I am a 38 year old mexican female. I had a miscarriage 3 years ago, which most likely triggered cystic acne breakouts I get every month, around my period. About 6 months ago, I went on Doxycline and Spironalacton, which greatly controlled the acne, although I still get occasional whiteheads and blackheads. I don't want to be on medication forever, so I consulted with my dermatologist, who suggested several treatments. One of these is PDT, but she's also worried about discoloration. I went somwhere for a second opinion, and the nurse said I should have Levulan with the DUSA blue light. She said she uses it on dark patients and has never seen anyone hyperpigment. What do you think about the blue light vs. PDT? Which should I go for?
Acne Medicine Alternative: PDT Vs Levulan Blue Light?
Doctor Answers 2
PDT or Levulan with Blu Light
PDT and Levulan are terms that we typically use together. Our Photodynamic Therapy (PDT) treatments involve the use of Aminolevulinic Acid (Levulan or ALA as it is commonly referred to) with an accompanying Blu-U or Pulsed Dye laser treatment. To us, it sounds like both practices were suggesting the same treatment so we will address your concern for Hyperpigmentation.
While temporary hyperpigmentation is possible after PDT, it occurs in less than 10% of our dark skinned patients. In addition, as long as sun avoidance is practiced, it very rarely lasts more than a few weeks and is easily addressed with hydroquinone bleaching products.
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Post-inflammatory hyperpigmentation post PDT treatable and potentially preventable
Levulan with Blue light therapy is one of the two PDT modalities available in US currently. Metvixia with Red light therapy is the other PDT available. Post-inflammatory hyperpigmentation (PIH) does occur not infrequently in darker skin type individuals, particularly if strict daily sun protection is not adhered to. However, in my clinical experience with greater than 1000 patients treated with PDT, the PIH is often transient and almost always reversible with bleaching cream. One can take pre-emptive step to minimize PIH by utilizing prescription bleaching cream for 2-3 weeks starting 5-6 days post PDT treatment.