What is Photodynamic Therapy?

Photodynamic therapy (PDT) is a light treatment that includes Levulan (Aminolevulinic acid), a photosensitizing compound. Levulan is applied 20-40 minutes before a treatment and is preferentially absorbed by certain cells such as precancerous skin cells, oil glands, pores and other structures, making them more sensitive to light. After the incubation period, a treatment using the Cutera Xeo Intense Pulsed Light is performed. Using this technology we can treat actinic keratoses, rosacea, acne, photodamage and other conditions without surgery and/or medication.

Who is a candidate?

Patient with diffuse actinic keratoses, moderate to severe acne and/or rosacea, or moderate to extensive sun damage are good candidates for photodynamic therapy.

If you are pregnant, have been on Accutane within 3 months, or have an active cold sore you should not have this procedure. If you are taking aspirin or blood thinners, you may experience some bruising that can take up to 2 weeks to resolve. If you are tanned or have recently been exposed to the sun in the area you are having treated, you may be more susceptible to potential side effects such as blisters or crusts and/or your treatment may need to be reduced in intensity or postponed until the tan fades.

What is Photodynamic Therapy like?

You will be asked to arrive 40 minutes before your treatment. During this time the treatment area will be cleased with acetone and alcohol. Levulan will be applied to the treatment area and allowed to incubate for a specified amount of time. During the incubation time you will be allowed to rest in a separate waiting room.  After the incubation, the Levulan will be removed with alcohol and the treatment area will be cleansed with soap and water. Treatment will follow with the Cutera Xeo Intense Pulsed Light. After the treatment, sunscreen will be applied.

How does Photodynamic Therapy work?

When applied, Levulan is preferentially absorbed by certain cells such as precancerous skin cells, oil glands, pores and other structures, making them more sensitive to light. Thus when a light treatment follows, we can treat conditions such as actinic keratoses, acne, rosacea, and sun damaged skin.

What desired results can be expected?

Results depend on the condition being treated.

Actinic keratoses can usually be treated in 1-2 treatments. Occasionally thicker actinic keratoses may not fully respond to light treatments, and alternative treatment, such as cryotherapy or topical chemotherapy, may be necessary. Subsequent actinic keratoses may develop over time and future treatments may be needed.

Acne breakouts can be greatly reduced in three treatments and rosacea is usually improved in three to five treatments. Rosacea and acne can be chronic conditions, and maintenance treatments may be necessary to remain in remission.

Are there any negatives?

The majority of patients undergoing photodynamic therapy have minimal discomfort with no adverse effects or very mild redness and peeling. About 25% of patients have redness and peeling with some discomfort that lasts for 2-3 days and feels and looks similar to first-degree sunburn. Less than 2% of patients can have extreme redness, peeling, pustules, and/or blisters as well as significant pain that can last for 5-10 days. After Levulan is applied, the area will be sensitive to sunlight or other intense light sources for 48 hours. YOU MUST STAY OUT OF DIRECT LIGHT, EVEN PROLONGED EXPOSURE THROUGH A CAR WINDOW FOR 48 HOURS. It is also extremely important that following a treatment a sunscreen with zinc and or Titanium oxide and SPF# 30 or higher is used regularly for at least the first 48 hours following. For those who need to be mobile, use a thick layer of pure zinc oxide to the entire area that is treated (can buy in any drugstore). Failure to stay out of the sun following a treatment will increase your risk of these side effects, but they may occur regardless of sun exposure.

What happens after Photodynamic Therapy?

A sunblock containing zinc oxide with an SPF30 or higher should be used for at least 48 hours following a treatment. Consider a broad rimmed hat even when going to and from your car. Apply pure zinc oxide thickly to the treated area if you need to be exposed. Make up may be applied immediately after your treatment. Normal skin care can be resumed after 24 hours unless otherwise directed by your provider.

Is there another way to get the same effect?

Cryotherapy, topical chemotherapy, and surgery are alternative treatments for actinic keratoses.

Traditional oral and topical medications are alternative treatments for acne and rosacea.

Laser photorejuvenation, chemical peels and physician dispensed skincare products are alternative methods for treating photodamage.

How is this different than other procedures?

Photodynamic therapy allows effective treatment of actinic keratoses over large areas without pain and extensive downtime associated with cryotherapy and topical chemo.

Laser and intense pulsed light have already been effective in the treatment of rosacea and acne, but by adding Levulan we are able to treat it more effectively with fewer treatments and get longer lasting results.

What is the cost of Photodynamic Therapy?

In some cases, such as for the treatment of actinic keratoses, we may be able to submit treatment to your insurance if we are contracted with them. Treatments for conditions such as acne, rosacea, and sun damage are at this time rarely covered by insurance. Although some insurance companies do reimburse for a portion of the cost of treatment, the entire cost of treatment is not covered by the insurance company.  The cost of the treatment is 450/per session and usually 3-4 treatments are required as well as maintenance treatments. Payment is required in full prior to each treatment. Any amount reimbursed by your insurance company will then be directly reimbursed to you.  If you would like to check on your insurance companys reimbursement, you will need the following codes  99213 modifier 25, 17004 or 96567, J7308 for Diagnosis (ICD9) of Acne Vulgaris 706.1, Rosacea 695.3, Actinic Keratoses 702.0.