ALA/PDT
ALA/PDT
( Topical aminolevulinic acid-ALA, with Photodynamic therapy-PDT )
AMINOLEVULINIC
ACID / PHOTODYNAMIC THERAPY
What is Photodynamic Therapy?
It is a special treatment
performed with a topical photosensitizing agent called ALA (aminolevulinic
acid). ALA is activated with the correct wavelength of light within the non-UV blue
spectrum. This is known as “ALA/PDT treatment.” These treatments remove sun
damaged pre-cancerous zones and spots called actinic keratoses. Sun damage, fine
lines, and blotchy pigmentation are also improved because of the positive effect
of Levulan and the light treatment. ALA/PDT treatment also has the unique
ability to minimize pores and reduce oil glands, effectively treating stubborn
acne vulgaris, acne rosacea, and improve the appearance of some acne scars.
The uses ALA/PDT are still emerging with testing and case studies on the horizon for such ailments as psoriasis, hidradentis suppurativa (HS), and recalcitrant molluscum contagiosum.
How much improvement
can I expect?
Patients with severe sun
damaged skin manifested by actinic keratosis, texture, and tone changes
including mottled pigmentation and skin laxity may see excellent results. You
may also see improvements of large pores and pitted acne scars. Active acne can
improve dramatically.
How many treatments
will it take to see the "best results"
To achieve maximum
improvement of pre-cancerous (actinic keratoses) sun damage, skin tone and
texture, a series of three treatments 2-4 weeks apart is the most effective.
Some patients with only actinic keratoses are happy with just one treatment.
More treatments can be done at periodic intervals in the future to maintain the
rejuvenated appearance of the skin.
What are the
advantages?
1. Easier for patients
than repeated topical liquid nitrogen, Efudex (5-FU), or Aldara because the side
effects are minimal. Rapid healing occurs, and only 1-3 treatments are required.
2. The ALA/PDT treatment at our office is PAINLESS versus liquid nitrogen,
Efudex (5-FU),
and Aldara.
3. Reduced scarring and improved cosmetic outcome compared with cautery,
surgery, and Efudex. Liquid nitrogen can leave white spots on your skin.
4. Levulan improves the whole facial area treated, creating all one color,
texture, and tone rather than just spot treating with liquid nitrogen, cautery,
and surgery.
In summary, PDT matches the
“ideal treatment” for photodamaged skin:
- Well tolerated (essentially painless)
- Easily performed in a cosmetic dermatology office
- Non-invasive (no needles or surgery required)
- Excellent cosmetic outcome (particularly in cosmetic sensitive areas of the
face).
What are the
disadvantages?
Following PDT, the treated areas can appear red with some peeling for 2-7 days.
Some patients have an exuberant response to PDT, and experience marked redness
of their skin. Temporary swelling of the lips and around your eyes can occur for
a few days. Darker pigmented patches called liver spots can become temporarily
darker and then peel off leaving normal skin. (This usually occurs over seven to
ten days.) Repeat treatments may be necessary as PDT medicine is not an exact
science.
Photodynamic Acne Treatment
A new procedure is now
available that treats active acne as well as older acne scars leaving your skin
smoother. The procedure is called PHOTODYNAMIC ACNE TREATMENT using Levulan.
Photodynamic Acne Treatment is a process by which a photosensitizing agent (Levulan) is applied to your skin. The Levulan is then activated with specific wavelength of light, which “turns it on.” Levulan has been used extensively for the treatment of variety of different skin conditions.
Levulan is a 20% solution of Aminolevulinic Acid (ALA). ALA is a natural substance found throughout your body, as it is a precursor for hemoglobin synthesis. You won’t be able to make red blood cells to carry oxygen without ALA in your body. Consequently, it is a “natural” product found in all humans.
Acne results from the obstruction and inflammation of the sebaceous glands, and it affects 80% of the human population. Acne typically begins in adolescence with hormonal changes. However, there are many older individuals who suffer from “adult acne.”
There are several different presentations of acne ranging from comedonal (blackheads and whiteheads), popular, pustular, and cystic acne. In many cases, many of these presentations of acne can be present on an individual simultaneously.
Prior to photodynamic Acne Treatment, the best available treatment option for cystic acne was Accutane. However, with Accutane there are many possible systemic side effects including birth defects, liver abnormalities, mood depression, and virtually all patients get dryness and night vision changes. PDT Acne Treatment provides a viable alternative for all types of acne treatment.
Photodynamic Acne Treatment is done as follows: the Levulan, which is a clear painless solution, is applied to your skin and left on for 15-60 minutes. It is then activated with a specific wavelength of light called BLU-U. This takes about 8-10 minutes. The Levulan targets active cells like acne sebaceous glands. These cells preferentially absorb Levulan, and are targeted by the Levulan once it is activated; hence the term, photodynamic therapy. The Levulan will also target sebaceous hyperplasia (which are those small (1-3mm), benign, bumps on your skin) and the papules of acne rosacea. Skin oiliness is decreased, and the appearance of pores is minimized. The entire skin texture improves following a Photodynamic Acne Treatment.
The “downside” of Photodynamic treatment (PDT) is that you will be red and have some skin peeling (and crusting if you have skin cancers) for several days after the treatment. Usually, the first 1-2 days are the worst. Pressed mineral foundation base make-up (available in our office) will hide most of the redness. You must remain indoors the day following your treatment to avoid sun exposure, as you are photosensitive for about 24 hours after PDT. If you must go outside during day light hours in the first 24 hours, you must apply a total block sunscreen. This type of sunscreen is available at our office.
The advantage of PDT is rapid treatment of acne lesions all over the face without scarring or surgical excision. The skin appears refreshed and younger following these treatments. We advise 2-3 treatments at 2-3 week intervals to obtain optimal results. There are no systemic side effects. You can use your topical acne lotions in between your Levulan treatments once the redness has settled down after a few days.
These ALA treatments can be combined with our regular Photorejuvenation treatments using Intense Pulse Light, which targets redness and brown spots, and stimulates formation of more collagen in the skin. There is normally no downtime for IPL treatments without Levulan. However, one can enhance and “boost” the IPL photorejuvenation results by adding Levulan to the treatment process. This is termed an ALA/PDT/IPL photorejuvenation facial and is the fastest way to rejuvenate aging skin and treat acne and rosacea.