Photodynamic Therapy for Actinic Keratoses
Now’s the time to manage your skin damage!
Levulan® Kerastick® [20% aminolevulinic acid (ALA) HCl topical solution] plus blue light illumination using the BLU-U® Blue Light Photodynamic Therapy (PDT) Illuminator is FDA-approved/indicated for treatment of actinic keratoses of the face and scalp. Actinic keratoses (AKs) are smooth to rough-textured / dry skin spots that can become skin cancer. It is important to treat AKs because there is no way to tell when or which lesions will progress to squamous cell carcinoma (SCC), the second most common form of skin cancer. So, now’s the time to manage your skin damage!
Levulan Kerastick and BLU-U PDT is a 2-part treatment that uses a light activated topically applied drug therapy to destroy AKs.
How does it work?
Levulan Kerastick topical solution is applied to and absorbed by AKs, and subsequently converted to a photosensitizing chemical that makes the cells extremely sensitive to light. When the AK cells are exposed to the BLU-U Blue Light Illuminator, a photochemical-induced cytotoxic reaction occurs which destroys the AK cells.
The 2-part treatment offers the following conveniences:
- No prescription to fill
- No daily medication to remember
- Treatment is administered by a qualified healthcare professional
Levulan Kerastick and BLU-U PDT can also fit your lifestyle:
- The 2-part office treatment is completed within one day
- Low downtime*
- High ratings for cosmetic response
- No scarring reported to date (per manufacturer)
*Patients treated with Levulan Kerastick and BLU-U PDT should avoid exposure of the photosensitized lesions to sunlight or prolonged or intense light for at least 40 hours.
Ask Dr. Strimling if Levulan Kerastick and BLU-U PDT is right for you!
For more information about photodynamic therapy for actinic keratoses, download our PDT Informed Consent & Patient Instructions handout.
More Information and Frequently Asked Questions about PDT
What is Photodynamic Therapy?
Photodynamic Therapy (PDT) is a medical treatment that uses a light source to activate a topically applied photosensitizing drug (Levulan Kerastick). Levulan PDT selectively targets and destroys pre-cancerous and sun-damaged skin cells via activation of naturally occurring reactive oxygen. New, healthy, more youthful appearing skin re-populate the treated areas. This minor, out-patient procedure is performed in an office environment.
PDT requires three steps.
First, a light sensitizing drug (photosensitizer) is applied to the target skin areas. Second, there is an incubation period of up to one or two hours. And 3rd, the target skin areas are then exposed to a light or laser source which then activates the photosensitizing medication.
What is Photodynamic Therapy used for?
Since FDA-approval for actinic keratoses in 2000, PDT has also been used “off-label” for a variety other skin conditions / problems, including: acne, rosacea, oily skin, enlarged oil (sebaceous) glands, sun damage / age spots / wrinkles, skin rejuvenation (anti-aging), stubborn warts, hidradenitis suppurativa, psoriasis, and other skin conditions.
Does PDT make me permanently more sensitive to light?
No, PDT causes a temporary sensitivity to light, including natural sunlight and intense indoor lights; but only where the photosensitizer was applied. The light sensitivity typically resolves within 40 hours or less. Avoid sun (both directly and indirectly (i.e. windows) and intense light to the treated areas for the rest of the treatment day and the following day.
How is Photodynamic Therapy used to treat the skin?
PDT using Levulan (5-aminolevulinic acid / ALA) and a proprietary blue light is FDA approved for the treatment of skin pre-cancers called actinic keratoses (i.e. rough scaly spots generally on sun exposed skin of fair skin types.)
PDT is also known as “ALA/PDT treatment” or “Super Blue Light”. Intense pulsed light (IPL) activated Levulan, called a “super photofacial” is not only effective for AKs, but also for age-related sun/skin damage. PDT has also been shown to help decrease the appearance of pores, shrink oil glands, and treat stubborn acne, rosacea, and help improve the appearance of some small superficial acne scars.
What is Aminolevulinic acid or Levulan?
5-aminolevulinic acid, also called Levulan or ALA for short is a naturally occurring protein in the body. It is found in small quantities as part of the normal heme (blood) synthesis pathway. In larger quantities, it is a substance known to increase sensitivity to certain wavelengths of light.
How does Photodynamic Therapy work?
Levulan is preferentially absorbed by and hence targets abnormal cells for destrcution by photodynamic therapy generated reactive oxygen. Norrmal skin cells are relatively preserved; thus, minimizing side effects. PDT eliminates a significant majority to 100% of actinic keratoses in most. After healing from Levulan PDT, re-examination may be recommended to evaluate for any residual lesions that may need additional treatment or biopsy.
Cryosurgery (freezing with liquid nitrogen) only treats the visible AKs; thereby, leaving subclinical (incipient or not yet visible) AKs untreated. PDT allows for field or blanket treatment of an entire area of sun damage; thus, reducing the risk that undetected pre-skin cancer cells will go untreated.
