Is Photodynamic Therapy a Good Acne and Rosacea Treatment?

PHOTODYNAMIC THERAPY ( known as PDT) is an excellent for the treatment of acne and acne scarring. The treatment begins with the application of a photosensitive serum to the area to be treated  ( face, neck or decollate) .  Specific wavelengths of light then activate the serum , which in turn kill acne bacteria while  another spectrum of laser light reduces the redness  and inflammation and results in skin rejuvenation.On the other hand, this is not a recommended treatment for Rosacea .  Broadband light alone ( without the photosensitizing serum) is the best remedy to reduce broken capillaries and the redness of Rosacea.

While there is nothing that works better than Accutane, a series of PDT under the supervision of an experienced board-certified dermatologist can be a close second when combined with conventional therapies, e.g. oral/topical antibiotics, hormonal medication, topical acne creams. Photodynamic therapy otherwise known as PDT utilizes Levulan (levulinic acid, a naturally occurring breakdown compound of hemoglobin, part of red blood cells) and Blue light (~410nm wavelength). The effect of Blue light on acne is quite modest but gets potentiated substantially when preceded by application of Levulan. PDT involves 2 protocols, i.e. incubation time (duration of Levulan left on the skin) and exposure time (duration patient spends in front of a Blue light source). An experienced clinician can expertly manipulate PDT protocols to maximize clinical benefits while minimizing downtime. Staying away from bright light sources, e.g. sunlight, bright indoor lighting, computer screen, would be advisable for the first 48 hours. It is thought that PDT makes acne prone skin better by helping to shrink oil glands, minimizing colonies of bacteria responsible for acne and thereby making conventional acne therapy work even better.

PDT is a great treatment for acne and usually takes 4 treatments at 2 weeks apart at a cost of $350 per treatment. Levulan solution is applied to the skin for 45 minutes then a Blu U light is applied for 15-20 minutes. It is totally painless and very effective. You do look quite red for 2-3 days but it is so worth it.

Photodynamic therapy uses a medication called Levulan (aminolevulinic acid) and a light source such as red or blue light to activate the medication.  Activation of the medication with intense pulsed light or pulsed dye laser treats the redness and veins of rosacea as well as acne.  You should be assessed and treated by a board certified dermatologist.

PDT for acne is great – it works really well and seems to have lasting effects in many.  It can also help with rosacea, and depending on the light source used, can also help with the redness.

PDT works very well for acne.  Alternating red and blue light for a series of 8 treatments over 4 weeks is effective even without Levulan.  Topical retinoids and salicylic acid can be helpful in conjunction with this regimen.  A series of 8 treatments over 4 weeks tends to cost between $500-800.  Best results are achieves several weeks after the series of treatments.

The only approved FDA indication for Blu Light is for the treatment of Acne WITHOUT levulan. However, most dermatologists, if using blu light to treat acne will do so with the addition of levulan. It is felt that the levulan which is photoactivated by the Blu light results in better treatment of acne than Blu light without levulan. Either way in my experience the results are equivocal. Blu light for rosacea though not an FDA indicated use has been used by many dermatologists. There are mixed reports of its success.
Generally, if other treatments have failed for acne or rosacea, blue light and levulan can be tried with the understanding that it may not work and it is an off label use of an approved treatment.

I have seen this treatment work well for acne and we use a system that employs Levulan and a special light (Called a Blu Light).
The Levulan is absorbed by the skin and then activated by the light. This results in a significant decrease in bacteria and oil.
Treatments are spaced out a month apart and require 2-3 to make a difference.
Expect to be very red (imagine the worst sunburn of your life) for about a week.
There is another drug calle Metvix out but I have no experience with it so can not provide any guidance with it and until it is out for a while, would stick with Blu Light and Levulan

Rosacea is a chronic condition, and PDT will make your condition worse. In fact for patients who have sun damage (pre cancerous lesions) on a background of rosacea, I warn them that their rosacea will flare up after PDT. The inflammation from PDT can be intense (especially with red light). My suggestion is that you seek advice after an examination from a laser dermatologist. 1. Medical treatment should be considered, including avoidance of flare factors, possibly anti inflammatory tabs should be prescribed. 2 .Laser such Pulse Dye Laser and 532 KTP may help- especially for redness. These lasers can also be effective in reducing red acne scars. 3. The use of Low Level Laser devices eg. Red light at 630, orange light has shown to be effective in some patients with acne rosacea. (Blue light in acne patients as well). IMHO Lasers have more consistent results compared to red/blue/orange light source. RegardsDr Davin LimLaser DermatologistBrisbane, AUSTRALIA. 

Photodynamic therapy involves the pre-treatment with 8 aminolevulinic acid ( Levulan) before light treatment with the Blu-light or an equivalent light source. In other words the Levulan kerastick is applied to the intended area, there is an incuatiion period of one half hour and then a light treatment of approximately 16 minutes.
This has proven to be an excellent treatment for actinic keratosis. Typically, I use this in severe cases of actinic keratoses: either numerous actinic keratoses or actinic keratoses that are nearly becoming malignant ( squamous cell carcinomas).
This is an FDA approved treatment and is covered by insurance.
It is also being used for hidradenitis suppuritiva ( a condition of cysts in areas of apocrine glands such as the groin, armpits, breasts and curiously ears), psoriasis and even warts. Of course, these uses are off-label.
PDT is also used for photorejuvenation. Its effect is probably to a series of microdermabrasions, but since the cost is $180, this is less expensive and far more convenient ( one or two treatments opposed to six).
Now, for its use in acne. This works in a rather subtle manner. The bacteria that is incriminated as playing a villain role in acne ( though in actuality an otherwise harmless sort, P. acnes) produces a chemical called porphyins. The blue light is attracted to these porphyrins and zaps not only the porphyrins but the nearby bacteria. The 8 amino-levulinic acid is absorbed into the porphyrins and gives the blue light an extra punch. PDT used in this manner is about as effective as a good antibiotic. The kerastick costs about $104 ( though I think the company..DUSA.. recently raised their prices..so much for deflation) and the light treatment itself runs another $85.
I hope this explains PDT therapy.