PhotoDynamic Light Therapy for Acne

Photodynamic Therapy (Blue Light Therapy) with Levulan -

A breakthrough treatment for resistant acne and oily skin

Resistant and Cystic Acne frequently fails to respond to typical measures of control. A safe topical two-step treatment which chemically coats and then destroys acne bacteria offers a new solution. Hard-to-treat acne can require "power-level" treatments. A new procedure that treats resistant, hard-to-treat active acne combines light and a special light-activated solution that targets and destroys acne activity. This treatment also diminishes older acne scars leaving your skin smoother. The procedure is called Photo Dynamic Therapy. It is a form of Blue Light Therapy.

The procedure is done in a Doctor's office, with average cost running about $300.-500. per treatment. 2-3 Treatments are usually recommended. Results are said to last about a year before a maintenance treatment is needed, but this can vary.

Photodynamic Acne Treatment (PDT)is a process by which a photosensitizing agent (Levulan) is applied to your skin. A Photosensitizing agent is a special solution applied to the skin that is activated by a specific wavelength of light, which “turns it on.” Levulan has been used extensively for the treatment of a variety of different skin conditions.

Levulan is a 20% solution of Aminolevulinic Acid (ALA). ALA is a “natural” product found in all humans throughout the body. Its it is a precursor for hemoglobin synthesis. (You wouldn’t be able to make red blood cells to carry oxygen without ALA in your body.)

Blue Light Levulan acne treatment involves three mechanisms of action against acne. Levulan treatment inactivates the bacteria that trigger acne, exfoliates the skin to unclog pores, and the most exciting mechanism is that Levulan treatment shuts down the sebaceous glands in the skin. This is exciting because sebaceous glands are the root cause in the formation of acne so it has a long lasting effect even on severe acne.

PhotoDynamic Therapy is one of those rare acne treatments delivering what it promises, often more. Used for resistant acne, PDT offers life-altering improvements. Cystic acne, the kind that creates painful inflamed lumps deep in the skin, is a harsh reality for thousands of teens. The psychosocial impact of this type of acne can be overwhelming leading to depression, shyness and loss of confidence.

By the time physicians recommend Levulan/Photodynamic Treatment (L-PDT), topical and systemic (oral) antibiotics have failed. Although they are helpful in the treatment of cystic acne, they are not usually sufficient to provide adequate control. Left under treated or untreated, cystic acne will almost always leave permanent scars on the face or other affected areas such as the chest and back. An acne sufferer, therefore, suffers twice once with the active acne and then with embarrassing and sometimes with disfiguring scars. Proper treatment brings great relief on both levels by minimizing the acne and thus preventing the scarring that would otherwise come from it. The positive emotional impact of controlling acne is immeasurable.

Doctors apply light-activated Amino-Levulinic Acid (Levulan, the liquid agent that penetrates the offending acne cells) and then chooses Blu-U light or laser to turn on the action. The activated Levulan selectively destroys acne bacteria and shrinks overactive oil glands which supply nutrition for acne bacteria.

Treatment usually involves two Levulan treatments, two weeks apart for initial treatment. Subsequent maintenance treatments are usually required. The impact on acne is immediate and long-lasting. Levulan- PDT is the "big gun" in the war against acne and if used appropriately, will improve acne conditions faster and more completely (with the least side effects) than any other treatment available. The treatment will also improve oily skin conditions by actually shutting down the oil glands for a period of time.

Understanding Acne
Acne results from the obstruction and inflammation of the sebaceous glands, and it affects 80% of the human population. Acne typically begins in adolescence with hormonal changes. However, there are many older individuals who suffer from “adult acne.”

There are different levels of acne ranging from milder comedonal (blackheads and whiteheads) to moderate, pustular, on to severe cystic acne. In many cases, several or all of these levels of acne can be present on an individual simultaneously.

Cause of Acne
Acne is caused by overactive sebaceous glands in the skin. The sebaceous glands, triggered by the hormone androgen, produce sebum (oil) in the skin. Although androgen is a male hormone, it is present in both men and women. Production of this hormone is highest during puberty, but it is always present in the body.

When androgen levels increase, the sebaceous glands release sebum. Ordinarily this oily substance spills onto the skin. When cells from the lining of hair follicles shed too quickly—clumping together and clogging pores—sebum is trapped beneath the skin causing whiteheads and blackheads. Sebum can then mix with the trapped cells and cause Propionibacterium acnes (P. acnes)—bacteria normally found on the skin–to grow in the clogged follicles. P. acnes can cause inflammation and pus and can result in papules or pustules. When the follicles expand as much as they can, bumps called nodules are formed under the skin.

