Photodynamic therapy - is this a good acne and rosacea treatment?

More and more practitioners are using Aminolevulinic Acid with Photodynamic Therapy for various skin conditions. The conditions range from skin rejuvenation, rosacea, sebaceous hyperplasia, pre-cancerous lesions, and acne. In our practice, we are pleased with the consistent, predictable outcomes this treatment offers for our acne patients. Although our non-ablative lasers are an excellent treatment option, ALA/PDT (Aminolevulinic acid with Photodynamic Therapy) has proven to be a good option for those few that are non-responders to the lasers or those that are looking for a quicker resolution of acne. Of course, there are risks vs. benefits that must be addressed as with any treatment program.

ALA/PDT is a process that involves the use of a photosensitizing (light sensitive) agent (Aminolevulinic Acid hydrochloride aka: ALA), light and oxygen. When combining these components, a chain reaction of events occurs, which is confined in the sebaceous glands. Similar to Accutane, ALA sterilizes the glands by destroying the Propionibacterium (P.acnes bacteria) that has an important role in acne. However, unlike Accutane, ALA/PDT does not carry the same serious side effects that Accutane may pose. Because Accutane is taken orally, there are systemic effects associated with this treatment. On the other hand, ALA stays confined within the sebaceous glands.

Once the topical medication is allowed to "incubate" (stay on the skin) for approximately one hour, the medication must now be turned on (activated) with a specific light source, such as a Blu-U light or laser (pulsed dye laser). It is this activation that now results in the chain of events described.

Generally speaking, most of our patients require a minimum of 2-3 treatments, sometimes 4-5 for good, long-term outcomes. We also see approximately a 50% reduction in active lesions following each treatment.

There are some things to consider before deciding whether or not ALA/PDT is appropriate for you - there is downtime involved due to the need for strict sun avoidance following a treatment, there is a small to moderate risk of post-inflammatory hyperpigmentation that directly relates to your skin type, as well as other factors that you will need to be screened for.

Although there is no cure for acne - ALA/PDT has been an excellent treatment modality for many of our patients that were at the end of the road, so to speak. For those considering Accutane, please consider a treatment plan of lasers or ALA/PDT as a good option.