Photodynamic Therapy
Photodynamic therapy (PDT) utilizes a special liquid chemical that makes the skin more sensitive to light. This chemical, called Levulan, is applied to the skin and "activated" by a laser or light device to improve sun damaged skin, precancerous lesions, and acne. PDT is especially effective in removing precancerous cells on the skin because these cells absorb more of this light sensitive chemical than normal cells. Photodynamic therapy consists of two steps.  First, the topical light sensitizing agent called levulan is painted onto the skin.  Then, after the levulan has absorbed into the skin over several minutes, the area is treated with either the Vbeam laser or an intense pulsed light (IPL) device.  The application of levulan to the skin prior to treatment allows the skin to absorb more light energy than usual from a laser or IPL treatment. This treatment removes precancerous spots called actinic keratoses that are visible on the skin as scaly red and tan spots.  Sun damage, fine lines, and blotchy pigmentation are also improved because of the additive effect of levulan on the light or laser treatment.  Photodynamic therapy also has the unique ability to minimize pores and reduce oil glands, effectively treating stubborn acne and rosacea.  PDT can also improve the appearance of some acne scars.  Because of the dramatic improvement seen after treatments, photorejuvenation using levulan and intense pulsed light (IPL) is considered to be much more effective than a "regular" IPL treatment without the levulan .  This treatment results in significant improvement in precancerous skin conditions, sun damaged skin, moderate to severe cystic acne and potentially even undetected superficial skin cancers.  Additionally, it improves wrinkles, pore size, skin texture, pigmentation, rosacea, enlarged oil glands, and potentially prevents the development of skin cancer.

Who is a good candidate for levulan treatments?
Patients with active acne that is not responding well or only partially to conventional acne treatments are good candidates for PDT.  Those with sun damage manifested by red and brown discoloration of the skin and precancerous growths will see dramatic improvement in their condition.  Patients with a history of precancerous growths or skin cancer may also want to consider PDT to reduce their risk of future skin cancers.

What conditions does photodynamic therapy treat?
The treatment can remove precancerous skin growths and prevent skin cancer.  It also treats moderate to severe acne and rosacea and can improve acne scars.  PDT also has cosmetic benefits in people with sun damage in that it improves blotchy pigmentation, facial redness, and dilated blood vessels.  It also can improve fine lines, enlarged oil glands, skin texture and pores.

How many treatments will it take to see the best results?
While some patients may be pleased with the results of just one PDT treatment, it is recommended that most patients undergo three treatments, one per month, for most conditions. More persistent cases of acne or acne scarring may take several more treatments.  A repeat  PDT treatment can be done bi-annually or annually if the effects start to wear off and acne, rosacea, or precancerous lesions return.

How long does the treatment take?
The entire treatment process takes about 2 hours.  First, your face is vigorously cleaned and prepped prior to the application of the levulan.  Then, the levulan is applied as a thin layer all over your face.  This chemical is left to "incubate" on the skin anywhere from 45 to 60 minutes (sometimes even longer).   30 minutes prior to activation by either laser or IPL, a topical numbing cream is applied to the entire face over the levulan.  Just prior to the laser treatment, both the levulan and numbing cream are washed off the skin.  The application of the laser or IPL to the skin takes about 15 minutes.  After the treatment, cool compresses and moisturizer with sunscreen are applied and you are able to leave the office with strict instructions to avoid sun exposure.

Does the treatment hurt?
There is no pain during the period when the levulan is left to "incubate" and absorb into the skin.  During the laser or IPL treatment, there is moderate pain during each laser pulse that is similar to the sensation of a rubberband snapping on the skin.  A topical numbing cream can help lessen the sensation.  There is minimal discomfort after the laser treatment and during the healing phase.

What precautions do I need to take after the PDT treatment?
The application of the levulan to your skin can cause it to be extremely sensitive to sunlight for 48 hours after the treatment.  The recommendation is to not schedule any outdoor activities during this time and to wear zinc oxide containing sunscreen and a hat if driving or outdoors.  Even if staying indoors, stay away from windows and bright light and continue to wear sunscreen.

How will I look during the healing phase of PDT?
Following the treatment, the treated areas will appear red and swollen with some peeling for 2-7 days.  Some patients may have an exuberant response to treatment and experience marked redness and swelling of their skin.  Areas of mottled pigmentation will become temporarily darker and then peel off, leaving slightly pink skin which then fades to a normal skin tone.  This process happens over 7-10 days.

How does PDT compare to liquid nitrogen freezing of brown spots and precancerous spots?
Liquid nitrogen can leave permanent white patches on the skin.  With PDT, there is reduced scarring and a greater cosmetic outcome compared with spot treating with liquid nitrogen.  PLT with levulan improves the whole facial area creating one uniform color, texture, and tone.

Photodynamic Therapy for Acne

Photodynamic Therapy Aftercare Instructions

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