Photodynamic Therapy

Photodynamic Therapy (PDT)- for the treatment of active acne, rosacea, actinic/solar keratosis, and sun-damage.

What is photodynamic therapy (PDT)?


Photodynamic therapy (PDT) utilises a chemical reaction activated by light/laser energy to selectively destroy specific tissues and help with particular skin conditions.  
Specifically, photodynamic therapy utilises a substance called 5-aminolevulinic acid (5-ALA), which is applied topically to the skin. It is taken up by certain cells in the skin and then activated by light or laser. The cells that take up the 5-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, rosacea, 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, 5-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. 
 
5-ALA also enhances the usual photo-rejuvenating effect of lasers on skin (ie. reducing pigmentation, capillaries and improving skin texture). It has also been found to improve the effect of lasers on rosacea.

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.
* 5-ALA is then placed on the face for at least 30 minutes. The concentrations of ALA can range from 5% to 20%, but typically 20% is used.  

* The Gemini Laser is then used on its 532nm setting to pass over the areas covered with ALA to activate the product. This takes another 30 minutes usually.



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. 5-ALA was placed on his skin for 30 minutes each time and activated by the Gemini 532nm KTP laser. His acne has cleared significantly, with much of the inflammation and redness disappearing.


Photodynamic Therapy Case Study


How does it work?


Once on the face, the 5-ALA penetrates through the skin and is selectively attracted to abnormal (dystrophic) skin cells and sebaceous glands where 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, the Gemini Laser 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.
A new use of PDT is for the treatment of hidradenitis suppurativa. This is a condition that causes large, swollen lesions in the groin and armpits in particular, and is caused by blockage of the sebaceous glands. PDT is able to help reduce the number of sebaceous glands in this disorder. 


Benefits are gained not only from the activation of 5-ALA by laser, but also from the laser itself rejuvenating the skin.

 
Am I a suitable candidate?
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.
*resistant rosacea,
*pigmentation and for people with sun-damaged skin with or without actinic/solar keratosis and basal cell carcinoma (supercial only).
It is not suitable for people who are breast feeding, pregnant, those with a history of keloid scarring, and patients who have had Roaccutane in the past 6 months.

How many sessions are needed?


Best results are achieved by two to four sessions are required at  intervals between 10 and 30 days are for the treatment of acne and rosacea. Treatment of solar/actinic keratosis, basal cell carcinomas, 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. Generally speaking, the downtime is from 7 to 10 days, and the side effects are significant during this time.

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 sun-damage/photorejuvenation. This includes all aspects of the treatment, including microdermabrasion, application of the 5-ALA, and activation with the laser. The whole treatment time can take around 2 hours approximately.
For sun-damage/photorejuvenation, there may be an asssociated 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. 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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