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What is Photodynamic Therapy (PDT)?

Photodynamic Therapy is a procedure designed to target harmful agents in the body such as cancer cells, precancerous lesions, and to treat a variety of skin conditions, including acne, psoriasis, and age-related macular degeneration. The treatment, which can be known by many names, including PDT, photoradiation therapy, phototherapy and photochemotherapy, is a two part treatment. First, a drug known as a photosensitizer, is administered to the patient topically and applied to the skin. A photosensitizer, known also as a photosensitizing agent, is a type of drug that it sensitive to a certain wavelength of light, meaning that once the drug has entered the patient’s body, there are no toxic affects until a light is applied to the treatment area. The second part of the treatment is the use of a light to activate the photosensitizer drug that remains in the harmful cells or agents in the body while leaving the normal cells unaffected. The light can either be administered via a laser, Blue light, or a light-emitting diode (LED) light.

Photodynamic therapy is a very elegant way to remove superficial skin cancer without any disruption to your normal daily activities. PDT is a very popular procedure for superficial skin cancer treatment and photodamage.  It is a completely noninvasive procedure which means that you can return home immediately after your outpatient treatment procedure, meaning that you can return home back to your normal activities immediately after treatment. The treatment has been shown to be just as effective at eliminating superficial skin cancer as surgery without damaging the normal cells in the treatment area, thereby preventing unwanted scars. Additionally, there are no long-term side effects associated with the treatment.

When looking to treat several forms of cancer, pre-cancerous lesions, and a variety of skin conditions with photodynamic therapy, there are only a few doctor’s offices, and dermatologists with the proper equipment and expertise. In New York City, experienced, board-certified dermatologist, Dr. Michele Green, is able to treat patients with PDT in her Upper East Side dermatology office. With the photosensitizing agent, Levulan Kerastick, Dr. Green is able to treat pre-cancerous lesions, called actinic keratoses, stubborn acne vulgaris, and other forms of sun damage. Dr. Green has been recognized as an international expert in dermatology, and in cosmetically elegant ways of removing photo damage and precancerous lesions, to leave you with beautiful, clear skin.

What is photodynamic therapy used to treat?

There are many uses for photodynamic therapy for skin conditions, cancers, and pre-cancers. According to the National Cancer Institute, photodynamic therapy can be used to treat a variety of different types of cancer and cancer symptoms. Specifically, the treatment is best for cancers that affect the head and neck, skin, and lungs, including advanced cutaneous T-cell lymphoma, Barrett esophagus, Basal cell skin cancer, stage 0 of squamous cell skin cancer (also known as Bowen’s disease), throat cancer (also known as esophageal cancer), and non-small cell lung cancer. PDT can also be used for the pre-cancerous stage of skin cancer, called actinic skin cancer, and non-melanoma skin cancer. Certain cancer symptoms can also be relieved with the help of PDT treatment, including reducing throat blockage that occurs as a result of esophageal cancer and blocked airways that result from non-small cell lung cancer. PDT can also be used to address several other conditions that affect the skin, including psoriasis, acne vulgaris, age-related macular degeneration, and warts.

How does photodynamic therapy work?

Photodynamic therapy involves three steps in order to function properly: (1) the administration fo the photosensitizing agent, (2) the incubation or drug-to-light interval, and (3) the light activation. First, the photosensitizing agent is administered to the patient, via topical application to the affected area of the skin. Over the course of several hours to 72 hours (depending on the type of photosensitizing agent), the drug will travel through the patient’s body and leave the normal cells. However, the photosensitizing drug remains in the cancerous cells or harmful agents in the body. During the incubation phase, the photosensitizer drug is non-toxic and has no affect on the cells or tissue in the body. The drug becomes activated, however, when a specific wavelength of light is shone onto the treatment area. When the photosensitizing agent is activated, it produces a particular form of oxygen, which is known as an oxygen radical, that targets and kills that cells that have absorbed the drug, which kills them. The activation of the drug can also cause damage to the blood vessels in the treatment area, which prevents blood from reaching the cancerous cells.

There are two most widely used photosensitizing agents that use two different kinds of light to activate them: Porfimer sodium (also known as photofrin) and Aminolevulinic acid (also known as ALA or Levulan). Porfimer sodium is FDA approved to treat certain forms of lung and esophageal cancer and is activated by laser red light. ALA on the other hand is used to treat the pre-cancerous actinic keratosis and other forms of skin cancer. ALA is activated via the use of a blue light and is most frequently used to treat the face and scalp.

Which types of skin cancer is PDT/Blue Light used for?

