What is Photodynamic Therapy?
Photodynamic therapy (PDT) is the use of a topical medication (Levulan) activated by intense pulsed light (IPL).   Light converts the Levulan (ALA) into a photo-sensitizing agent, which destroys the targeted sun damaged and precancerous cells (Actinic Keratosis or AKs).   Another positive benefit with PDT is the reduction of pore size since the sebaceous glands are tempered, reducing oil flow and consequent pore blockage.  The use of IPL with levulan also results in targeting of melanin and hemaglobin.  The combination of IPL with Levulan is synergistic resulting in destruction of pre-cancerous cells, reduction in acne causing bacteria and amplifying the benefits of IPL photorejuvenation, for increased cosmetic results.

What can be treated with Photodynamic Therapy?
PDT is typically prescribed to remove actinic keratosis (AKs or pre-cancersous cells) all over the body, but mainly on the head, face, neck, hands and other sun exposed areas.  PDT is also effective for treatment of acne as well as a more aggressive form of IPL photorejuvenation.

Benefits of PDT for Actinic Keratosis
– It has no long-term side effects when used properly.
– It’s less invasive than surgery or cryotherapy.
– It usually takes only a short time and is most often done in-office.
– It can be targeted very precisely.
– PDT can be repeated many times at the same site if needed.
– There’s little or no scarring after the site heals.
– Cosmetic benefits of IPL photorejuvenation are achieved at the same time as AK destruction

Actinic Keratosis (AK) before and after PDT

Levulan for Acne
Levulan has also shown excellent results for the treatment of acne.  IPL with Levulan can be used to treat light to moderately-severe acne and may be suitable for those patients who wish to avoid taking heavy medications to rid their skin of acne.  Mechanisms include reduction of acne causing bacteria,  shutting down the oil glands (sebaceous glands) in the skin, and exfoliation of the skin to unclog pores.  If you have acne that is not responding to medications, or if you are unable to tolerate oral or topical medications for acne, photodynamic therapy with Levulan may be right for you. Combined with a light source, Levulan kills the p.acnes bacteria in your skin, decreases sebum (oil) production and often provides long term improvement of acne.  Results may vary depending on each patient’s unique physiology and lifestyle factors.

Acne before and after PDT

Levulan for general skin rejuvenation
Adding Levulan to an IPL treatment, is somewhat like putting your IPL photorejuvenation on steroids.  The Levulan photo-sensitizes the skin, allowing the IPL energy to be better absorbed by the targeted pigmented and vascular chromophores.  This results in a higher level of correction of freckles, sunspots, skin discoloration, broken blood vessels and redness compared to photorejuvenation alone. Although, Levulan does not penetrate to dermal layers of the skin, the heat and inflammatory response caused by PhotoDynamic Therapy does reach the Papillary dermis.  This heat stimulates the fibroblast to produce collagen.  This combination treatment also benefits enlarged oil glands (sebaceous hyperplasia), enlarged pores and uneven skin tone & texture.

What should I do prior to my PDT treatment?
It is extremely important to protect the treated skin from the sun for a full 4 weeks prior to PDT. This is best accomplished by the use of a quality SPF 30+ sunscreen daily and a hat worn during times of greater exposure to the sun’s rays.   Artificial tanners should be stopped 3 weeks before treatment.  All pre-treatment guidelines for regular IPL treatments should also be followed.  Your face should be washed immediately prior to your appointment to remove any make-ups or creams.

How is the procedure performed?
First your skin is pre-treated with an acetone scrub, to remove oil from the skin’s surface.  Sometimes microdermabrasion is also preformed before the Levulan is applied.  Microdermabrasion will remove dead skin cells and cause blood vessels to dilate, which will result in a more aggressive treatment. After the skin is prepared the Levulan Kerastick is cracked open and applied to the skin. The ALA is left on the skin to incubate, typically for 1 hour.  A longer incubation time can cause more reaction as well as more correction.  Non-facial skin generally tolerates a longer incubation time.  After the Levulan has been on for the determined amount of time, the skin is then treated with IPL to activate the Levulan and provide additional photorejuvenation effects.

What should I do after the PDT treatment?
– Sun protection including quality SPF 30+ sunscreen and a hat are mandatory for at least 48 hours after each treatment.  Avoid direct sunlight to the face even for a minute. Wear sun protection as above even when sitting near a window or in a car.
– Make-up may be put on gently 3-5 days following the procedure unless there is crusting or intense redness.
– Scrubs and facials must be avoided for 1 week after the procedure.
– Retinoids (Retrinal, Retinol, Retin-A, Renova) and glycolic acid products may be restarted after 5 days only if the skin is no longer red, swollen or peeling.
– Light scaling and peeling as well as mild to moderate redness are expected to occur for 2 to 7 days. Any areas of crusting or oozing should be covered at least 3 times per day with Vaseline petroleum jelly or Aquaphor ointment. Notify our office if heavy crusting, intense redness or swelling, or other unwanted side effects occur. Symptomatic relief may be obtained by placing cool tap water compresses on the skin. Compresses made from one cup of cool tap water mixed with one tablespoon of white vinegar may provide additional relief from discomfort if necessary. Advil (ibuprofen) and Tylenol (acetaminophen) can also help alleviate discomfort.
– All post-treatment guidelines for regular IPL treatments should be followed.

Side effects
Redness, swelling, increased warmth and tingling sensations may occur for 1 to 3 days after treatment. Redness and scaling may be present for up to 1 week depending on the degree of sun damage.  Crusting, darkening or lightening of areas of the skin, intense redness and prolonged swelling or stinging may occur.  These generally resolve with proper skin care.  Sun avoidance is absolutely necessary for 48 hours after the procedure.  A quality spf 30+ sunscreen containing titanium and zinc oxide must be worn daily.  Patients must wear a hat to protect the face from sunlight while outside during this 48 hour period as well.  Patients should also stop the use of any topical acne creams and avoid hot showers during this time to allow skin to properly heal.

Will I feel any discomfort during the treatment with the Levulan® PDT system?
Although the Levulan® Photodynamic system has been designed for less patient discomfort, many patients do report some stinging and burning, swelling and temporary reddening. At least 50% of patients experienced significant stinging and burning during the light treatment, usually plateauing in intensity at about 6 minutes.  Almost all patients experienced swelling and temporary reddening immediately following light treatment. This will begin to subside soon after treatment and will be gone in a few weeks. The discomfort usually occurs immediately following treatment, rather than in the weeks following.

How many PDT treatments are required?
Current recommendations suggest 1 to 2 treatments are necessary to achieve results.  Recent data suggests approximately 90% of patients obtain significant improvement from this regimen.  Improvement will last longest with continued use of sunscreens and anti-aging creams such as retinoids (Retrinal, Retinol, Retin-A, Renova).  Maintenance PDT treatments may be required at different intervals ranging from 6 months and up, depending on patient response, aging, exposure to sun and other environmental lifestyle factors.