Treating the difficult acne sufferer with Levulan for prolonged improvements
Article by Steven F. Weiner, MD
Pensacola Facial Plastic Surgeon
Acne is an extremely common disease, affecting approximately 17 million people in the United States. It’s presentation is varied; ranging from small occasional blemishes, to deep painful cysts, to infected pustules on the skin surface. The consequences of acne can affect ones self confidence, social life, and interpersonal relationships. Facial scarring from acne can affect individuals into their adult lives, even after the disease process has long subsided.
The disease process is due to a combination of factors, but primarily related to excessive secretion of sebum, which is the product of sebaceous glands and often an associated infection. Topical therapy can control most cases and is essential to maintain skin health for acne sufferers. Retin A (or derivatives such as retinols, Tazorac, Renova) is indicated for ALL acne patients, whether the problem is mild or severe. Other topicals used, depending of the severity and type of acne are: Antibiotics, Benzyl Peroxides, and anti-inflammatories as well as chemical peels. For the most recalcitrant forms of acne, Accutane has been used with fairly good success. This drug has very strict guidelines because of it’s multiple and often severe side effects which include: birth defects, liver inflammation, depression/suicide ideation. Lower doses (20mg/day) seem to have fewer side effects but monitoring is still required whenever taking the drug.
For the patient with acne that’s not responding to topicals and wants an alternative to Accutane, Photodynamic Therapy (PDT) with Levulan is great choice. (Levulan is currently not FDA approved for this disease but is currently undergoing clinical trials for acne treatment.) The process starts out with a thorough cleaning of the skin with acetone. The skin is then prepared by microdermabrasion or dermaplaning (if the skin is not too inflamed or infected) to allow for greater penetration of the Levulan when applied. The Levulan is spread over the affected area and allowed to “incubate” for anywhere from 30 minutes to 1.5 hours usually with the skin occluded with plastic wrap as well. During this incubation time, the Levulan is slowly being absorbed by the sebaceous glands. After the desired time has completed, the Levulan is thoroughly washed off and then it is activated by light. At the Aesthetic Clinique, activation is performed with both the VBeam (pulsed dye laser) and the Blu U so as to achieve the maximum results from the treatment. At this point, the patient can experience burning and stinging, which can last for several hours, like a bad sunburn.
For the next 36 hours, the area treated needs to be protected from any form of light (sunlight, light bulbs). Even when leaving the office, we make sure the face is wrapped in a scarf and a hat is on. We have found it’s best to be treated in the late afternoon/early evening so you can resume your normal schedule at treatment day +2 in the AM. At about day 3-4, the skin will begin to peel and will do so for about 48 hours. During this time, a flair of the acne can occur and is nothing to be concerned about and can be treated with antibiotics if needed. The full results will take about 12 weeks to appreciate and it is recommended to have 3 treatments, spaced about 3-4 weeks apart. Long lasting improvements of about 75% can be obtained for 9-12 months or longer. Some doctors have shown slides at meetings of 5 year or more improvements. Typically, a “refresher” treatment at 1 year is recommended. Results which are similar to Accutane are not uncommon, but without the associated side effects of the drug.
(It’s not uncommon to have to treat the acne scarring after the acne is under control. The Vbeam and/or the Fraxel Dual 1550 are good treatment options for the scarring.)
At the Aesthetic Clinique, there have been many happy clients who suffered for years with their acne, who have had success with using Levulan (PDT) and the recommended topical therapy. Call our office for a consultation. 850.622.1214