Q: What are the pros and cons of photodynamic therapy?

Pros PDT can permanently remove precancerous skin lesions and nonmelanoma skin cancers in just one session. It’s a noninvasive skin cancer treatment that shouldn’t leave any scars. Severe acne that has persisted through many other treatment options may finally be cleared by photodynamic therapy. It’s a viable alternative to Accutane for people with cystic acne. Cons Photodynamic therapy, particularly the type used to treat actinic keratosis, can be quite painful. You may experience a hot, burning sensation as the photosensitizer on your skin reacts with the light energy. Recovery after treatment for precancerous or cancerous skin lesions can be lengthy and uncomfortable, with redness, crusting, and peeling for one to two weeks. Following treatment for acne, your skin will be red for a few days. If you have skin that reacts unfavorably to light exposure (e.g., fair, sensitive skin that burns easily in the sun or melanated skin prone to hyperpigmentation), you risk those reactions during treatment and may not be a good candidate for PDT.

Question 1

What is photodynamic therapy?

Accepted Answer

Photodynamic therapy (PDT) combines light energy with drugs called photosensitizers to treat a variety of skin conditions.

Dermatologists most frequently use photodynamic therapy to treat actinic keratosis (AK), a precancerous skin condition that presents as rough, scaly patches. Actinic keratoses develop as a result of long-term exposure to the sun. They’re a form of sun damage that can become cancerous if left untreated, so doctors recommend removing AK skin lesions early. The most common approach combines a photosensitizing agent called 5-aminolevulinic acid (ALA) with blue light. This type of photodynamic therapy has approval from the U.S. Food and Drug Administration (FDA) for treatment on the face and scalp.

PDT is also a viable treatment for certain types of cancer—particularly nonmelanoma skin cancers, such as squamous cell carcinoma and superficial basal cell carcinoma—because of its ability to target and kill cancer cells.

Dermatologists have also found success using PDT off label, to treat severe acne, psoriasis, and rosacea as well as improve overall skin tone and texture by stimulating the production of collagen. “Published studies on PDT have shown not only improvement of precancerous spots but measurable improvement in sunspots, broken blood vessels, collagen production, and skin texture,” says San Diego dermatologic surgeon Dr. Melanie D. Palm.

One 2014 review of studies and clinical trials details improvements in skin elasticity, fine lines, and hyperpigmentation following photodynamic therapy. However, it’s unlikely your dermatologist will recommend PDT first if those are your primary skin concerns, given the prevalence of many other proven and better-tolerated skin rejuvenation treatments.

RealSelf Tip: Beyond its benefits in the realm of dermatology, PDT, sometimes called photochemotherapy or photoradiation therapy, is also a treatment for cancerous tumors throughout the body, including lung cancer, esophageal cancer, and pancreatic cancer.

Question 2

What are the pros and cons of photodynamic therapy?

Accepted Answer

Pros

PDT can permanently remove precancerous skin lesions and nonmelanoma skin cancers in just one session.
It’s a noninvasive skin cancer treatment that shouldn’t leave any scars.
Severe acne that has persisted through many other treatment options may finally be cleared by photodynamic therapy. It’s a viable alternative to Accutane for people with cystic acne.

Cons

Photodynamic therapy, particularly the type used to treat actinic keratosis, can be quite painful. You may experience a hot, burning sensation as the photosensitizer on your skin reacts with the light energy.
Recovery after treatment for precancerous or cancerous skin lesions can be lengthy and uncomfortable, with redness, crusting, and peeling for one to two weeks. Following treatment for acne, your skin will be red for a few days.
If you have skin that reacts unfavorably to light exposure (e.g., fair, sensitive skin that burns easily in the sun or melanated skin prone to hyperpigmentation), you risk those reactions during treatment and may not be a good candidate for PDT.

Question 3

How much does photodynamic therapy cost?

Accepted Answer

The price varies with the size of the treated area, the number of treatments you need, the experience level of your provider, and where their practice is located.

Question 4

Photodynamic therapy before and after pictures

Accepted Answer

The photodynamic therapy photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

How does photodynamic therapy work?

Accepted Answer

Dermatological photosensitizers are medicated creams that are applied topically to targeted lesions and then activated by a light source. Each type of photosensitizer responds to a specific wavelength of light. Once exposed, it undergoes a chemical reaction and produces a form of oxygen that kills nearby cells.

There are two photosensitizer drugs approved by the FDA for dermatological use: 5-aminolevulinic acid (branded as Levulan Kerastick) and methyl aminolevulinate (branded as Metvix), activated by blue light and red light, respectively.

For skin cancers and actinic keratosis, PDT destroys both cancerous and precancerous cells. Most normal cells are not affected. In the case of acne, that destructive power targets breakout-causing bacteria and fungus.

One treatment suffices for removal of nonmelanoma skin cancers and AK lesions, but significant resolution of acne or improvement in other skin conditions requires a series of two to three sessions, spaced four to six weeks apart.

RealSelf Tip: The photosensitizer drugs set PDT apart from other forms of phototherapy, like IPL and BroadBand Light. Those two treatments can also address acne, rosacea, and sun damage, but they don’t have the power to destroy malignant cells. A true alternative to photodynamic therapy is phototherapy with light-emitting diodes (LEDs), a safe and effective treatment that’s growing in prevalence.

Question 6

What happens during photodynamic therapy treatment?

Accepted Answer

Photodynamic therapy happens in two stages: photosensitizer incubation and light exposure.

Your provider first cleanses the treatment area with alcohol, to remove excess oil. Then they apply the topical photosensitizer cream, which needs a one- to three-hour incubation period to allow the drug to penetrate and disperse throughout your skin cells. All cells absorb the photosensitizer, but it stays in the cancer cells longer than it does in normal cells, allowing them to be specifically targeted.

