Beauty Advice from Dermatologists

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Laura Skellchock, M.D.
Laura Skellchock, M.D.

Learn about Photodynamic Therapy from Farhad Niroomand, M.D. Farhad Niroomand, M.D.

Photodynamic Therapy (Photorejuvenation)

WHAT IS PHOTODYNAMIC THERAPY (PDT)?

Photodynamic Therapy is the combination of a light sensitizing chemical (5-ALA or "Levulan") with light to treat skin problems. The light gets converted to heat in the skin, which can close down open blood vessels (which are not needed), break up irregular pigment deposits so that the body can clear them, get rid of abnormal cells, and make oil glands smaller and less active.

WHAT SKIN PROBLEMS WILL PDT TREAT?

  • • Sun damaged skin, evidenced by irregular pigmentation and "spots" along with increased vascularity – telangiectatias
  • • Broken blood vessels, overall "redness." Pre-cancerous lesions called "Actinic Keratoses"
  • • Acne and Sebaceous Gland Hyperplasia – both caused by overactive oil glands.

HOW DOES PDT WORK?

When Levulan is applied to the skin for 30-60 minutes before being exposed to light, the skin become more sensitive to light, which makes the light treatment much more effective. The Levulan will preferentially enter sun damaged cells and oil glands – thus its ability to treat pre-cancerous lesions and conditions where oil glands are overactive, such as acne and sebaceous gland hyperplasia.

WHAT PREPARATION IS REQUIRED BEFORE THE TREATMENT?

For approximately 4-6 weeks before the treatment, the skin must be protected from sun by wearing an SPF 50+ sunblock DAILY. A good one which is not costly and not greasy is Neutrogena's SPF 70 "Dry Touch" sunblock, available at WalMart and drugstores. Using Retin-A or another retinoid for 4-6 weeks before the treatment will put the skin into a "regenerative" mode and shorten the healing time after the treatment.

WHAT ELSE SHOULD I KNOW TO MAXIMIZE TREATMENT RESULTS?

By avoiding anything which prevents blood from clotting (alcohol, aspirin, aspirin containing products, NSAIA agents such as Aleve, Motrin, Naprosyn, Advil etc.) the vessels in sun damaged skin will be able to close down more efficiently, leading to a better result. ALSO, anything which causes the skin to vasodilate (excessive exercise for 2-3 days, taking hot showers or using the Jacuzzi/steam room, drinking alcohol, getting upset/angry) should be avoided.

WHAT CAN I EXPECT AFTER THE TREATMENT?

Immediately after treatment the skin will be inflamed, pink, warm and perhaps tender, sometimes with some mild swelling and possibly bruising. Cool soaks for 24 hours (15 mins every hour while awake) will help the vessels close down and minimize pain and inflammation. All of these side effects will minimize over the first 2-3 days, after which the skin may peel. Make-up can be worn after the first 12-24 hours as needed. Keep the skin moist with a good moisturizer as it is healing.

WHAT LIMITATIONS ARE THERE AFTER THE TREATMENT?

Because the Levulan increases the photosensitivity of the skin, it is best to stay indoors, away from windows and bright lights for 36 hours after the treatment. Low level light for reading or watching movies is OK.

WHAT DO I NEED TO BRING WITH ME TO THE TREATMENT APPOINTMENT?

Wear an old washable shirt. Remember to bring your BLT anesthetic cream since we will put that on after we apply the Levulan. Also bring something to read since you’ll need to sit for an hour while the Levulan is absorbed and the anesthetic cream takes effect. A hat is a great idea to protect from the light as you return home, and if you feel you might need one (you probably won't) you might ask a friend to drive you to your appointment or pick you up after it's done.

HOW MANY TREATMENTS WILL I NEED?

Each patient and their problem is individual. One PDT treatment is equivalent to two regular PhotoFacials. Worse sun damage will need more treatments than minor sun damage, but generally two PDT treatments a month apart will be enough for most patients. Two to three treatments a month apart will significantly reduce acne for up to 12-18 months or longer.

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