Blue light/PDT is best used to treat pre-cancerous skin lesions, called actinic keratoses. Actinic keratoses develop as a result of too much sun exposure and can take the form of red, pink, or flesh-colored scaly patches on the skin. Many of these lesions developing on the surface of the skin may not be uncomfortable but can be unsightly and potentially develop into skin cancer. If new or irregular lesions develop on the surface of your skin, it is always best to have them examined by a board-certified dermatologist, such as Dr. Michele Green in NYC, to ensure that they do not develop into skin cancers. For patients with many actinic keratoses lesions, PDT Is the optimal treatment, as the procedure can treat all of the lesions in one area in as little as one session.

The process of the Blue Light treatment is a straightforward two part process. The Blue light treatment is paired with the photosensitizing agent, Aminolevulinic acid, also known as ALA or Levulan. This photosensitizer is applied directly to the skin of the treatment area. The incubation period is generally fairly short, typically one hour, and then the area is exposed to the wavelength of blue light and the Levulan is activated.  The precancerous actinic keratoses lesions “light up,” get more red after treatment, and disappear in a number of days. For patients with many actinic keratoses lesions, PDT Is the optimal treatment, as the procedure can treat all of the lesions in one area in as little as one session.

What is the process of PDT?

Photodynamic therapy works by utilizing a photosensitizing molecule and a light source which activates this medication.  There are different photosensitizers used such as Levulan or 5-aminolevulinic acid , and methyl aminolevulinate (MAL-PDT). The photosensitive molecule which Dr. Green utilizes is called Levulan. Photodymaic therapy is a three part treatment process. First is the application of photosensitive drug, second is the incubation period involved, and last the light activation.

Step 1:  Application of photosensitive drug

The patient comes to the office and the treatment area is cleaned of any moisturizers or sunscreens. Alcohol may be used before your treatment to remove any makeup or oils from your face. Pre-treatment photographs are taken for your patient record and procedure consents are removed and signed. To begin the treatment the photosensitizer, Levulan Kerastick Topical solution (20% delta-aminolevulinic acid HCL), is applied to the treated area, which is typically the face.  Other areas such as the back, chest, or scalp, can be treated as well. The medicine is allowed to air dry for a few minutes and then patients wait in the office for an hour or more for the Levulan to incubate.

AS BluLight Before And After MGWatermark

Blu-U light & Levulan treatment before and after

Step 2:  Incubation time

The incubation time for Levulan is typically one hour on the treatment area. Levulan is a clear liquid which is applied and there is no discomfort during this incubation period.  The incubation period for the face is 60 minutes. Other areas of the body may have longer incubation times. Some areas such as the back, chest, arms, or legs, may need incubation times of more than one hour.

Step 3:  Light Activation

Levulan is removed completely with water. There are many different PDT light sources, which include laser light, intensed pulsed light, blue light, red light, and visible lights including natural sunlight. The patient sits in front of the UV light, most commonly blue light (BLU-U) is used.  The light source needs to be directly applied to the treatment area where the photosensitized medication was applied.  With BLU-U, typically the treatment area is six inches away from the light source.  The patient sits in front of the blue light for approximately 16 minutes while the Levulan is activated by the light source.  Most patients prefer to sit up in a comfortable chair facing the BLU-U light when treating the face.  When treating other areas such as the legs, you can lie down on the exam table to complete your treatment. Eye shields are worn during the procedure to help protect your eyes from the UV light.

Levulan can cause sun sensitivity to the treated area for 24-72 hours after exposure.  It does not cause sun sensitivity on other parts of the body where the Levulan was not applied.  It is best to avoid direct light or sun light to your treatment area for 24-72 hours after your procedure. Sun glasses and a wide brimmed hat, as well as sunscreen, are recommended.

What are the side effects of photodynamic therapy?

The possible side effects of photodynamic therapy include:

  • Redness
  • Swelling
  • Peeling
  • Crusting
  • Burning
  • Sunburn
  • Temporary hyperpigmentation
  • Stinging
  • Blisters

Approximately 50% of patents experience stinging or burning during the treatments.  This burning usually plateaus within 5 to 6 minutes of treatment.  We often apply a fan to cool the area during the treatment to improve patient comfort.

Most of the side effects that are potentially associate with PDT are minor and resolve themselves on their own within a couple of days post-treatment. One type of photosensitizer drug, called porfimer sodium, which is used to treat some forms of lung and esophageal cancer, can be associated with sensitivity to light for as much as six weeks post treatment. In that case, patients should avoid direct sunlight as well as bright indoor lights and reflective surfaces. In rare cases, depending on the part of the body and type of cancer being treated, more serious side effects may occur including:

  • Cough
  • Difficulty swallowing
  • Trouble breathing
  • Stomach pain

Who is a good candidate for PDT in dermatology?

