PhotoDynamic Therapy™ (PDT) is a treatment protocol for the treatment of pre-cancerous actinic keratoses (AKs), superficial basal cell skin cancer (sBCC) and skin photorejuvenation.

Photodynamic therapy (PDT) involves the use of photochemical reactions mediated through the interaction of photosensitizing agents (Levulan), light and oxygen. PDT is a two-step procedure.  In the first step, the thin layer of photosensitizer Levulan (ALA, 5-aminolevulinic acid) is applied to the affected skin. In the second step the photosensitizer is activated in the presence of oxygen with a select wavelength of light (Blu-U or red).  Because the photosensitizer is preferentially absorbed by hyperproliferative damaged skin and the light source is directly targeted on the lesional skin Levulan PDT achieves dual selectivity, minimizing damage to adjacent healthy structures.

Indications

The only FDA-approved indication for Levulan-PDT in dermatology is currently the treatment of actinic keratoses (AKs). Common off-label uses include the treatment of superficial basal cell carcinoma (sBCC), photoaging, and squamous cell carcinoma in situ (Bowen disease).

A clear liquid called Levulan® Kerastick® is applied to the skin. After a selected period of time (incubation period) the skin will be exposed to a blue or red light.

What are the benefits of PDT?

The benefits of Levulan PDT include:

• Reducing the risk of developing skin cancer by treating pre-cancerous AKs
• Improvement in the appearance of your skin. After Levulan PDT treatment sun damage, fine lines, pore size and blotchy pigmentation are less visible.
• Less downtime than other treatment options

Many of the patients participating in the studies experienced 75-100% clearance of early AKs eight weeks after treatment with Levulan® Kerastick® Topical Solution and blue light.

What are the disadvantages?

Levulan PDT treatment may be associated with burning/stinging sensation.  Following Levulan PDT, the treated areas can appear red and/or swollen. The skin may peel within 2 – 7 days. Darker pigmented patches may become temporarily darker and then peel off leaving normal skin. Treated areas of the skin should not be exposed to direct sunlight 72 hours after treatment. Repeat treatments may be necessary.

What precautions should be taken post-treatment?
Patients should avoid exposure of the photosensitive treatment sites to sunlight or bright indoor light prior to and at least 48 hours after light treatment. Exposure may result in a stinging and/or burning sensation and may cause erythema or edema of the lesions. Sunscreens will not protect against photosensitivity reactions caused by visible light.

Post-Photodynamic Therapy (PDT) Instructions

The treated area is very delicate and should be treated gently.  Burning /stinging, which could be severe, may last up to 24 hrs after the treatment and should be progressively improving.   If discomfort worsens please contact our office immediately as this may represent bacterial, fungal or viral infection.  After treatment you may experience redness for a few days to 2-3 weeks.   It is common to experience immediate swelling and discomfort of the treatment site, and a crust may form.  A small amount of bleeding may also occur.  Please read and follow these instructions.

General Instructions

Avoid direct exposure to sunlight during the first week or two following your laser treatment.  Wide-brimmed hats, sunglasses, sun-protective clothing may be used to protect from the sun.  An SPF 30 or higher sunscreen should be used when skin has healed.

• Avoid any trauma, such as scratching, picking or rubbing to the treated areas as permanent scarring may result.
• You may shower normally, but gently pat the area to dry.
• It is OK to apply makeup on the treated areas the day after treatment unless the area is eroded or a crust forms.
• Swimming and contact spots should be avoided until your skin has healed completely.

Wound Care Instructions

Wash the treated area with a mild soap (Dove, Purpose, Basic or Cetaphil) twice daily, and then apply Hydra Balm,  Aquaphor Healing Ointment or Vaseline twice daily until the area has completely healed.  ONLY IF the treated area is crusted or blistering apply water and white vinegar (water to white vinegar ratio 3:1) compresses to the area every hour for 10-15 mins.

The area does not need to be covered, but non-stick (Telfa) gauze should be applied to protect the treated area from irritation by clothing, jewelry, eye glasses etc.

If your face has been treated, keep your head elevated by sleeping on three to four pillows or raising the head of the bed for two to three days to help prevent swelling.

Any discomfort or burning sensation at the treatment area may be relieved by acetaminophen (Tylenol) and the application of ice or a cool washcloth.  Mild topical steroid such as hydrocortisone applied twice daily may reduce local inflammation.

If you have any questions or concerns regarding your PDT treatment or post-operative care, please do not hesitate to contact our office at 646-759-8449.