Does Photodynamic Therapy Really Work for Acne and How Long Does It Last?

PDT has worked very nicely in my practice for acne patients, but I use 2 different lasers and light sources to activate the medicine, making it more effective in my hands than with a single light or laser source.  Unfortunately there is no true "cure" for acne. Even after accutane one may continue to break out.  The PDT shrinks the sebaceous glands, so in some of my patients the results from a single session have worked as long as 2 years in controlling their acne, and then they do a repeat treatment.

The only "permanent" solution to acne is Accutane, which has about an 80% care rate. All other treatments are just that, treatments.

PDT does work for acne, in part by decreasing oil production and in part by killing the bacteria that causes acne. But while this treatment works well, the patients require multiple sessions and invariably relapse - i.e., require more sessions.

Blue light, photodynamic therapy, antibiotics and topicals suppress acne but do not "cure" it.  Smoothbeam laser has been shown to work for 18 months or longer, but not everyone responds to treatment.  The only therapy that I have found to be curative in a significant precentage of patients is Isotretinoin, also called Accutane.  About 1/3rd of patients never need another acne treatment of any kind.  About 1/3rd of patients eventually will need to go back to topicals or another less severe treatments, and about 1/3rd get retreated with Isotretinoin eventually in the future, though this may be many years later.  Although there is a lot of controversy surrounding Isotretinoin, it remains a great treatment for severe, chronic or scarring acne.

Hope that helps.

Madeline Krauss, M.D.

Photodynamic therapy can be a great treatment for treatment resistant acne or as an addition to an acne treatment plan.  The most important thing to remember is that the treatment is considered cosmetic and will most likely not be covered by your insurance.  The other thing to keep in mind is that there are several light sources that are effective and the treatment can be done with or without levulan (levulanic acid).  It is hard to predict how long the treatment will last, as this can depend on several things including the type and severity of the acne, the location of the acne, the use of levulan, and the light source used to perform the treament.  We have many patients who are very satisfied with this treatment for their acne.

Photodynamic therapy is a great treatment for acne.  Not only does it clear up severe cases, even cystic cases of acne but it also makes the skin surface look so much more even, shrink the appearance of pores and help make the skin look much healthier.  My protocol in my office is to recommend 3-4 treatments approximately 3-4 weeks apart and then evaluate at 1 month and 3 months.  The results are better at 3 months after a series of treatments than after 1 month so you do need some patience.  Expect to continue to need at least one treatment every 3 months (this can be quite variable and sometimes it is only every 6 months).  Unfortunately, the only truly permanent treatment for acne is the medication isotretinoin (Accutane), which does seem to have a long term effectiveness rate of 60-70%.  I am frankly surprised at how many people do NOT choose to do PDT before isotretinoin.  The main reason is that it isn't covered by insurance so it will cost over $1000 for the 3 treatments.  It isn't approved by the FDA for this usage so it is "off-label" although there are some studies, including mine, in the medical literature that show that it is effective.  Make sure though if you do get PDT for acne that the practitioner is using pulsed dye laser or intense pulsed light (IPL) to activate it and not blue light.  Blue light has been shown to work but it doesn't have as much of a long term result becuase the light doesn't penetrate deeply enough to change the actual oil gland.