Photodynamic Therapy

Quick facts

  • Photodynamic therapy is a relatively new procedure used for the treatment of acne, pre-cancerous skin lesions,  some cancerous skin lesions (not melanoma), and psoriasis.
  • A substance called ALA is applied to the skin.
  • ALA is a substrate for the production of porphyrins which are produced by certain cells such as those which cause acne/skin cancers/psoriasis. The application of ALA produces large amounts of porphyrins in these areas.
  • An LED light source to activate porphyrins causing the production of oxygen free radicals which then specifically destroy those surrounding cells.
  • Recovery time is approximately 7-14 days from this treatment and usually 1-3 sessions are required.
 

What is photodynamic therapy (PDT)?

Photodynamic therapy (PDT) utilises a chemical reaction activated by light energy to selectively destroy specific tissues and help with particular skin conditions such as solar/actinic keratosis (pre-cancerous skin lesions), squamous cell carcinoma, basal cell carcinoma, acne and psoriasis. It cannot be used for the treatment of melanoma.
It works on the principle that those cells/bacteria that cause the above problems are metabolically more active and produce large amounts of a substance called porphyrins. These porphyrins are sensitive to certain types of light, and when exposed to light can produce toxic oxygen free radicals which destroy cells in the very nearby vicinity. Because these oxygen free radicals do not actually traverse far, they are very specific to the cells that create the porphyrins, hence it is possible to specifically target the problem cells without damaging normal ones.
To stimulate cells to produce more porphyrins, a substrate called 5-aminolevulinic acid (ALA) which is a precursor to the porphyrins is applied to the skin firstly. The cells that take up the ALA are generally those which are more active, for example sebaceous glands, the bacterial that cause acne (p.acnes) or more rapidly dividing skin cancer or pre-cancerous cells. Therefore PDT can help reduce; acne, psoriatic plaques, solar or actinic keratosis, reduce superficial basal cell carcinomas (skin lesions caused by sun-exposure/damage) by targeting the cells that cause these problems. In summary, ALA selectively targets the cells that cause acne, and particular skin problems like solar keratosis, and then is activated by the laser which selectively destroys these cells. 

PDT can be used on any part of the face or body e.g for back acne or for solar keratosis on the hands.

There is some evidence to suggest that photodynamic therapy also enhances the usual photo-rejuvenating effect of lasers on skin ie. reducing pigmentation, capillaries and improving skin texture (see article at bottom of page).

What does photodynamic therapy involve?

Photodynamic therapy involves;
  • Pretreating the skin with microdermabrasion for at least 30 minutes to help remove the top layer of skin cells and allow the process to work more effectively.
  • The skin is then degreased with acetone.
  • 20% ALA is then placed on the face from 30 minutes to 3 hours. 
  • The skin is then exposed to a LED or laser light. Either a blue/red LED light is used to activate the ALA. 
  • Sun avoidance for 48 hours


Photodynamic Therapy case study

This male patient has had numerous treatments for acne before. This included a series of antibiotics, and an uncompleted course of Roaccutane (non-compliance was due to side effects unacceptable to the patient such as dry lips/skin). This is after 2 treatments of photodynamic therapy one month apart. ALA was placed on his skin for 30 minutes each time and activated by the LED light. His acne has cleared significantly, with much of the inflammation and redness disappearing.


Photodynamic Therapy Case Study - Before

Photodynamic Therapy Case Study - After

How does it work?

Once on the face, the ALA penetrates through the skin and is selectively attracted to abnormal (dystrophic) skin cells, acne bacteria and sebaceous glands where it is then transformed into protoporhyrin IX (PpIX). PpIX is then activated by a special light source or laser which then selectively destroys these cells by producing a singlet oxygen molecule that is toxic to the cells. At The Victorian Cosmetic Institute, an LED light is used as the activator light for photodynamic therapy.

What can be achieved with photodynamic therapy?

