bacitracin or Polysporin at least 2 times per day to keep the area moist. Please call us immediately if these are not minimal, localized or superficial. Please review your home care instruction sheet that details what you should expect on a daily basis.
consent on the next page. Questions and concerns can be answered by calling Parkway Medical Laser & Skin Centre at 480-348-3245.
IN-DEPTH DISCUSSION OF PDT FOR ACNE
Photodynamic Acne Treatment is a process by which a photosensitizing agent (Levulan) is applied to your skin. The Levulanis then activated with a specific wavelength of light, which “turns it on” and converts to Protoporphyrin IX. Levulan has been used extensively for the treatment of a variety of different skin conditions, and the FDA approves it for Actinic Keratosis and the Health and Welfare Canada for the treatment of sun damaged skin.
Levulan is a 20% solution of Aminolevulinic Acid (ALA). ALA is a natural substance found throughout your body, as it is a precursor for hemoglobin synthesis. You would be unable to make a red blood cell to carry oxygen without ALA in your body. Consequently, it is a “natural” product found in all humans.
Acne results from the obstruction and inflammation of the sebaceous glands, and it affects 80% of the human population. Acne typically begins in adolescence with hormonal changes. Nonetheless, there are many older individuals who suffer from “adult acne”.
There are several different presentations of acne ranging from comedonal (blackheads and whiteheads), papular, pustule, and cystic acne. In many cases, many of these presentations of acne can be present on an individual simultaneously.
Prior to Photodynamic Acne Treatment, the best available treatment option for cystic acne was Accutane. However, with Accutane there are many systemic side effects including birth defects, liver abnormalities, mood depression, and virtually all patients get dryness and night vision changes. PDT Acne treatment provides a viable alternative for all types of acne treatments.
Photodynamic Acne Treatment is done as follows: TheLevulan is applied to your skin and left on for thirty minutes, up to four hours. Levulan is a clear solution and painless. Levulan is then activated with a specific wavelength of light. This takes about 10 – 15 minutes. The Levulan targets active cells. Acne sebaceous glands are active cells. These cells preferentially absorb Levulan, and these cells are targeted by the Levulan once it is activated; hence the term photodynamic therapy. TheLevulan will also target sebaceous hyperplasia (which are those small (1-3 mm), benign, bumps on your skin) and the papules of acne rosacea. Skin oiliness is decreased, and the appearance of pores is minimized. The entire skin texture improves following a Photodynamic Acne Treatment.
The “downside” of Photodynamic treatment (PDT) is that you will be red and have some skin peeling and possibly some crusting for several days after treatment. Usually, the first 1-2 days are the worst. Pressed mineral (available in our office) will hide most of the redness. We advise remaining indoors the day following your treatment to avoid sun exposure, as you are photosensitive for about 24-48 hours after PDT.
The advantages of PDT are rapid treatment of acne lesions all over the face without scarring or surgical excision. The skin appears refreshed and younger following these treatments. We advise 3-4 treatments at 2-4-week intervals using the blue light twice per week between the Levulan treatments to obtain optimal results. There are no systemic side effects and few if any adverse events have been reported.
These ALA treatments can be combined with our regular Photorejuvenation treatments using IPL, which targets redness and brown spots, and stimulates formation of more collagen in the skin. There is normally no downtime for IPL treatments withoutLevulan. However, one can enhance and “boost” IPL Photorejuvenation results by adding Levulan to the treatment process. This is termed photodynamic skin rejuvenation when PDT is added to regular IPL Photorejuvenation.
You can use your topical acne lotions in between your Levulan treatments once the redness has subsided.