I have sebaceous hyperplasia. One MD recommended Levulan; another recommended Fraxel. What is the difference?
What is the Difference Between Levulan and Fraxel Treatments?
Doctor Answers 2
Sebaceous hyperplasia and treatment with Fraxel or PDT
fraxel laser is either the restore / dual or the repair. The fraxel restore is a 1550nm. erbium-yag fractional laser, the dual adds a 1927nm. thurium laser that is more specific for pigment reduction, and the fraxel repair is a fractional carbon dioxide laser. These lasers (the thurium is not expected to help the sebaceous hyperplasia) are nonspecific for the sebaceous hyperplasia, but may help reduce the mass from their resurfacing. PDT, or photodynamic therapy, involves the application of a photosensitizing liquid, Levulan, to the sebaceous hyperplasia which may preferentially absorb it more than normal skin, and then the skin is exposed to a light source after the skin incubates with the Levulan for a specified time. The Levulan-soaked sebaceous hyperplasia then are affected by the photochemical reaction between the light and the levulan. None of these treatments are cures, but they can minimize the growth of the sebaceous hyperplasia.
Very different therapies
Levulan refers to a chemical (ALA= amino levulenic acid) that is used in PDT (photodynamic therapy). ALA is activated by certain wavelenghts of light and initiates a reaction in the skin to reduce bacteria and to diminish pre-cancers. It is used "off-label" for aging and other conditions. Fraxel refers to a laser in the infrared range which heats the skin and improves skin texture and color. I use Tazorac and a birtcher hyfrecator for sebaceous hyperplasia (SH), because no matter how it is treated, SH ALWAYS comes back, and I have found this combination the least expensive so it can be repeated yearly.