Blonde, Bluebeard fair and in 60s. I have AK skin damage. Why was no reaction after my first PDT? Should I continue treatments?

Question

A child of 1950s before SunBlock, I had many water-blister sunburns. I've confirmed AK by other Drs. Family history: skin cancers removed by freezing, laser and surgery. I had PDT 6 days ago: Face was cleaned w/ acetone, Levulan applied, 1 hr wait, then 15 mins with Blue Light. Told to wash face & apply sunblock, then left office. No reaction No pinkness No peeling. I'm depending on these treatments to help eliminate, pre-cancerous damage. Should I ask for more Levulan or light time?

Jason Emer, MD · Answer

I personally like co2 laser resurfacing or fraxel lasers for AKs. I find the PDT only partially destroys the cells and they often come back.  If you didnt get a good response, they should do microdermabrasion or fraxel first and then do the 1 hour incubation and blue light.  if you want you can do over night incubation.  there are many options to get a more robust response.  Best, Dr. Emer.

Morris Westfried, MD · Answer

Can be repeated with longer incubation time of up to 14 hours. The other alternative is prescription picato gel which needs to be applied for two days only. May require prior authorization. Form insurance company which should be possible with pdt failure.

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  While not having a reaction does not mean that the PDT has not worked, please be advised that most patients need at least a cycle of 2 PDT treatments to boost efficacy.  In the future you can have microdermabrasion, fraxel, or micro needling done beforehand to enhance the effect of the levulan.  As well longer incubation times, ambient heating of the room while having the blue light applied, and making sure you are only 4 finger breadths from the light will dramatically improve the efficacy of PDT.  In my practice we give patients an anti-histamine approximately 30 minutes before sitting under the light and that mitigates against a lot of the pain and side effects, so if you were given an antihistamine this could be the reason why you saw no effect.  Again this does not mean it didn't work.  Regards, Dr. Matt Elias

Davin Lim, MBBS, FACD - Account Suspended · Answer

See the video for how many variations of PDT there are. If you did not get a good reaction there maybe a few reasons. 1. You actinic keratosis are pigment - Fraxel 1927 high density will help. 2. The cream did not get absorbed enough. Levulan can be applied to gently abraded skin - see video.3. Increase incubation period - leave Levulan longer4. Increase fluency or power ie. length of blue light exposure. All in the web reference. Best,Dr Davin LimBrisbane, Australia.

Blonde, Bluebeard fair and in 60s. I have AK skin damage. Why was no reaction after my first PDT? Should I continue treatments?

Answers (4)

Answer: Skin prep and PDT

Answer: Skin prep and PDT

Recommended reading

Everything you need to know about Photodynamic Therapy

Our mission is to create a world where every investment in modern beauty is Worth It.

Blonde, Bluebeard fair and in 60s. I have AK skin damage. Why was no reaction after my first PDT? Should I continue treatments?

Answers (4)

Answer: Skin prep and PDT

Answer: Skin prep and PDT

Browse related questions

Recommended reading

Everything you need to know about Photodynamic Therapy

Our mission is to create a world where every investment in modern beauty is Worth It.