Moderate acne may include blackheads and whiteheads in addition to papules —inflamed lesions that appear as small, reddish or pinkish bumps that can be sensitive to touch—or pustules—inflamed, white-centered bumps that can be red at the base.

Severe acne is characterized by nodules —large, painful, solid lesions that appear as lumps under the skin—and cysts —deep, inflamed, pus-filled lesions that can be very painful. Nodules and cysts are inflammatory and can cause scarring.

Prior to Photodynamic Acne Treatment, the best available treatment option for resistant and cystic acne was Accutane. However, with Accutane there are many systemic* side effects including birth defects, liver abnormalities, mood depression, and virtually all patients get dryness and night vision changes. *Systemic treatments are any medications that are taken orally, injected or infused that affect the entire body system. PDT Acne Treatment provides a viable alternative to all types of acne treatment without having negative systemic effects.

Advantages
The advantages of PDT are rapid treatment of acne lesions all over the face, no scarring, no surgical excisions and no systemic side effects. The skin appears refreshed and younger following these treatments. We advise 2-3 treatments at 2 to 3 week intervals to obtain optimal results.

Downside
The “downside” of Photodynamic treatment (PDT) is that your skin will be red and have some skin peeling (and crusting if you have skin cancers) for several days after the treatment. Usually, the first 1-2 days are the worst. Pressed mineral base powder (available in our office) will hide most of the redness. You must remain indoors the day following your treatment to avoid sun exposure, as you are photosensitive for about 24 hours after PDT. Topical acne lotions can be used in between your Levulan treatments once the redness has settled down over a period of a few days.

Photodynamic Skin Rejuvenation for Anti Aging, Sun Damage

What is Photodynamic Therapy? (PDT)
It is a special treatment performed with a topical photosensitizing agent called Levuan (ALA activated with the correct wavelength of light. This is known as “ALA/PDT treatment.”) These treatments remove sun damaged pre-cancerous zones and spots called actinic keratoses. Sun damage, fine lines, and blotchy pigmentation are also improved because of the positive effect of Levulan and the light treatment. ALA/PDT treatment also has the unique ability to minimize pores and reduce oil glands, effectively treating stubborn acne vulgaris, acne rosacea, and improve the appearance of some acne scars. Levulan is revolutionizing how we perform skin rejuvenation and how we treat sun damaged skin.

Photodynamic Therapy with Levulan is indicated for:

• Removing pre-cancerous actininc keratoses
• Preventing skin cancer
• Improving wrinkles
• Reducing pore size
• Improving skin texture
• Improving pigmentation
• Treating moderate to severe cystic acne
• Treating sebaceous hyperplasia

Patients with severe sun damaged skin manifested by actinic keratosis, texture, and tone changes including mottled pigmentation and skin laxity may see excellent results. You may also see improvements of large pores and pitted acne scars. Active acne can improve dramatically.

How many treatments will it take to see the "best results"
To achieve maximum improvement of pre-cancerous (actinic keratoses) sun damage, skin tone and texture, a series of three treatments 2-4 weeks apart is the most effective. Some patients with only actinic keratoses are happy with just one treatment. More treatments can be done at periodic intervals in the future to maintain the rejuvenated appearance of the skin.

What are the advantages?

• Reduced Scarring and improved cosmetic outcome
  
• Levulan improves the whole facial area treated, creating all one color, texture, and tone rather than just spot treating with liquid nitrogen, cautery, and surgery.

What are the disadvantages?
Following PDT, the treated areas can appear red with some peeling for 2-7 days. Some patients have an exuberant response to PDT, and experience marked redness of their skin. Temporary swelling of the lips and around your eyes can occur for a few days. Darker pigmented patches called liver spots can become temporarily darker and then peel off leaving normal skin. (This usually occurs over seven to ten days.) Repeat treatments may be necessary as PDT medicine is not an exact science.

In summary, PDT matches the “ideal treatment” for photodamaged skin:

- Well-tolerated
- Easily performed in a specialty clinic environment
- Non-invasive (no needles or surgery required)
- Excellent cosmetic outcome (particularly in cosmetically sensitive areas of the face).