35-44 year old man treated with photodynamic therapy to remove red spots

Results with ALA-PDT photodynamic therapy are impressive.  For patients with acne vulgaris who are non responding to topical or oral antibiotics, photodynamic therapy is a great option.  It can be performed on all skin types with minimal side effects.  ALA-PDT treats the active acne lesions, active pimples, decreases comedonal acne, kills the bacteria which cause acne and improves the appearance of acne scars. Again, it is a very popular alternative for many patients who are reluctant to take oral medications or unable to take isotretinoin (Accutane) and want to avoid systemic side effects.  Photodynamic therapy will leave your skin smooth and reduce both acne and acne scars on your face.

In addition, patients who have had chronic sun damage and many pre-cancers, benefit with ALA-PDT as it treats and removes actinic keratosis and the surrounding sun damaged skin. Most patients prefer photodynamic therapy over Efudex cream to treat actinic keratosis, since the cream needs to be used for several weeks and leaves patients red, sore, and scaly for a prolonged period of time, rather than the typical 48 hours from photodynamic therapy.  The other huge advantage of photodynamic therapy over spot treatment of actinic keratoses, is that the entire face can be treated in one session. The entire face will be treated, leaving even, rejuvenated skin, treating the entire photo damaged area.  Unlike other spot treatments for the face, such as liquid nitrogen, there is no risk of hypopigmentation or scarring associated with ALA-PDT.  All skin types can be treated with photodynamic therapy.  However, care must be used in treating Fitzpatick skin types III or greater, as they have increased risk of temporary hyperpigmentation.

Photodynamic therapy can only be performed in a dermatology office, such as the NYC office of Dr. Michele Green. Since this treatment is more expensive than prescription medications, it is best to check directly with your health insurance company to ascertain if they cover this treatment for your skin. If you have any pre-existing photosensitive conditions, such as lupus erythematous or porphyria, it is best to tell Dr. Green before your procedure. If you have an active herpetic or bacterial infection, it is best to let Dr. Green know before to prescribe the proper oral antivirals or antibacterial medications and possibly defer treatment until the condition resolves.

PDT/ Blue Light for Actinic Keratoses and Skin Cancer

PDT is an elegant way to treat abnormal cells, or skin cancers from the face. PDT was originally FDA approved to treat skin cancer. The very superficial skin cancers are called actinic keratoses. The prompt treatment of these superficial pre-cancers prevents these abnormal cells from growing and transforming into deeper skin cancers.  PDT has also been used to treat other skin cancers such as basal cell carcinomas and squamous cell carcinomas.

PDT works by direct injury to the targeted abnormal cells.  Activated oxygen molecules are produced which injure or destroy precancerous lesions. Since the normal skin barrier is not present at the sites of the actinic keratoses, the photosensitizing molecules are absorbed by this sun damaged skin and are activated by light. These activated oxygen molecules, porphyrins, treat these actinic keratoses and leave the normal skin undamaged.  Several weeks after treatment it is important to follow-up with your dermatologist to ensure which areas were treated and see if any of the remaining areas need to be biopsied for possible deeper skin cancer.

Originally, Blue light or PDT was used for the treatment of actinic keratoses of the face and scalp.  Now, this method of treatment is utilized for the neck, chest, arms, legs and trunk. The number of treatments for actinic keratoses depends on the amount, number, and severity of your precancerous lesions. Typically 3 sessions are indicated, four weeks apart, with a greater number of treatments are advised in more severe cases.

How does PDT or photodynamic therapy work for acne vulgaris?

While PDT was originally approved by the FDA for the treatment of actinic keratoses, after various clinical trials, it was determined that PDT is a safe and effective way for treating acne vulgaris, cystic acne, acne scars, and severe acne. PDT works by shrinking the skin’s oil glands and reducing its oil production.  By reducing the oil in the sebaceous glands, it reduces the sebum production, and the result is that the pores are not clogged.  It further decreases the number of comedones produced and the overall number of pimples and comedonal acne lesions. PDT’s mechanism of action is that it causes a phototoxic damage to sebaceous glands and hair follicles.  PDT for acne vulgaris has been proven to be a safe and effective treatment for patients with severe acne who do not respond to traditional topical acne treatments. ALA-PDT (5-aminilevulinic acid with PDT) has also been used for patients who have severe acne for whom isotretinoin (Accutane) is not an option.  In addition, ALA-PDT has been proven to kill the bacteria, p.acnes, which causes acne.  Photodynamic therapy not only reduces the acne, but improves the skin’s overall texture, and the appearance of acne scars.

