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Photodynamic Therapy
- What Is Photodynamic Therapy?
- How Much Improvement Can I Expect?
- How Many Treatments Will It Take To See The "Best Results"?
- What are the Advantages of Photodynamic Therapy in the Treatment of Sun-Damaged Skin?
- What are the Advantages of Photodynamic Therapy in the Treatment of Acne and Rosacea?
- What are the Disadvantages of PDT?
- How is Photodynamic Therapy Performed?
- What Precautions Should I Take After Photodynamic Therapy?
- How do I Prepare for Photodynamic Therapy?
- How do I Take Care of My Skin After Photodynamic Therapy?
- Who is Not a Candidate for PDT?
1. What Is Photodynamic Therapy?
Also known as "ALA/PDT treatment", Photodynamic Therapy (PDT) is a novel treatment performed by applying a topical photosensitizing agent known as Levulan (5-aminolevulinic acid, or ALA) followed by activation with the appropriate wavelength of light. ALA occurs naturally in the body, and is involved in heme (iron) synthesis. PDT removes sun damaged pre-cancerous zones and spots called actinic keratoses. Sun damage, fine lines, and blotchy pigmentation are also improved. PDT also has the unique ability to minimize pores and reduce sebaceous (oil) glands, effectively treat stubborn acne vulgaris and rosacea and improve the appearance of some acne scars.
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2. How Much Improvement Can I Expect?
Patients with severely 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 some pitted acne scars. Active acne and rosacea may also improve dramatically.
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3. How Many Treatments Will It Take To See The "Best Results"?
To achieve maximum improvement of pre-cancerous lesions (actinic keratoses), sun damage, and skin tone and texture, a series of three treatments 2-4 weeks apart is the most effective. Some patients with only actinic keratoses are satisfied with just one treatment. More treatments may be done at periodic intervals in the future to maintain the skin’s rejuvenated appearance. Acne and rosacea is also treated with a series of 2-3 treatments.
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4. What are the Advantages of Photodynamic Therapy in the Treatment of Sun-Damaged Skin?
Photodynamic Therapy has a number of characteristics which make it an excellent treatment for photodamaged skin:
- PDT improves the appearance of the whole face, helping to create one colour, texture, and tone rather than just spot treating with liquid nitrogen, electrodesiccation or surgery.
- PDT is often easier for patients than repeated use of liquid nitrogen, Efudex (5-FU), or Aldara because the side effects are minimal, healing is rapid and only 1 – 3 treatments are required.
- It is well tolerated and essentially painless, especially when compared to treatments such as liquid nitrogen. Some individuals experience a stinging or burning sensation.
- PDT is non-invasive – no needles or surgery are required.
- When compared to electrodesiccation, surgery and liquid nitrogen therapy, PDT gives an excellent cosmetic outcome and has a reduced risk of scarring, particularly in cosmetically sensitive areas of the face.
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5. What are the Advantages of Photodynamic Therapy in the Treatment of Acne and Rosacea?
Unlike many other treatments which require prolonged use of medications by mouth or on the skin, PDT is applied on the skin and there are no medications to take internally. Thus, it eliminates the concern about drug reactions or resistance that are occasionally seen with such medications. Additionally, the need for use of potent medications such as Accutane may sometimes be avoided. Photodynamic Therapy usually consists of a limited number of applications. Some individuals will derive long-term benefit from PDT, while others with more severe disease may require more sessions or alternative forms of therapy.
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6. What are the Disadvantages of PDT?
Following PDT, the treated areas can appear red with some peeling for 2-7 days. Some patients have an exuberant response to PDT, and experience marked redness of their skin. Temporary swelling of the lips and around the eyes may also occur for a few days. Darker pigmented patches, known as lentigines or “liver spots” may become temporarily darker with subsequent peeling to leave normal skin. This typically occurs over a period of 7 – 10 days. Repeat treatments may be necessary as Photodynamic Therapy is not an exact science.
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7. How is Photodynamic Therapy Performed?
