Photodynamic Therapy (PDT) using Levulan®
Photodynamic therapy with IPL (intense pulsed light) is a medical procedure that has both benefits and risks that need to be weighed. During your consultation, we will review with you the potential benefits, alternatives, and the few risks associated. It is important that you read this information carefully and completely.
PDT is a light treatment performed with the topical photosensitizing agent, Levulan® (aminolevulinic acid or ALA). When Levulan® is applied; abnormal cells, pores, and oil glands preferentially absorb it. This makes these areas more susceptible to light. This technology has allowed us to treat pre-cancerous lesions called actinic keratoses, as well as freckles or pigmentation from sun damage, and acne. It can also be used to reduce oil glands and minimize the appearance of pores. This treatment in combination with IPL can destroy actinic damage, stimulate new collagen growth, minimize fine lines, and improve the overall texture and tone of the skin.
Typically, a series of treatments are performed 3-4 weeks apart. At each treatment, the area will first be scrubbed with acetone. This prepares the skin and allows to a better penetration of the Levulan®. The Levulan® is then applied to the treatment area and left on for 30-90 minutes. After the desired incubation time, the Levulan® will be removed. The IPL treatment is then performed. Afterwards, the area will be washed to remove any residual Levulan®, and a sunblock will be applied.
Depending on the condition, alternative treatments may be recommended. Actinic keratosis can be treated by a dermatologist using cryotherapy, topical chemotherapy, and surgery. Alternate treatments for acne include oral and topical antibiotics, Accutane, and other laser or light-based therapies.
Who is a good candidate for pdt?
Patients with actinic keratoses or sun damaged skin, patients with acne, patients looking for a reduction in oiliness, and patients looking to improve their overall skin texture and tone are good candidates for PDT.
who is not a good candidate for pdt?
If you are pregnant, have been on Accutane within three months, or have an active cold sore, you should not have this procedure. You should advise us of all oral and topical medications that you are currently using prior to treatment, as some medications are photosensitizing and PDT should not be performed while you are taking such medications. If you are tanned, or have recently been exposed to the sun in the area to be treated, you may be more susceptible to potential side effects, such as blisters or crusts. Also, if you have recently used any type of gold therapy on your skin you should make us aware as this can cause a bluish/gray discoloration. Your treatment may also need to be reduced in intensity or postponed until the tan fades. In addition, patients with pacemakers, metal implants or internal defibrillators should not have this procedure.
Photodynamic therapy is an effective treatment for a wide variety of conditions. It usually can treat these conditions in 2-3 treatments with little or no downtime, and very few potential side effects. Benefits can include normalizing of the keratotic cells, reduction of freckles and/or pigmentation, and fewer, or remission from, acne breakouts.
Every medical procedure involves a certain amount of risk and it is important that you understand the risks involved with PDT. Although the majority of patients do not experience these complications, it is important that your decision to proceed with PDT treatments is based upon a consideration of the alternatives to treatment, as well as the risks, benefits, and costs of the proposed plan.
- Discomfort: During a PDT procedure, you will experience little to no discomfort. A slight warmth and tingling may be felt in the area being treated. Some patients experience a “snapping” sensation, like that of a rubber band, with the IPL pulses. Most people find this to be mild and quite tolerable. A topical anesthetic or cold packs may be applied prior to your treatment to lessen this discomfort.
- Redness and Peeling: Some patients may experience mild redness, peeling, and/or crusting after an IPL with Levulan® treatment. This usually lasts for a few days. After Levulan® is applied, the area will be sensitive to sunlight and other intense light sources for 48 hours. Therefore, you must avoid sun exposure. Following a treatment, regular use of a sunscreen of SPF 30 or higher for at least 48 hours is recommended. Failure to do this can result in extreme redness and peeling that may last up to 10 days.
- Bruising: Bruising from this treatment is uncommon, although the risk increases if you take aspirin products or are on blood thinners. Bruises are temporary and resolve in 1-2 weeks.
- Skin wounds, Infection, and Scarring: Uncommonly, a skin wound such as superficial blistering or scabbing can occur. These heal within 2-14 days. Use of an antibiotic ointment on a regular basis usually results in uneventful healing. There is a less than 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 not usually broken.
- Pigmentation: Another risk is the possibility of hypo (too little) or hyper (too much) pigmentation. This is very uncommon. Usually, this is treatable with prescription creams, chemical peels, or further laser treatments. There is a less than 1% possibility this could be permanent. There is an increased risk of this with tanned or naturally dark skin. It is also important that you let any tanning lotions fade and do not seek artificial tanning treatments (sprays, UV beds, etc.) for 3-4 weeks prior to your procedure.
- Allergic Reaction: There is a possibility of an allergic reaction to materials used during the PDT procedure.
multiple treatments & maintenance
While most patients will receive good results with 2-3 treatments, sometimes more treatments will be needed to achieve the desired results. Occasionally actinic keratoses, especially if they are thicker, may not fully respond to these treatments. Alternative treatment, such as cryotherapy, may be necessary. In addition, subsequent actinic keratoses, sun damage, sebaceous glands, etc. may develop over time and future treatments may be needed.
A sunblock containing zinc oxide with an SPF30 or higher should be used for at least 48 hours following a treatment. Makeup may be applied immediately after your treatment. Normal skincare can be resumed unless otherwise directed by your provider. You may 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 Polysporin, at least two times per day to keep the area moist.
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