Photodynamic therapy is a safe, effective, FDA-approved in-office procedure.
What is a typical skin Photodynamic Therapy session like?
After informed consent and thorough cleansing of your skin areas to be treated to allow optimum penetration, the photosensitizer liquid Levulan is applied topically to the entire area to be treated (e.g. the entire face or scalp.)
After the photosensitizer dries for a few minutes, incubation is necessary. Up to 60 to 90 minutes of incubation time in the waiting room is usual. Some areas, such as chest, back and particularly forearms and legs may require longer incubation times for better results. Results vary by individual and treatment location.
After incubation, you are brought back into the light source room and you will be provided protective eyewear to be worn during the treatment. After you are properly positioned within the Blu-U light source, the light source is turned on and set to 17 minutes of exposure time. Over the next 17 minutes, activation of the medication occurs. Some patients may experience warmth, tingling or burning during the treatment.
The treatment area is then washed off and sunscreen applied before leaving. After-care instructions are provided and a follow-up visit is scheduled.
How much improvement can I expect?
Individual results vary from minimal to significant improvement.
Usually, patients with severe sun damaged skin manifested by AKs, texture and skin tone changes including mottled pigmentation, dull or sallow skin, and skin laxity may expect good to excellent improvement with PDT. Large pores, non-pitted acne scars, and active acne may also improve.
Multiple treatment sessions may be required to see optimal improvement. Follow all instructions and recommendations for best results.
How long does a skin Photodynamic Therapy procedure take?
You are generally in the medical office for several hours (average 2 hours) on the day of your Photodynamic Therapy. Facial PDT takes 10 minutes to apply the medication, ~60 minutes to allow proper skin incubation, and ~17 minutes for light application. Other areas may require longer incubation times; you may leave the office (so long as you avoid sunlight) and come back when it is time for the light activation.
Is skin Photodynamic Therapy only for pre-cancerous skin growths (AKs)?
No, PDT is a used to treat many conditions in addition to pre-cancerous AKs, including acne, rosacea, sebaceous hyperplasia (enlarged oil glands), psoriasis, fine wrinkles and other cosmetic indications. PDT is not for malignant melanoma, invasive skin cancers, moles or birthmarks.
What are the advantages with PDT for treating skin pre-cancers?
The greatest advantage of PDT is the ability to selectively treat an entire area of skin damage and pre-cancers (i.e. blanket or field treatment). Additionally, PDT demonstrates secondary cosmetic benefits, improving appearance, tone, color, and enhanced skin texture.
In several studies, patients preferred PDT for ease of use and recovery versus alternative treatment chemotherapy creams like 5-fluorouracil (Efudex). PDT side effects may be milder with less down time than 5-fluorouracil.
Cryotherapy combined with PDT (2-6 weeks later) may be more effective than cryosurgery alone, especially in those with extensive sun damage and AKs. Some patients are unable to tolerate the prolonged treatment required with fluorouracil (Efudex) or imiquimod (Aldara / Zyclara) because of irritation, redness, and possible downtime with these topical creams.
PDT is easy, essentially painless, non-invasive (no needles nor surgery) and not only reduces pre-cancerous sun damage, but also enhances cosmesis.
How many treatments of Photodynamic Therapy will I need?
Most patients benefit from 1 to 3 PDT treatments followed by perioidic maintenance or touch up treatments. Faces respond faster requiring fewer treatments; whereas, arms and legs may be more resistant, necessitating more treatments.
Can I remove my moles or birthmarks using Photodynamic Therapy?
No, photodynamic therapy is not for mole or birthmark removal. Moles are usually removed by standard or traditional scalpel surgery.
Am I a good candidate for Photodynamic Therapy?
The best candidates for PDT may be those with fair skin and sun damage.
You may not be a good candidate for PDT if you have darker skin that tends to turn brown or discolor with exposure to light or laser treatments. You also may not be a good candidate for PDT if you are very sensitive to light, burn extremely easily, are unable to avoid sunlight for the required 40 hours, or take medications that make you sensitive to sunlight or light based therapies.
What if I have other health issues?
Contraindications to PDT include pregnancy, porphyria, lupus or any other medications or conditions that promote hypersensitivity to porphyrins, Levulan or blue light therapy. Or if you have had a previous negative reaction to PDT.
An oral anti-viral medication (cold sore prevention pill) may be prescribed if you have frequent oral cold sores (herpes virus infections on your face). Chronic conditions that may affect healing, including chronic infections, such as hepatitis or HIV / AIDs may be additional contraindications.
Generally, other health issues are not contraindications to PDT.
What are alternatives for Photodynamic Therapy?
Alternative or complimentary treatments to PDT vary depending upon the condition being treated among other factors.