Photodynamic Therapy is a two step process which can safely be performed in our specialty clinic environment. The process is described below:
Step One – Levulan Application:
Levulan is a clear solution which is applied to freshly cleaned skin. The skin absorbs ALA and converts it to a natural photosensitizer called Protoporphyrin IX (Pp IX). After a period of 30-90 minutes, the area is illuminated with an appropriate light source. This 30-90 minute application time is termed the Levulan incubation period. Short incubation times retain efficacy while reducing discomfort and side effects. There is normally no discomfort with short incubation times and 8-10 minutes of BLU-U blue light therapy or IPL activation.
NOTE: Levulan is indicated for the treatment of actinic keratoses with an incubation time of 14-18 hours and activation under the BLU-U blue light for 16 minutes and 40 seconds. Unfortunately, such a prolonged incubation period results in significant pain and prolonged skin redness. Research has shown that one can achieve superb clinical results with far shorter incubation times (30-90 minutes) and exposure times.
Step Two – Photoactivation:
After applying Levulan, the treated area of skin is illuminated to start the photodynamic process of singlet oxygen production. Levulan may be activated with a number of light sources, amongst which the BLU-U blue light and Intense Pulse Light systems. Light activation results in the release of singlet oxygen from Protoporphyrin IX and destruction of the target cell membrane.
8. What Precautions Should I Take After Photodynamic Therapy?
Avoid sun exposure or bright indoor light for 24-48 hours after treatment. Exposure may result in stinging and/or a burning sensation and may cause more intense redness and swelling of the treated area. Treated areas should be protected from the sun by wearing a wide-brimmed hat or similar head covering made of opaque material (i.e. material that does not allow light to pass through. Sunscreens are not sufficient to protect against photosensitivity reactions caused by visible light in the first 24 hours. However, opaque sun-blocking agents such as zinc oxide will provide some protection in the first 24 hours.
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9. How do I Prepare for Photodynamic Therapy?
Photodynamic therapy is a simple treatment which requires very little preparation. In order to give the best possible results with the least risk of complications, we suggest that you carefully follow all instructions provided to you. The following reminders will help to make this a
- If you have a history of recurring cold sores or facial Herpes simplex virus infection, make sure to notify Dr. Bertucci and/or his staff ahead of time so that he can prescribe an appropriate antiviral medication to be taken starting the morning of your photodynamic therapy.
- Do not use any irritating or drying skin care products for 5 days prior to treatment (e.g. Vitamin A Acid, Retin-A, Glycolic Acid, Hydroquinone, Tazorac, etc.).
- Make sure your skin is clean and free of all makeup, moisturizers, and sunscreens at your appointment time.
- Bring a wide-brimmed hat, sunglasses, and scarf when appropriate to the clinic.
- Plan to be in the office for approximately 1 to 2 hours on the day of your treatment.
- Following completion of your treatment, plan on going directly home to stay indoors and away from bright light.
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10. How do I Take Care of My Skin After Photodynamic Therapy?
- Immediately following PDT treatment, Levulan is washed off using soap and water. You may use a bland moisturizer such a Cetaphil or Toleriane for any redness or peeling.
- Should there be significant redness or peeling after treatment, we may suggest that you use a prescription topical steroid product.
- Remember that you must avoid sun exposure for 24-48 hours after your treatment. This means that you must stay indoors and away from bright light, even if it is cloudy outdoors.
- After the first 24-48 hours, you may use a wide-spectrum UVA & UVB sunscreen with SPF 30 or higher when outdoors (e.g. Anthelios, Ombrelle, Coppertone).
- Do not start using irritating or drying skin care products until the skin has returned to a stable state (usually 4-7 days).
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11. Who is Not a Candidate for PDT?
Photodynamic Therapy is a safe procedure with a proven track record. The vast majority of individuals may undergo PDT without any major difficulty. You should not undergo PDT if you suffer from a rare disorder of metabolism known as porphyria in which you have sensitivity to light or if you suffer from other disorders that make you sensitive to sunlight.
Please call our office at 905/ 850 4415 if you have any questions and to arrange your prompt, confidential consultation, or to schedule your treatment.
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