Photodynamic therapy for acne usually begins with microdermabrasion to remove the dead skin cells on the surface of the skin.  Having microdermabrasion before the Levulan is applied allows the medication to have better penetration.  Levulan is then applied to the skin for 15 to 60 minutes, and later removed thoroughly with water.  The patient is positioned to sit in front of the Blu-U and has blue light therapy for approximately 16 minutes. A series of three to five PDT treatments are typically performed in a period of four-week intervals. The number of PDT treatments will be determined during your consultation and based on the severity of your acne. Most patients see improvement in their acne after a single treatment but the rest results come with the full course of treatment.

How do I prepare for my treatment?

It is best to come into the office for your procedure without any makeup or sunscreen. You should continue your regular medications but can refrain from Retin-A or any exfoliating creams for a few days before your treatment. You should bring a wide brimmed hat and sun glasses to the appointment. If you are having your arms treated, you should wear a long-sleeve shirt and if your hands are being treated, bring gloves. You may also want to bring personal musical earphones to listen to music or a pod cast during your treatment time.  In addition, you will be advised to come to the office at least one hour before your scheduled treatment time for Dr. Green to apply the Levulan medication. If you are having an area which requires a longer incubation time, you may need to come to the office earlier. Patients are encouraged to avoid smoking for one week after the procedure as smoking delays wound healing.

What can I expect after photodynamic therapy?

It is essential to avoid sun exposure for the first 48 hours after your PDT light treatment. Sunscreen is also an essential component after the treatment to prevent future sun damage and pre-cancers. Avoiding sunlight for the first 24 hours is critical to avoid getting an increased erythematous reaction to the treatment. Other sun protection includes wearing a wide brimmed hat and proper sun avoidance. PDT treatment can cause hypersensitivity to light, such that even bright indoor light can be irritating. Patients should avoid bright lights or reflective spaces for several days post-treatment while sensitivity persists.

Patients are advised not to go into saunas or steam rooms for the first few days and avoid using any exfoliating products, retinoids, or alpha hydroxy acid creams. Dr. Green also recommends applying gentle lotions or emollients for at least one week to the treated area. It is advised not to pick or scrub the skin after the procedure as this could lead to scarring or infection.  If patients feel any mild discomfort after the procedure, acetaminophen (Tylenol) or another mild pain reliever can be taken.

Patients are thrilled with this procedure as there is minimal downtime and is an outpatient procedure, meaning patients may return home immediately after the treatment. Depending on the degree of actinic keratoses, the best treatment results may take three or more sessions. PDT or Blue Light may also be combined at different periods with such treatments as Intense Pulsed LightV-Beam (pulsed dye laser), or Fraxel® Dual Laser, in order to remove sunspots, rosacea, and sun damage, and leave the skin as rejuvenated and beautiful as possible.  PDT has been described as a “super photo facial” when it is combined with intense pulsed light or IPL .

45-54 year old man treated with BLU-U light (2 weeks post treatment)

Does photodynamic therapy help wrinkles?

While photodynamic therapy is most well known for cancer and pre-cancer treatments, research has begun to emerge that PDT can also be used for cosmetic purposes. According to a study done by Wolfgang Philipp-Dormston (available on PubMed.gov), the PDT treatment also works to eliminate fine lines and wrinkles in the treatment area and to improved skin texture. The implications suggest that PDT treatment could be a useful procedure in the lineup of treatments to reverse signs of the natural aging process. Dr. Green is very experienced in reducing the appearance of fine lines and wrinkles in her NYC dermatology office. If you are feeling self-conscious about the signs of aging, there are many non-invasive, safe, and effective options available and you can make a consultation appointment with Dr. Green today.

How can photodynamic therapy treat cancer?

Photodynamic therapy can be used to treat a variety of forms of cancer, including skin, lung, and esophageal cancers. When used to treat cancer, the photosensitizing agent is administered to the treatment area and the incubation period begins. Once the photosensitizer has moved through the normal cells, it remains in the cancerous cells. Then, when the specific wavelength of light is shone on the affected area, the light activates the drug, which then kills the cancerous cells.

When treating forms of skin cancer, the photosensitizer can be applied topically to the surface of the skin and then the light is shone directly onto the affected area. If PDT is being used to treat esophageal or lung cancer, the oncology nurse performing the procedure will use an endoscope, inserted into your throat, to see the treatment area. Following the insertion of the endoscope, the doctor will shine line via a fiber optic cable onto the tumor to destroy the cancer cells.

