PDT greatly improves sun-damaged skin, fine lines, blotchy pigmentation and rough skin patches. PDT even has the unique ability to minimize pores and reduce oil glands. The therapy involves an application of a topical photosensitizing agent called aminolevulinic acid (ALA, brand name Levulan™). When applied topically, it is selectively absorbed into rapidly growing photo-damaged skin cells, sebaceous (oil) glands, and hair follicles (pores). Application of blue light activates the ALA, destroying the target cells. The skin improves in both texture and tone. Patients with severely sun-damaged skin manifested by actinic keratoses (pre-cancers) and poor texture and tone may achieve excellent results.
To achieve maximum cosmetic improvement, a series of three treatments at 2 to 4 week intervals are most effective. Some patients with actinic keratoses will achieve results in only one treatment. More treatments may be done in the future, as necessary, to maintain the results of the newly rejuvenated skin. The scalp, face, neck, chest, hands, arms, and legs may be treated.
The advantage of PDT is that it is a quicker treatment than using Efudex or Aldara. It has minimal side effects and provides rapid healing. There is a less scarring than with liquid nitrogen, and patients see improvements of the entire facial area treated, instead of just in spot areas.
The disadvantages of PDT are that the treated skin may appear red, with peeling for 2 to 7 days post-treatment. Some people may experience swelling especially around the lip and/or eye areas. Pigmented lesions will temporarily darken and peel off, leaving a normal appearance to the skin. Repeat treatments may be necessary, as this is not an exact science, and everyone’s skin is different.
The ALA is converted by skin cells into protoporphyrin IX, a non-toxic substance that naturally occurs in your body. The light used to activate the protoporphyrin IX is either red light or blue light, part of the natural visible spectrum of sunlight, and it is not ultraviolet radiation. Sometimes we combine PDT with salicylic acid facial peels. Salicylic acid (aspirin) is a compound naturally found in the bark of the willow tree. These 2 treatments together are an excellent option for patients frustrated with traditional treatments or looking for a non-toxic alternative treatment for sun damage.
Frequently Asked Questions about Photodynamic Therapy
What is the process for PDT?
The skin in the area to be treated is cleansed and prepped. The ALA is applied and incubated for 15 minutes to 2 hours. The time is determined by the locations and skin conditions being treated.
Is the treatment painful?
The ALA may sting when applied, but the feeling quickly subsides. The actual light treatment feels very warm, as though you are lying in the sun. Patients with severe sun damage may experience a burning sensation during the treatment, but we will provide you with medication, if it is needed to make you comfortable.
What happens after the treatment?
After your treatment, you will be asked to remain totally out of the sun for the first 48 hours to prevent reactivation of the medication. You may experience a sunburn effect the first 2 days following application (redness and a warm feeling). Beginning day 3, your skin may feel tight and begin to peel.
How many treatments will I need?
It is recommended that you receive 1 to 3 treatments with the ALA at 2 to 4 week intervals. Your treatment schedule will be discussed with you, and it will depend on your individual needs.
Will my health insurance pay for PDT?
Insurance companies usually pay for treatment of precancerous lesions if it is medically necessary. They never pay for treatment of cosmetic sun damage. You can call your insurance company and ask them about your benefits. (A quick shortcut is to ask if they cover codes 96567 and and J7308 for acne or actinic keratoses.) Or you can call our office at 760.230.2537, and we will help you figure it out. We offer discounted prices on PDT for our patients who need to or want to pay out of pocket.
Posted on Wed, March 19, 2014
by Heidi Gilchrist