Photodynamic Therapy (cont.)
Gary W. Cole, MD, FAAD
Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is photodynamic therapy (PDT)?
- What photosensitizer drugs are available?
- What light sources are available, and how are they applied?
- How does photodynamic therapy work?
- Does PDT make me permanently more sensitive to light?
- How is PDT used to treat the skin?
- What is a typical skin PDT session like?
- How much improvement can I expect with photodynamic therapy?
- Where can I have photodynamic therapy, and who performs the procedure?
- What are the advantages with photodynamic therapy for treating actinic keratoses?
- Am I a good candidate for photodynamic therapy?
- What growths is PDT not good for?
- What are possible complications of photodynamic therapy?
- Is there scarring from photodynamic therapy?
- What are alternatives for photodynamic therapy?
- What about insurance coverage and costs of photodynamic therapy?
- How do I prepare for my procedure?
- How is recovery after photodynamic therapy (PDT)?
- Is there pain after PDT?
- How do I take care of my treatment area after photodynamic therapy?
- What is the chance that my actinic keratoses will recur?
- Find a local Dermatologist in your town
What are the advantages with photodynamic therapy for treating actinic keratoses?
The greatest advantage of PDT is the ability to selectively treat an entire area of skin damage and precancerous actinic keratoses (blanket or field treatment). PDT generally decreases the likelihood of lighter or darker skin spots (post-inflammatory hyper- or hypopigmentation) caused by routine freezing with liquid nitrogen. Additionally, PDT frequently may facilitate smoother skin and an overall improved appearance, tone, color, and enhanced skin texture.
In several studies, PDT has been preferred by many patients for ease of use and rapid recovery as compared to alternative treatments including freezing and topical fluorouracil (Efudex). The PDT side effects may be milder with less downtime than with fluorouracil.
For patients with many skin lesions, PDT may be generally more effective than repeated spot treatment with topical liquid nitrogen. Some patients are unable to tolerate the prolonged treatment required with fluorouracil or imiquimod (Aldara) because of the irritation, redness, and possible downtime with these topical creams. PDT is very well-tolerated, noninvasive (no needles or surgery required) procedure to help reduce sun damage and enhance the overall cosmetic outcome (particularly in sensitive areas of the face and chest).
Am I a good candidate for photodynamic therapy?
The best candidates for PDT may be those with lighter or fair skin with sun damage.
You may not be a good candidate for photodynamic therapy if you have darker skin that tends to turn brown or discolor with certain light or laser treatments. You may also not be a good candidate for PDT if you are very sensitive to light, burn extremely easily, would be unable to stay out of sunlight for the required 24-48 hours, or are taking medications which may make you very sensitive to sunlight or light-based therapies. People with certain medical diseases (such as systemic lupus erythematosus) may not be candidates for PDT because of increased risk of burning from the light exposure.
Your decision on the best treatment choice may depend on different factors such as the location and type of skin lesions, your past treatments, your overall health, and level of comfort. Your physician can help you sort through the different treatments.
Your physician needs to know of any other medical conditions that may affect your procedure or overall wound healing. You would want to make sure to tell your physician beforehand if you have any extreme sensitivity to light-based treatments, take medications which make you very sensitive to light, have had a problem or bad effect from prior PDT, have systemic lupus erythematosus, or suffer from a condition called porphyria.
Your PDT physician needs to know if you have had a history of staph or other skin infections in the recent past. You will also want to advise your physician if you have a history of frequent cold sores (herpes virus infections on your face). In that case, you may be prescribed an antiviral tablet (cold-sore prevention pill) to take before and after your procedure. You may be asked to wash with a special antibiotic soap or wash like chlorhexidine (Hibiclens) the night or morning before your procedure to help reduce the number of bacteria on your skin.
Patients may need to also advise their physician of any drug allergies such as to topical anesthetics or other photosensitizers. Additionally, the surgeon may need to know of any bleeding or bruising tendencies, hepatitis, HIV/AIDS, or pregnancy.
Your physician will want to know of any factors that may affect your surgery or wound healing.
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