For actinic keratoses (AKs) treatment options include, but are not limited to: cryosurgery (cryotherapy), surgical removal, chemical or laser peeling, or topical medicines, such as fluorouracil (5-FU), imiquimod (Aldara / Zyclara), ingenol mebutate (Picato), and diclofenac (Solaraze) or no treatment.
For acne, complimentary and/or alternatives to blue light or PDT include: oral and topical anti-acne medications, facials, peels and lasers or intense pulsed light (IPL / photofacial) among others.
What about insurance coverage and costs?
Photodynamic therapy for skin actinic keratoses of the face and scalp is a covered insurance benefit of Medicare and most other insurances. Medicare Advantage Plans may have different coverage rules than traditional / standard Medicare.
Other uses or body locations are generally not covered benefits, but, may be depending upon your insurance carrier and plan. Insurance benefits and reimbursement vary by insurance carrier and plan.
How do I prepare for my procedure?
No special preparation is required for most patients.
Stop using any topical retinoids (e.g. Differin, Epiduo, Retin-A, Tazorac) for at least several days to a week before PDT. According to the manufacturer, there have been no consistent adverse reactions to concomitant photosensitizing antibiotic use or other medications.
Wash and shave (if applicable) the area/s to be treated. Avoid make-up, moisturizer and sunscreen on the day of treatment. (Also, practice sun protection of the areas to be treated for at least one to two weeks prior the day of treatment.) Eat your regular diet and take all of your regular daily medications. Bring a wide brimmed hat and UVA & UVB SPF 30 or > sunscreen with you on the day of treatment.
Wear comfortable casual protective clothes, depending treatment sites. Bring gloves or a long sleeve shirt if having hands or forearms treated.
You do not need a driver unless you are planning on taking a sedative.
Since you may be at the office for a couple of hours, you may want to bring along water and reading material or an iphone / ipad to help relax and pass the time during your PDT incubation time and treatment.
How is recovery?
Recovery is relatively easy and uneventful for 95% or more of patients. Most patients have a faint to mild sunburn-like reaction associated with mild dryness of the treated area. A small percent of patients may experience a more intense reaction. Some of these patients had inadvertent sun exposure for only a minute or two during the immediate post treatment period promoting a more severe reaction. Remember to avoid all sun exposure for 40 hours after photodynamic therapy. Otherwise, you may resume all normal indoor activities immediately. After 40 hours, you may resume outdoor activities with proper sun protection.
Can I return to work or school?
Most patients are able to return to work or school 40 hours or more after PDT, when the extreme photosensitivity has diminished.
How do I take care of my treatment area after PDT?
Please refer to our PDT Informed Consent / After-Care Instructions handout. You will be asked to go home and stay indoors for the rest of the day and the following day and wear an SPF 30 or > sunscreen daily until healed.
Keep the area cool with frozen gel or ice packs as instructed. Cleanse with a mild, gentle cleanser (e.g. Aquanil) twice daily. (Avoid harsh or abrasive cleansers.) Avoid picking / peeling and scrubbing. A dilute vinegar solution may be recommended for any crusting if present. Use a moisturizing cream (e.g. Vanicream) or Aquafor as needed for dryness. Avoid make-up, hot tubs, pools and spas until healed. Topical antibiotics and/or hydrocortisone cream / ointment maybe recommended. OTC ibuprofen or acetominophen (Tylenol) may be taken for any discomfort. OTC anti-histamines may be taken for any healing associated itching.
Notify us of any signs or symptoms of infection (fever, increasing pain), cold sore outbreaks, excessive swelling or any other adverse reactions.
What is the chance that my skin pre-cancers will recur?
PDT clearance rates are reported as high as 60-90% with even one treatment. Although PDT is very effective, new and recurrent AKs will continue to occur. Underlying layers of sun damage from prior years continually rise to the surface over time. Thus, additional successive or periodic treatments are recommended due to the ongoing development of new and recurrent AKs.
There are no treatments for AKs that provide an indefinite or 100% cure. Because some AKs will develop into dangerous Squamous Cell Carcinomas; ongoing, periodic dermatologic evaluation and treatment is recommended.
Patients should perform monthly self skin exams and any changing or new growth should be promptly evaluated by one of our dermatologists.
At Strimling Dermatology, Laser & Vein Institute of Summerlin, Las Vegas, our board certified Dermatologists, Dr. Strimling and Dr. Handler specialize in the diagnosis and treatment of actinic keratoses, including with PDT. Voted or selected multiple times among the “Best / Top Dermatologists” in Las Vegas and America, our dermatologists and staff are among the most experienced in Las Vegas.
Contact Us at (702) 243-6400 to schedule a personalized consultation.
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Strimling Dermatology, Laser & Vein Institute of Summerlin, Las Vegas treats patients from all over the Clark County valley, including Henderson, Green Valley, Anthem, North Las Vegas, Boulder City as well as Summerlin, Las Vegas, Nevada and the rest of the southwest. We have also seen patients from all over the country and world.