Photodynamic Therapy
Photodynamic Therapy (PDT) is a special treatment to remove sun damaged pre-cancerous zones and spots called actinic keratosis (AK’s). It is performed with a topical photosensitizing agent called Levulan® (5-aminolevulinic acid or ALA) that is activated with the correct wavelength of light. This treatment is approved by the Federal Drug Administration (FDA).
WHAT IS ALA or Levulan® (AMINOLEVULINIC ACID)?
Aminolevulinic acid (ALA) is a clear solution that is put on the skin. ALA naturally occurs in the body and is part of the synthesis of hemoglobin. ALA is absorbed by abnormal precancerous skin cells and will cause little to no damage to healthy skin cells. A special blue light is then used to activate this solution.
WHAT IS AN ACTINIC KERATOSIS (AK’s)?
Actinic keratosis is a small, rough, raised area found on skin that has been in the sun for a long period of time. Some actinic keratosis may develop into a type of skin cancer. Actinic keratosis is usually found on the face, scalp, back of the hands, chest, or other sun-exposed areas.
Symptoms of AK’s may include:
Patients with severe 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 pitted acne scars. Active acne can improve dramatically.
HOW MANY TREATMENTS WILL IT TAKE?
To achieve maximum improvement of pre-cancerous (actinic keratosis) sun damage, skin tone and texture, a series of two treatments for actinic keratoses and two to four treatments for acne are most effective. Some patients with only actinic keratosis are happy with just one treatment. More treatments can be done at periodic intervals in the future to maintain the clearance of the actinic keratoses and the rejuvenated appearance of the skin.
WHAT ARE THE SIDE EFFECTS FOLLOWING TREATMENT?
PDT causes the skin to have a sunburn-like reaction. Following PDT, the treated areas can appear red with crusting which is followed by peeling for 2-7 days. Some patients have an exuberant response to PDT, and experience marked redness of their skin for a couple of weeks. Less commonly temporary swelling of the lips and around your eyes can occur for a few days. Darker pigmented patches called lentisines (commonly known as Liver Spots) can become temporarily darker and then peel off leaving normal skin. (This usually occurs over seven to ten days.)
WHAT ARE THE ADVANTAGES?
DOES INSURANCE COVER MY PROCEDURE?
This procedure is covered by Medicare/Medicaid and the majority of insurance companies. A copay for private insurance may apply. It is your responsibility to check with your insurance about coverage.
TREATMENT PROCESS:
WHAT IS ALA or Levulan® (AMINOLEVULINIC ACID)?
Aminolevulinic acid (ALA) is a clear solution that is put on the skin. ALA naturally occurs in the body and is part of the synthesis of hemoglobin. ALA is absorbed by abnormal precancerous skin cells and will cause little to no damage to healthy skin cells. A special blue light is then used to activate this solution.
WHAT IS AN ACTINIC KERATOSIS (AK’s)?
Actinic keratosis is a small, rough, raised area found on skin that has been in the sun for a long period of time. Some actinic keratosis may develop into a type of skin cancer. Actinic keratosis is usually found on the face, scalp, back of the hands, chest, or other sun-exposed areas.
Symptoms of AK’s may include:
- They begin as flat and scaly areas.
- The color may be gray, pink, red, or the same color as the skin.
- Often, it has a white or yellow crusty "scale" on top.
- Later it develops a hard and wart-like or gritty, rough, surface. It may be easier to feel than see.
Patients with severe 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 pitted acne scars. Active acne can improve dramatically.
HOW MANY TREATMENTS WILL IT TAKE?
To achieve maximum improvement of pre-cancerous (actinic keratosis) sun damage, skin tone and texture, a series of two treatments for actinic keratoses and two to four treatments for acne are most effective. Some patients with only actinic keratosis are happy with just one treatment. More treatments can be done at periodic intervals in the future to maintain the clearance of the actinic keratoses and the rejuvenated appearance of the skin.
WHAT ARE THE SIDE EFFECTS FOLLOWING TREATMENT?
PDT causes the skin to have a sunburn-like reaction. Following PDT, the treated areas can appear red with crusting which is followed by peeling for 2-7 days. Some patients have an exuberant response to PDT, and experience marked redness of their skin for a couple of weeks. Less commonly temporary swelling of the lips and around your eyes can occur for a few days. Darker pigmented patches called lentisines (commonly known as Liver Spots) can become temporarily darker and then peel off leaving normal skin. (This usually occurs over seven to ten days.)
WHAT ARE THE ADVANTAGES?
- Easier for patients than repeated applications of topical products and a shorter recovery period.
- It is less painful than cryotherapy.
- Reduced scarring and improved cosmetic outcome compared with cautery, surgery and liquid nitrogen.
- Levulan® treats visible and subclinical lesions-also referred to as a field treatment.
- It may improve the appearance of photoaging with decreased sebaceous hyperplasia (oil glands), minimize pore size and improved facial color, texture and tone.
DOES INSURANCE COVER MY PROCEDURE?
This procedure is covered by Medicare/Medicaid and the majority of insurance companies. A copay for private insurance may apply. It is your responsibility to check with your insurance about coverage.
TREATMENT PROCESS:
- Patients who have a history of recurring cold sores (Herpes simplex type I) or a history of herpes zoster in the treatment area will be started on a prescription antiviral medication on the day of the treatment.
- Make sure your skin is clean and free of all makeup, moisturizers, and sunscreens. Bring a hat, sunglasses, and scarf when appropriate to the clinic. If treating a body area, UPF clothing may be appropriate.
- Photography may be done by the staff before the Levulan® is applied.
- A consent form is required. You cannot be pregnant or breastfeeding.
- An acetone scrub is performed. This will enhance the absorption of the Levulan® and to give much more even uptake.
- Levulan® is applied topically to the whole area/zone to be treated (such as the whole face, back of the hands, extensor part of the forearms).
- The Levulan® is left on for 30-90 minutes before any light treatment is performed. Please bring a book, magazine or other activity to help pass the time.
- The Levulan® is activated with a unique spectrum of light. During this time you will be given a cool cloth and a device that blows cool air to make you as comfortable as possible. Most patients will experience a sensation that ranges from tingling to burning and stinging.
