PHOTODYNAMIC THERAPY

Photodynamic Therapy (PDT) is a special treatment performed with a topical photosensitizing (light sensitizing) agent called Ameluz activated with a specific wavelength of light. These treatments remove pre-cancerous areas and spots called actinic keratoses. Sun damage, fine lines, and blotchy pigmentation are also improved because of the positive effect of PDT. 

Photodynamic Treatment is performed as follows: The skin is prepared by removing surface debris with an alcohol wipe; a light filing may be done on thicker areas.  The Ameluz is applied to your skin and left on for 60 minutes- 2 hours depending on the area being treated. Ameluz is a clear solution and painless. During this time, you will remain in the office and may read or listen to music. Ameluz is then activated with a specific wavelength of light generated by a machine called a BF-RhodoLED.  This takes approx. 10-30 minutes. The Ameluz targets pre-cancerous cells and sebaceous (oil) glands. Following treatment, you should avoid sunlight for 48 hours. 

Immediately following PDT, the skin feels sunburned. Cool compresses are applied. The treated areas can appear red and slightly swollen and there may be some puffiness around sensitive areas such as lips and eyes. Some peeling occurs for 2 – 7 days. Darker patches called “liver spots” can become temporarily darker and then peel off leaving normal skin in usually 7 – 10 days. Repeat treatments may be necessary depending on the severity of your sun-damage. Rarely, there may be permanent scares or discoloration. 

Please let us know if you are taking or have taken any of the following types of medication: - Anti-arrhythmic (Amiodarone), Antifungal antibiotics (Griseofulvin), Anti-acne (Isotretinoin) or chemotherapy medications (Methotrexate) The treatment with red light is contraindicated if you are taking the above drugs. 

It is important to tell us if you are prone to cold sores as it may be necessary to take preventative medication before treatment. 

Patients with severely sun-damaged skin manifested by mottled pigmentation and actinic keratoses (precancers) show in most cases dramatic improvement in their skin texture and tone. Pre-cancers dramatically diminish in number and size. Depending on the severity of the sun-damage repeat treatments may be necessary. 

1. Easier. Treatment is usually complete within one week. Side Effects are minimal, healing is rapid and usually only requires 1 – 2 treatments. 

2. No Scarring reported with PDT.

3. Improves the whole facial treatment area. PDT creates an even color, texture, and tone over the entire treatment area rather than liquid nitrogen or electric cautery which treats only one spot. 

4. PDT is an optimal treatment for Actinic Keratoses because: 

∙ It is well tolerated with minimal side effects or down time compared to conventional treatments for actinic keratoses (pre-cancers) such as extensive use of liquid nitrogen, electric cautery, or treatments with Effudex or Carac cream. 

∙ Non-invasive. No needles or surgery are required. 

∙ Excellent cosmetic outcome. PDT improves the texture and color of the skin particularly in cosmetic sensitive areas such as the face.

∙FDA approved for treatment of AKs.

∙Well covered by Insurance.

Download a PDF copy of our Photodynamic Therapy Before Care Instructions here.

PHOTODYNAMIC THERAPY  – 

PRE-TREATMENT INSTRUCTIONS

This treatment is designed to help decrease the number of pre-cancers called actinic keratoses (AKs). Depending on the length of Ameluz incubation and the amount of sun damage you have incurred over your lifetime, you can expect to have a sunburn-like reaction that usually lasts about a week. Swelling, scabbing, crusting and mild discomfort may occur. Some patients may have a more exuberant response to PDT than others and experience a much more severe sunburn-like effect. If this happens, the healing time is usually longer, up to 4 weeks. It is recommended for two sessions per treatment area, typically 4-6 weeks apart. The second session is where most of the results are achieved. Expect the reaction from PDT to be about 25% of the reactions you would get from creams such as Efudex or Aldara. 

Preparation for PDT 

1. On the day of treatment, please come to the office with CLEAN SKIN (wash area prior to appointment) and free of any makeup, moisturizing creams, sunscreens, perfumes, or lotions on the treatment area. 

2. For anyone with thick, dense hair in the planned treatment area, the treatment area should be shaved 2 days before treatment. You should not shave the treated area for at least 3 days after treatment. 

3. Bring sun-protective clothing to your appointment to protect you on your way home. We suggest bringing sunglasses, and a scarf if we are treating the face or scalp. If you're having your hands or arms treated, you will need gloves and long sleeves. The risks of side effects (swelling, redness, scabbing, crusting and discomfort) increase dramatically with ANY sun exposure, including INDIRECT exposure in the 48 hours following treatment. Plan to cover the treated area prior to leaving the office and while incubation occurs. 

4.  It is important to complete errands prior to treatment and make sure you have purchased post treatment supplies prior to therapy.

5. Plan to be in our office for 1.5 – 2 hours. This includes your incubation time of 60 minutes and light activation of about 10-30. Please plan meals accordingly and bring reading material, laptop/iPad and headphones with you (we will ask that you turn down the brightness on any electronic device you use).  Free wi-fi is available.

6. If you have a history of herpes simplex virus outbreaks (“cold sores” or “fever blisters”) in the areas being treated, make sure to let us know so we can prescribe medication to minimize the possibility of an outbreak after treatment. 

7. Please tell us if you have any contraindications to PDT including pregnancy, Lupus, porphyria, allergies, hypersensitivity to Ameluz, or PDT.

