Photodynamic Therapy

PDT Procedure for Sun Damage, Actinic Keratoses and Superficial Skin Cancers

PhotoDynamic Therapy (PDT) is a safe, effective, non-surgical procedure used to treat a variety of skin conditions including acne, rosacea, sun-damage, actinic keratoses (precursor lesions to skin cancers) and certain types of skin cancer.

A photosensitizing agent called aminolevulinic acid (ALA) in either a solution or gel form (Levulan® or Ameluz® respectively) is applied to the skin. Although the connotation of an application of an acid onto the skin sounds painful, the application of ALA is not uncomfortable whatsoever. The ALA is then allowed to incubate on the skin overnight. The following morning, ALA must be activated by a light source, and although the ALA can be activated by a variety of light sources, in our office, ALA is activated by a light device called Intense Pulsed Light (IPL); the same light device used for photorejuvenation and photofacials. This effect activates and destroys abnormal cells, while leaving healthy skin unharmed. 

Prior to Treatment:

1. Avoid prolonged direct sun exposure (golf, beach, pool, etc) for 1 week prior to your procedure.
2. Avoid use of retinoids (Retin-A, Tazorac, Differin, Z*RO Wrinkles) or retinol-containing products 1 week prior to your procedure.
3. Please inform your provider if you have a history of recurrent cold sores. We will prescribe an oral antiviral medicine to be started the day of your treatment.
4. All patients with darker skin tones must use Z*RO Dark Spots hydroquinone for a minimum of 2 weeks prior to treatment. This down-regulates pigment and prepares the skin for treatment.
5. Do not apply makeup, lotions, or any skin care products prior to treatment.
6. All men must shave their face the day of the application of Levulan® or Ameluz®.

Treatment Day:

1. Do NOT wash your face once the Levulan® or Ameluz® has been applied.
2. Avoid outdoor activities (IE walking your dog) in the morning prior to treatment as even sunlight through the clouds can activate the photosensitizing agent.
3. Wear a hat or use an umbrella to shield your skin from the sun.
4. A slight burning or stinging sensation is normal even when only walking to the car.
5. It is normal for the skin to turn a pinkish hue prior to treatment.
6. If your pain threshold is low and you have been prescribed a narcotic medication, please take this medication an hour and a half prior to treatment and make arrangements to be driven to our office for treatment.
7. The activation portion of the procedure with IPL is performed by your Z*Roc dermatologist and takes approximately 15-30 minutes.
8. The sensation of the treatment can be compared to multiple rubber band “snaps”, however, the treatment can be paused if necessary to minimize pain.

Post Treatment:

1. Immediately following your treatment, stay indoors for the entire day
2. Avoid direct sunlight as well as bright indoor lights for 24 to 48 hours. The photosensitivity to sunlight is usually gone 24 hours after treatment but may last as long as 48 hours.
3. If you have any discomfort, begin applying ice packs or cool compresses to the treated areas as frequently as necessary.
4. Use a moisturizer (IE Avene® Cicalfate Post Procedure or Z*RO Downtime Intensive Antioxidant Recovery Cream) as frequently as necessary.
5. Moisten and irrigate the skin to promote the wound healing process with Lasercyn Dermal Spray as frequently as necessary. Leaving the spray in the refrigerator to cool the solution will also help alleviate pain when applied.
6. If swelling occurs, it may last for a few days. Elevate your head on two pillows to decrease swelling. Ice 20-minutes per hour for significant swelling.
7. For pain relief, take an over the counter pain reliever like Advil®, Motrin® or Tylenol®.
8. You may apply topical Hydrocortisone 1% lotion or cream to reduce stinging and burning however USE ONLY IF NECESSARY. Using a topical steroid blunts the immune response which decreases the efficacy of treatment. This can be purchased over-the-counter.
9. You may shower as desired. Do not let hair products touch the face or treated area.
10. Avoid hot tubs and spas for one week post-treatment.
11. Avoid working out or excessively sweating until the peeling (if it occurs) stops.

Skin Care:

1. Be sure to thoroughly wash your hands prior to touching your face.
2. Cleanse skin with Z*RO Downtime Ultra Gentle Revitalizing Cleanser, cool water and your fingertips. Do NOT use a Clarisonic® brush or anything similar until after the peeling stops.
3. Use Z*RO Sun Sheer Mattifying Antioxidant Sunscreen daily. It is especially effective at protecting your newly rejuvenated skin.
4. Your skin may appear red and flaky and feel dry and tight for 1-2 weeks following treatment. Use a moisturizer (IE Avene® Cicalfate Post Procedure or Z*RO Downtime Intensive Antioxidant Recovery Cream) as frequently as necessary to aid in discomfort.
5. Moisten and irrigate the skin to promote the wound healing process with Lasercyn® Dermal Spray as frequently as necessary. If you leave your house, when you return, use the Lasercyn® Dermal Spray immediately to kill bacteria, viruses and fungi you may have encountered after leaving your home.
6. Treated brown spots usually darken after treatment, and crusting begins to form within a few days. This crusting usually resolves in 7-10 days and should be allowed to naturally flake off for best results.
7. No picking, peeling or scrubbing the skin in any way while healing which could lead to scarring.
8. For facial hair, no shaving with a razor blade until day 5 post treatment.
9. You may use makeup and return to your normal skin care routine once any peeling or crusting has healed, and as long as the skin is not broken. Most patients have completed the peeling process after 7 to 10 days.
10. If the skin is broken or a blister appears, apply antibiotic ointment (Bacitracin or Polysporin) and contact the office immediately.
11. The area may be a healthy pink for up to 1 month. 

Treatments are typically spaced in 4 week intervals, although the actual number of treatments, treatment time, and treatment intervals will vary depending on your condition. A follow up examination is conducted 2 weeks post-procedure to assess the efficacy and possible necessity of further treatments. 

The most obvious benefit of this procedure is the improvement in the overall appearance of the treated area. There will be a significant decrease in number of brown spots and dilated blood vessels with an evening out of skin tone and pigmentation. The number of pre-cancerous lesions will decrease by about 80%. In addition, tightening of the skin with a decrease in fine lines and wrinkles may also be observed. With each treatment, these improvements will continue to increase ultimately providing you with smoother, healthier, younger-looking skin.

PDT for Acne

When used to treat acne, PDT activates the porphyrins in the bacteria, effectively killing the bacteria that causes acne. The PDT procedure for acne is slightly different. As opposed to an overnight incubation, ALA is left on the skin for only an hour prior to light activation with IPL. However, the activation portion and post-procedure care is exactly the same as discussed above.

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