After the appropriate incubation time, your doctor will give you a pair of protective eye goggles to wear and then expose your skin to the light source (usually blue light, red light, or LEDs). The light exposure stage of PDT treatment takes about 15–20 minutes.

Question 7

Is photodynamic therapy painful?

Accepted Answer

The level of pain you experience during photodynamic therapy depends on the specifics of your treatment and your own sensitivity, but you should prepare for significant discomfort—during treatment and throughout recovery.

Some RealSelf members say they simply felt a warm sensation, but others felt intense burning and stinging while under the light source. “It felt like I was literally being burned,” says RealSelf member buffnbalanced in her review of treatment for actinic keratosis and superficial basal cell carcinoma.

Question 8

How long does it take to recover from photodynamic therapy?

Accepted Answer

Your skin won’t be back to normal for one to two weeks after a PDT treatment. It will be red and swollen, looking and feeling like you have a bad sunburn. It’s also normal to experience itching, roughness, and peeling after photodynamic therapy for actinic keratosis or nonmelanoma skin cancers.

“In general, most of our patients experience about the same reaction every time [they have the treatment], although it depends on how bad your sun damage and actinic keratoses are,” says Dr. Amy Paul, a dermatologic surgeon in Grand Junction, Colorado. “Discuss the possible reaction and recovery with your dermatologist before your treatment so you can understand what their post-treatment instructions are and what to expect.”

If you’re treated for acne or another skin condition, your recovery should be much easier, with post-treatment redness that resolves in a few days. Unfortunately, you may find that your breakouts temporarily get worse.

In all cases, the skin will be extremely light-sensitive. Follow your doctor’s aftercare instructions carefully in order to avoid causing harm. Dermatologists typically recommend staying out of direct sunlight for at least 48 hours. If possible, try to stay indoors. At the very least, plan to wear sunscreen, sunglasses, and a broad-brimmed hat, to combat photosensitivity.

In the first few days of recovery, keep your skin-care routine simple, with only gentle, soothing basics. Avoid shaving or applying makeup until you have significantly healed.

Question 9

How soon will you see photodynamic therapy results?

Accepted Answer

If you had PDT cancer treatment, your skin should clear up after the one- to two-week recovery period.

If you’ve been treated for acne, you may see fewer breakouts after your first treatment, but final results will be evident after your full treatment series of up to three sessions (four to six weeks apart).

Question 10

How long do photodynamic therapy results last?

Accepted Answer

The removal of actinic keratosis or nonmelanoma skin cancers is permanent. However, you can still develop new precancerous or cancerous lesions.

Photodynamic therapy can also treat underlying sun damage that hasn’t evolved into AK or skin cancer, but this is not necessarily a preventative treatment.

It’s on you to protect your skin from further sun damage, but if you’ve had a lifetime of chronic sun exposure, you’ll need to stay alert to the development of more concerning skin lesions down the line.

Question 11

Is photodynamic therapy safe?

Accepted Answer

Photodynamic therapy comes with no serious risks, but unpleasant side effects can emerge following treatment. Common side effects include redness, swelling, itching, and even small blisters.

In severe cases, you may experience lasting post-inflammatory redness. “This may occur when the protocol involved is aggressive,” says Dr. William Ting, a dermatologic surgeon in San Ramon, California. “Unfortunately, conservative protocol [i.e., abbreviated incubation time and blue-light exposure time] used in PDT may not be as efficacious as a more aggressive protocol.”

For this reason, it’s vital to go to a board-certified dermatologist or plastic surgeon who has extensive experience using PDT to treat your specific concern.

People with medium to deep skin tones may also be prone to post-inflammatory hyperpigmentation, when the skin produces excess pigment in response to injury. If this could be a concern for you, talk with your provider about alternative treatment options.

Question 12

Will insurance cover photodynamic therapy?

Accepted Answer

If you’re undergoing photodynamic therapy to resolve actinic keratosis or skin cancer—especially on FDA-approved locations—your insurance may consider it medically necessary and provide coverage.

PDT for acne is considered a cosmetic treatment and won’t be covered.

Question 13

What are the alternatives to photodynamic therapy?

Accepted Answer

Possible alternative treatment options depend on what you want to address.

Actinic keratosis can instead be treated with cryotherapy or topical prescription medications to be applied at home.
Nonmelanoma skin cancers may be addressed with certain topical creams, Mohs surgery, cryosurgery, excision, radiation, or curettage and cautery.
Severe or cystic acne is most successfully treated with Accutane, a prescription-only oral retinoid called isotretinoin. Additional prescription options include Retin-A and spironolactone. A series of cosmetic treatments, such as chemical peels or IPL, can also help clear breakouts.

Talk to a board-certified dermatologist to determine the best treatment options for you.

Question 14

Sources & studies

Accepted Answer

Ablon, Glynis. “Phototherapy with Light Emitting Diodes: Treating a Broad Range of Medical and Aesthetic Conditions in Dermatology.” The Journal of Clinical and Aesthetic Dermatology, Feb. 2011.

Del Rosso, James Q., et al. “Comprehensive Management of Actinic Keratoses: Practical Integration of Available Therapies with a Review of a Newer Treatment Approach.” The Journal of Clinical and Aesthetic Dermatology, Sept. 2015.

Lin, Jennifer, and Marilyn T. Wan. “Current Evidence and Applications of Photodynamic Therapy in Dermatology.” Clinical, Cosmetic and Investigational Dermatology, Sept. 2014.

PHOTODYNAMIC THERAPY

Melanie D. Palm, MD

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Melanie D. Palm, MD

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