Photodynamic therapy (PDT), also known as a Turbo FotoFacial, is a combination chemical and laser treatment that uses Levulan® and Intense Pulsed Light (IPL) to rejuvenate the skin. Photodynamic therapy was first used by dermatologists for treatment of actinic keratoses lesions (AKs) and actinic cheilitis (chronically chapped lips)—two precancerous skin conditions associated with chronic exposure to sunlight. PDT is designed to improve sun-damaged skin along with oily skin conditions, such as inflammatory acne and rosacea. This method has been shown to be effective in the treatment of many bothersome symptoms, including AKs, sun damaged skin, age spots, acne, sebaceous hyperplasia (soft, yellow bumps), and rosacea. PDT even has the unique ability to minimize pores and reduce oil glands. At our practice, Dr. Eugenie Brunner utilizes this approach to help correct several types of skin conditions and rejuvenate the appearance while treating acne and pre-cancers.
Photodynamic Therapy Treatment
For skin rejuvenation utilizing PDT, one treatment is typically equivalent to three to five FotoFacial treatments without Levulan®, thus the name “Turbo FotoFacial.” Along with the ability to improve skin quality and reduce sun spots, this technique has the advantage of helping to treat precancerous cells, which ordinary photo rejuvenation treatments will not do. PDT can often also reduce the oiliness of the skin and reduce sebaceous hyperplasia.
For the treatment of acne, PDT comes to the rescue when many other treatments have failed or have not offered substantial improvement. This treatment may be used in conjunction with prescription medications to give the current regimen a boost. PDT is designed to kill the bacteria in acne, as well as reduce the size and activity of the sebaceous glands that are a main factor in acne. Furthermore, PDT can help restore the skin’s integrity, resulting in the overall improvement of the acne condition.
Treating rosacea with PDT helps to decrease overall facial redness and reduce breakouts. Because rosacea is a chronic skin condition, PDT treatments can typically be used in conjunction with prescription medications. A series of treatments is usually required for the treatment of acne and rosacea.
AKs are dry, scaly, rough-textured precancerous lesions that form on the outermost layer of the skin after years of exposure to ultraviolet (UV) rays, such as sunlight. PDT can typically offer easier treatment for AKs than using common alternatives, including liquid nitrogen, 5-FU-based chemotherapy, or Aldara cream. This method generally has minimal side effects and can provide rapid healing. The advantage of treating AKs with PDT is that patients will often see cosmetic and health benefits of the entire facial area treated, instead of spot treating each patch of AK lesions.
How Does PDT Work?
The first step of treatment is to apply Levulan® topical solution to the skin. The formula will be selectively absorbed into rapidly growing photo-damaged skin cells, sebaceous glands, hair follicles, and AKs. Next, IPL therapy is used to illuminate the solution, which causes it to convert into a photosynthesizing agent that can destroy the damaged cells. Because Levulan® is preferentially absorbed by certain skin conditions in the treated area, it results in very targeted treatment with little to no damage to the surrounding area. The skin will gradually improve in both texture and tone. An additional benefit of PDT is the ability to reduce pore size by tempering the sebaceous glands, helping to reduce oil flow and minimize pore blockage.
How Is Photodynamic Therapy Performed?
The skin in the area to be treated is cleansed and prepped with a microdermabrasion treatment and/or an acetone scrub. Levulan®, a clear, odorless solution, will be painted on the skin and incubated for 30 to 120 minutes. The time will be determined by the areas and skin conditions being treated. After the solution has incubated for the predetermined amount of time, it will be activated by performing an IPL treatment. While some patients report a mild stinging sensation when Levulan® is applied, and again during the IPL treatment, most individuals do not report any discomfort. The preparation of the skin, incubation time, wavelength, and light source used to activate the medication will be dependent upon the area of the body being treated, as well as the condition.
PDT Recovery and Skin Care
After the procedure, while the PDT drug is still active, it is imperative that patients avoid sun exposure for at least 48 hours. Levulan® is activated by light, so treated skin will experience extreme photosensitivity to UV rays. As a result, sun exposure and exposure to fluorescent lights must be avoided for at least 48 hours following treatment. Even sunlight entering through windows can be harmful, so use of sunscreens containing titanium oxide or zinc is essential in the first few weeks after treatment.
After the procedure, the treated skin will typically appear red and peeling will likely occur for two to seven days post-treatment. Patients may also experience a sunburn sensation with mild itching and burning. Depending on the treatment area, some individuals may experience swelling around the lip and/or eye areas. Pigmented lesions will temporarily darken and peel off, ultimately leaving a normal appearance to the skin. To help minimize discomfort, Dr. Brunner recommends patients apply cold compresses or take anti-inflammatory over-the-counter medication, such as Motrin or Advil. Our office can supply a list of approved options.
Individuals with more heavily sun-damaged skin, increased acne, or severe rosacea will require longer incubation times with Levulan®. This will likely result in more redness and peeling during the recovery period. To help achieve maximum improvement, a series of three treatments performed at two to four week intervals, or as Dr. Brunner recommends, can be most effective. More treatments may be done in the future, as necessary, to maintain the results of the newly rejuvenated skin.
Photodynamic therapy for treating aging and sun-damaged skin is a powerful tool for skin rejuvenation. Patients are often thrilled with the clinical ‘boost’ they receive by adding PDT to their non-ablative laser or light treatment because of its enhanced clinical results and minimal side effects. Using PDT as an adjunct to laser/light therapy can often achieve better results with fewer treatment sessions.