What is Photodynamic Therapy? Could it be the Solution to your Seemingly Unsolvable Skin Concerns?

Photodynamic Therapy (PDT) is one of my favorite procedures we do.  I do it to myself at least once or twice a year, plus we have many patients who enjoy the medical and cosmetic benefits of this procedure.  At the recent AAD conference, I attended a two-hour session on PDT.  One of my friends jested with me a little,  “Why are you going to a class about something that is 20 years old and something you already do?”  Well, there’s always something to learn and ways to improve!  Here are the latest advancements, research, and improvements in PDT that we are starting to implement in the office.

First, for those who are new to PDT, here are the basics:  PDT is used to treat actinic keratoses, acne, rosacea and sun damage.  For PDT, a solution or gel of Aminolevulinic Acid (ALA) is applied to targeted areas of the skin.  The ALA is allowed to incubate for at least one hour.  ALA is preferentially absorbed by abnormal precancer and cancerous cells as well as oil glands.  After incubation, patients sit under a panel of lights.  There is a reaction between the light and the solution that is in the targeted cells that causes selective destruction of the targeted cells.  The procedure is usually done in a series of two procedures at least six weeks apart.  Insurance generally covers PDT for treatment of actinic keratoses (precancerous spots) on the face, scalp and arms only. Treating precancerous areas on other parts of the body or treating acne or rosacea is usually not covered by insurance.

Let’s check out the new ways we will be trying to augment the effect of PDT!

Pretreating with a retinoid!  Retin A helps remove old skin cells to prepare the skin to more readily absorb ALA.  The most inexpensive and least irritating way to prepare the skin with a retinoid is using Differin (generic – adapalene) available OTC and by prescription. We will start recommending pretreating with Differin nightly for three weeks prior to PDT.

You can purchase Differin at local stores or online.

Saran Wrap!  Wow, now that is scientific advancement.  Seriously! In dermatology, we often place medications on the skin under occlusion to increase their penetration.  We will start using plastic wrap to improve penetration on the scalp and other non-hair bearing flat areas.  On the face, we can also use a plastic gel mask to improve penetration.

Heat! There have been a number of studies evaluating ways to make the ALA penetrate better and more effective.  In addition to occlusion with plastic wrap, heat improves efficacy.   We are experimenting with heat using warm packs, warming gel masks and space heaters

Meet Poly!  Poly is our new light for PDT.  In addition to providing the traditional blue light, Poly uses red light.  Poly panels can also be molded to conform better to the targeted are and get closer to the skin as well.

Red light!  ALA can be activated by both red and blue light.  The benefit of red light for treating precancerous cells and sun damage is that red light penetrates deeper into the skin than blue light.  However, blue light remains the treatment of choice for acne and rosacea because only blue light targets bacteria seen in acne and rosacea. In upcoming blog posts, we plan to discuss the benefits of LED red light therapy alone and a new cosmetic procedure for the decolletage using this technology.

For more details about PDT see on our website!

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