Photodynamic therapy, sometimes shortened to PDT, is a medication and light-based treatment that allows us to treat certain skin conditions such as precancerous lesions called actinic keratoses. During this treatment, a topical photosensitizing agent called Levulan® (aminolevulinic acid or ALA) is applied to the skin. Levulan® is absorbed preferentially by abnormal cells, pores, and oil glands, making them more susceptible to light. Next, we use IPL (intense pulsed light) to target these ‘highlighted’ areas. Photodynamic therapy is a medical procedure, and as with all of our treatments, our team will carefully review its potential benefits and risks with you to help you make an informed decision.
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What does photodynamic therapy treat?
Photodynamic therapy is an effective treatment for a wide variety of conditions. In addition to normalizing keratotic cells, photodynamic therapy can improve the appearance of freckles and pigmentation from sun damage, and reduce or resolve acne breakouts. It can also be used to reduce oil glands and minimize the appearance of pores, which can make it a good choice for patients seeking a reduction in oiliness. As this treatment incorporates the collagen-stimulating benefits of IPL, it can help to minimize fine lines and boost the overall texture and tone of your skin.
How long do photodynamic therapy results last?
Depending on your needs, we typically recommend a series of 2-3 treatments performed eight weeks apart. For severely sun damaged skin with more actinic keratosis involvement, more treatments may be needed to achieve the desired results. Although most actinic keratoses can be treated and resolved, it is possible for them to return or for new ones to appear. It is essential to adopt a sun protection regimen to protect against future sun damage, and our medical aesthetics team will be happy to help guide you in this regard.
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On your treatment day, we’ll walk you through the process so you know exactly what to expect at each step. We prioritize your comfort and welcome you to bring up any questions or concerns with your provider. After cleansing the treatment area with acetone, Levulan® is applied and left on for 60 minutes. We’ll then remove the Levulan® and perform the IPL component of your treatment. Afterwards, the area will be washed to remove any residual Levulan®, and a sunblock will be applied.
During your photodynamic therapy treatment, you will feel a slight warmth and tingling in the treatment area. Some patients experience a “snapping” sensation against their skin, like that of a rubber band, as the IPL pulses. Most people find this to be mild and quite tolerable. This treatment makes the treated area extremely sensitive to sun exposure for 48 hours, so you will need to minimize your outdoor activities for two days post treatment.
Although we only offer treatments with excellent safety profiles, photodynamic therapy is still a medical procedure that carries a certain amount of risk, and it’s important to us that patients are fully educated on their treatment of interest so they can make an informed choice. Although the majority of patients do not experience complications, potential risks include:
- Redness and peeling: Some patients may experience mild redness, peeling, and/or crusting after a photodynamic therapy treatment. This usually lasts for a few days. After an application of Levulan®, the area will be sensitive to sunlight and other intense light sources for 48 hours and it is essential to avoid sun exposure during this time. Following a treatment, regular use of a sunscreen of SPF 30 or higher for at least 48 hours is strongly recommended, otherwise you may experience extreme redness and peeling that could last up to 10 days.
- Bruising: Bruising after photodynamic therapy 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, and use of an antibiotic ointment on a regular basis usually results in normal healing. There is a less than 0.5% possibility of a skin wound leaving behind a permanent scar. It is rare for an infection to occur since the skin is not usually broken.
- Pigmentation: There is a very small risk that the treated area could become lighter (hypopigmentation) or darker (hyperpigmentation) in colour compared to the surrounding skin. In the event you experience this complication, it is usually treatable with prescription creams, chemical peels, or further laser treatments. There is a less than 1% possibility this could become permanent. The risk of this complication increases with tanned or naturally dark skin. It is important that you let any tanning lotions fade and do not seek artificial tanning treatments (sprays, UV beds, etc.) for 3-4 weeks leading up to your procedure.
- Allergic reaction: There is the possibility of an allergic reaction to the materials used during the photodynamic therapy procedure.
Photodynamic therapy is not right for you if you are pregnant or breastfeeding, have been on Accutane® within the past three months, or have an active cold sore. 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. You should also let us know if you have recently used any type of gold therapy on your skin, as this can cause a blueish/gray discolouration. If you are tanned, your treatment will be rescheduled until the tan fades.
Depending on your skin concerns, we may recommend alternative treatments. Actinic keratoses can be treated by a dermatologist using cryotherapy, topical chemotherapy, or surgery. Alternate treatments for acne include oral and topical antibiotics, Accutane®, and other laser or light-based therapies.