How effective is photodynamic therapy?

Photodynamic therapy is a safe and effective treatment for a variety of skin conditions and different types of cancer. Studies have shown that photodynamic therapy works just as well to reduce the prevalence of cancerous cells as radiation therapy and surgery for certain forms of cancer or pre-cancer. Another benefit of the treatment is that it does not cause damage to normal cells and tissue in the treatment area. After the treatment, there may be redness, swelling, and irritation on the surface of the skin but it PDT is much less disruptive to the body as a whole than radiation therapy is and it is noninvasive. The procedure is also an outpatient procedure, meaning that patients can go home following the treatment rather than staying in the hospital or healthcare facility.

What should I do after photodynamic therapy?

Following photodynamic therapy, patients should be careful to avoid sun exposure or bright light. PDT can cause increased sensitivity to light and, further, directly sunlight on the treatment area following the procedure can inhibit the healing process. The amount of time that patients remain sensitive to light following the treatment depends on the type of photosensitizing agent used and the area that is being treated. For patients who are receiving photodynamic therapy for skin cancer or actinic keratosis will likely experience photosensitivity for only 48 hours post-treatment. The area treated by the procedure may be red, itchy, and flaky in the days following and, in some more severe cases, can appear blistered. It may feel a bit like a sunburn, however, the side effects will fade after several days on their own.

Is photodynamic therapy safe?

Photodynamic therapy is a very safe and effective treatment for a variety of cancers and skin conditions. The side effects of the treatment are usually fairly mild, including redness, swelling, and irritation to the surface of the skin, and resolve themselves quickly following the treatment. The treatment is noninvasive, meaning no surgery is necessary, and for that reason, much lower risk and does not cause scarring. Further, PDT therapy does not do damage to healthy, normal cells in the body unlike some other common cancer treatments.

Is photodynamic therapy painful?

Photodynamic therapy is a non-invasive treatment but may be painful or cause discomfort to some patients. Approximately half of patients report feeling a stinging or burning sensation during the course of the treatment. For patients feeling this discomfort, Dr. Green may fan the area in order to keep the skin feeling cool throughout the course of the procedure.

Can I wear make up after photodynamic therapy?

When treating skin conditions, such as acne vulgaris, AK, and more, photodynamic therapy may be used to target harmful cells and agents on the face. The treatment has the potential to leave the skin red, swollen, and irritated for several days following the procedure. During that time, Dr. Green advises that you do not wear make up until the side effects have been resolved. When you come for the treatment, Dr. Green also suggests that you do not wear make up as it will need to be removed before the photosensitizing agent is applied.

How much does photodynamic therapy cost?

The cost of PDT is dependent on several factors, including your geographic location, the type of institution at which you are receiving treatment and the size and scope of the treatment area. Photodynamic therapy is a very specialized treatment that requires specific equipment, which limits the kinds of dermatology offices which offer this special treatment, like Dr. Green’s New York dermatology office. For lung or esophageal cancer patients, an oncology center will offer the treatment while those patients with skin cancer or precancerous lesions can seek treatment from a dermatologist, such as Dr. Green. PDT can be performed on a number of areas of the body that range in size and then number of treatment areas or size of the treatment area has an impact on the price.

Is photodynamic therapy covered by insurance?

If you are wondering if photodynamic therapy is covered by your insurance company, it is best to contact your insurance company and ask them directly. Different insurance companies have varying policies. It is best to consult with your insurance company before coming in for treatment.

Does Medicare cover photodynamic therapy?

If you are asking, is photodynamic therapy covered by Medicare, the answer is: it depends. Patients covered by Medicare should call their insurance provider to determine if the procedure is covered before coming in for treatment.

Who performs photodynamic therapy?

Only a board certified dermatologist, such as Dr. Michele Green in NYC, can perform photodynamic therapy.

How do I get started with photodynamic therapy today?

If you are concerned with your skin due to photodamage, actinic keratoses, skin cancer, acne, sun spots, and overall sun damage, board certified NYC dermatologist, Dr. Michele Green, is here to help. Dr. Green is an expert in acne, acne scars, rosacea, age spots, and sun damage and the best rejuvenation for your skin. If you would like to remove unwanted signs of aging and sun damage, it is best to contact the office of Dr. Michele Green at 212-535-3088 or contacting us online to help schedule your private skin care consultation today and learn about the many treatment options. Dr. Green has been consistently voted as one of the best dermatologists in NYC by Castle Connolly, the New York Times, Super Doctors, and New York Magazine for her superior expertise with both cosmetic and medical dermatology.

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