Photodynamic Therapy (PDT) is a procedure done in a doctor’s office that involves topical application of 20% 5-aminolevulinic acid, a photosensitizing cream (ALA, under the tradename Levulan), in conjunction with light exposure. The ALA is applied to the skin and is then “activated” when you sit in front of a red or blue LED panel (light-emitting diode) or IPL (intense pulsed light), which explains the name photodynamic. The IPL is not related to UV light from the sun but the LED is; in fact, you could just go out in the sun to activate the ALA.
Initially Photodynamic Therapy was cleared by the FDA in 1999 for the treatment of actinic keratosis (AK), precancerous lesions found on the head and scalp. A year later, the BLU-U, Blue Light Photodynamic Therapy Illuminator, was also FDA approved for the treatment of AK.
Shortly after that, PDT started being looked at for treating acne. Today many physicians feel PDT is a very effective option for acne, especially for those who aren’t having success with traditional topical treatments. It is thought to work by shrinking the skin’s oil glands, which could significantly reduce the amount of oil within the pores, thereby reducing blemishes. ALA-PDT may also kill bacteria that cause acne breakouts and normalize the shedding of dead skin cells within the follicle. It also seems to improve the skin’s overall texture, and holds promise in the repair of acne scarring.
A series of three to five one-hour treatments are usually performed, timed over a given period at two – to four-week intervals. The number of treatments recommended depends on the severity of acne. (Sources: Journal of Cosmetic Dermatology, September 2008, pages 180-188; Journal ofDrugs in Dermatology, July 2008, pages 627-632; and Lasers in Surgery and Medicine, February 2007, pages 180-188.)
There is also research showing that having microdermabrasion before the procedure can enhance the effectiveness of the PDT, both by helping improve results and shortening the time needed to activate the ALA. (Source: Journal ofDrugs in Dermatology, February 2007, pages 140-142.)
Initially the results of ALA-PDT for acne treatments seemed promising. However more recent studies have put those results in question, showing minimal success as well as uncomfortable side effects of burning and hyperpigmentation. The need for repeated treatments in the doctor’s office and the cost doesn’t make this a practical process, not to mention that topical treatments are still required to achieve and maintain improvement. Outcome can also vary based on skin color. (Sources: British Journal of Dermatology, December 2008, pages 1245-1266; Acta Dermato-Venereologica, July 2007, pages 325-329; and Lasers in Surgery and Medicine, January 2007, pages 1-6.) As a treatment, PDT needs to be evaluated rationally with your physician, who should present the pros and cons and not describe this treatment as only having benefits.