The number of dystrophic or sun-damaged cells are decreased leading to an improvement in the texture of the skin and a reduction in the probability that these cells will become cancerous.
It also is very effective in helping to reduce the number of sebaceous glands along with the bacteria, propionobacterium acnes, that causes acne. Hence, dramatic improvements in the number of active acne lesions are seen. Particular improvements are seen in those people who have cystic or inflammatory type acne.

Benefits are gained not only from the activation of ALA by laser, but also from the laser itself rejuvenating the skin.

Am I a suitable candidate for photodynamic therapy?

Yes, those with;
  • Active, cystic, or inflammatory acne are suitable for the treatment. It is especially suitable for people who want to avoid Roaccutane use and its side effects.
  • Those who have solar/actinic keratosis (pre-cancerous skin lesions)/squamous cell carcinoma/basal cell carcinoma removed with minimal effect on normal skin and the least chance of scarring in comparison to other treatments such as cryotherapy (liquid nitrogen) therapy which tends to leave white areas on the skin, or surgery which tends to leave scars
  • Those with psoriasis and resistant psoriatic plaques that have not responded well to other treatments

It is not suitable for people who;

  • are breast feeding or pregnant
  • have a history of keloid scarring
  • have had Roaccutane in the past 6 months.
  • have a history of porphyria

How many sessions are needed?

Best results are achieved by two to four sessions at intervals between 10 and 30 days for the treatment of acne. Treatment of solar/actinic keratosis, basal cell carcinomas, psoriasis and skin rejuvenation generally requires less treatments (one to two) at intervals of 4 to 6 weeks.

What are the side effects of photodynamic therapy?

Immediately post treatment, the skin appears red and sun-burnt. This can persist for up to one week. The skin may flake, crust or peel during this time. You may also experience approximately 2 days of mild swelling in the face if this is the treated area. Strict sun avoidance is required for 36 hours. There also may be some heat, discomfort, and itch felt in the treated areas for a couple of days. Generally speaking, the downtime is from 7 to 10 days, and the side effects are significant during this time if larger areas of the face are treated.

What is the cost of photodynamic therapy?

At The Victorian Cosmetic Institute, we charge $660 per session (including GST) for acne and $990 per session for the treatment of pre-cancerous/cancerous skin lesions. The treatment of psoriasis will depend on the size of the area treated. This includes all aspects of the treatment, including microdermabrasion, application of the ALA, and activation with the laser. The whole treatment time can take around 2 hours approximately.
In some cases, there may be an associated Medicare rebate, but this depends on the condition treated. If a rebate applies then the Medicare Safety Net will also help in reducing the cost of the treatment e.g if safety net level is assumed to be $1000, then;

Cost of treatment - medicare rebate (14100) = $990 - 114 = $876 out of pocket for one session

Therefore, for two sessions, the cost is;
$1752 which exceeds the safety net by $752. 80% of $752 is rebated, so out of pocket, will pay $1150.40 for two sessions.

Each subsequent treatment for PDT with an item number under the medicare safety net is $175.20 (876 X 20%)

Why should I choose The Victorian Cosmetic Institute to perform photodynamic therapy for me?

For those people with resistant acne or sun-damaged skin, photodynamic therapy may be a suitable treatment for you. Our doctors will first assess your suitability for the treatment, and then help you decide whether this treatment is suited to your skin and also your lifestyle. Our doctors have a vast amount of experience in this treatment, and keep up-to-date with the latest international trends in photodynamic therapy.
 
The first step is simply contacting us for your initial consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your treatment.
 
Making that first phone call about any cosmetic procedure can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you and gain an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.
 
It's as easy as clicking either of the buttons below and completing the provided form.
 
Otherwise, you can phone us directly on (03) 8850 0655 (Templestowe) or (03) 9707 0888 (Berwick).
 

Photodynamic Therapy Clinical Study Articles

Click here to download Photodynamic therapy clinical studies for acne

Click here to download Photodynamic therapy clinical studies for photodamage

 
 

 




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