8. Discontinue use of any topical vitamin A products (retinoids or related derivatives) such as Differin, Epiduo, tretinoin (Retin-A) and Tazorac for one week before PDT. You may restart these medications 1 month after your second treatment. 

9. Please let us know if you are taking any of the following medications as they might make your reaction more severe and increase your side effects: griseofulvin, sulfonamides (sulfamethoxazole/trimethoprim compounds like Bactrim or Septra), phenothiazines (medications ending in “azine;” these are anti-psychotic medications), and tetracyclines (doxycycline, tetracycline, minocycline). 

10.  To minimize swelling or discomfort that may arise during or after treatment, you may take 600mg Ibuprofen or 2, 500mg of Acetaminophen prior to your appointment.  Do not take any narcotic pain medication or anti-anxiety medication prior to treatment.  

11. Please note that the most common side effects of treatment include scaling/crusting, lightening and/or darkening of the skin called hypo/hyper-pigmentation and itching. These symptoms usually go away after 5-7 days but may persist for several weeks. 

12. If you are having an extremity treated, please do not wear jewelry to your appointment. You will be asked to refrain from wearing jewelry for 3 days following your treatment due to possibly swelling. Wearing jewelry can lead to loss of circulation and possible amputation. 

13. You will need to bring the following to your appointment and to have at home to use after treatment: 

• A wide-brimmed hat for face and scalp treatments. 

• Gloves for upper extremity treatments and long-sleeved clothing for all extremity treatments. 

• A gentle cleanser such CeraVe, Cetaphil or Dove Unscented with no active ingredients and/or fragrances. 

• A high-quality sunblock of at least SPF 50 (We recommend sunscreens to include: zinc oxide and/or titanium dioxide) 

• A thick moisturizing cream, such as CeraVe, Cetaphil, Eucerin, Aveeno with no active ingredients and/or fragrances. 

14. You may also want the following for relief: 

• A new container of Vaseline pure petrolatum ointment that is placed in the refrigerator and q-tips or tongue depressors to remove ointment from the container for application to your skin. It is important to keep the container of Vaseline uncontaminated by bacteria (dirty fingers, etc.). 

• You may need to take a pain reliever such as ibuprofen or acetaminophen, especially for the first few days after treatment. 

Download a PDF copy of our Photodynamic Therapy After Care Instructions here.

PHOTODYNAMIC THERAPY  – 

POST-TREATMENT INSTRUCTIONS

What to expect during PDT treatment: 

• Your skin will be cleansed with acetone to enhance penetration of the Ameluz. 

• The Ameluz will be applied to the treatment area – you may experience tingling/mild burning. The Ameluz is a clear liquid - there will not be any visible sign of anything on your skin while you sit during the incubation period (60-120 minutes). 

• Duration of the light treatment will be 10-30 mins. During treatment, you may experience tingling, stinging, burning, or itching. These symptoms are typically mild and improve after the first 6 minutes of treatment. The extent of discomfort will depend on the amount of sun damage and AKs that you have. We have fans to help with discomfort. 

• After the light treatment, a thick layer of sunblock will be applied to the treatment area. Wear protective clothing and go straight home. 

Instructions Following PDT Treatment: 

• If your face and ears were treated, you must stay indoors for 48 hours and avoid exposure to bright light for the first 48 hours. This includes direct or indirect sunlight, such as being outside or sitting close to a window while indoors, lamps, overhead lights. Wear a thick layer of sunblock that has at least SPF 50 and contains Zinc Oxide or Titanium Dioxide during the first 48 hours. If your scalp, hands, arms were treated, follow strict sun protection precautions (wear sunscreen and protective clothing) but you are not restricted to staying indoors for 48 hours. 

• Wash your skin with a mild cleanser such as Cetaphil Gentle Cleanser or CeraVe Cleanser once to twice a day. Use pure Vaseline or Aquaphor in the evening to minimize crusting. Reapply emollients such as, Vaseline/Aquaphor, CeraVe, or Cetaphil Cream, frequently during the day to soothe and hydrate the skin. 

• During the first 24-48 hours, your skin may appear red and swollen or “hot” like a sunburn although it is not an actual burn. Swelling is not uncommon the first day or two after PDT and can be lessened by taking an antihistamine. Application of frozen peas in their bag, cool packs, or ice every five to 15 minutes every hour for the first eight to 24 hours after your procedure may be very soothing. Swelling may be more common around the eyes or lips. Sleeping propped up on a few pillows or in a reclining chair may help decrease swelling after treatment of the face. 

• After 24-48 hours, your skin may start to peel. This may vary from no peeling or redness at all to severe peeling. Peeling may last up to 7 -10 days. Some patients do not have any redness or peeling which is normal – it does not mean the treatment was not effective. If you have peeling, DO NOT pick at peeling skin, scale, or crust – picking increases the risk of infection and scarring. The scale and crust will fall off naturally as the skin beneath it heals. You can wear make-up or shave once any crusting has healed. 

• After 48 hours: Avoid sun exposure as your skin is healing and practice diligent sun protection with at least SPF 30 sunblock that contains Zinc Oxide or Titanium Dioxide. 

• If you have an emergency and must go out during daylight during the first 48-72 hours after PDT, you need to wear sunblock, a scarf, a broad-brimmed hat, or appropriate clothing to cover and protect the treated area. 

• If arms or legs were treated, long-sleeved shirts and pants should be worn for the first 72 hours, even during the summertime! 

• Follow up in 4-6 weeks or as instructed by your clinical provider.