High Dose PDT
New Treatment for Severe and Resistant Acne
The severest of acne has been treated with the oral medication Accutane for a number of years. Concerns over side effects have made the medication far less popular. A new “High Dose PDT” procedure is the latest and most effective treatment which carries none of the associated risks of oral isotretinoin. Although Photodynamic Therapy for acne is an “off-label” use of Levulan, it has been FDA approved for treatment of pre-cancerous Actinic Keratoses for a number of years.
High Dose PDT
Severe Acne requires a concentrated effort to get under control and keep under control. One of the most stubborn aspects of severe acne is the problem of hyper-function of the sebaceous glands. The acne-producing oil glands CAN be destroyed and/or put on “lock down” for a substantial period of time with the right treatments. High Dose PDT is as close to a “cure” as there is for severe acne.
Dr. Pilest’s 34 years of experience with acne and acne scarring has provided the background for the use of the new High Dose PDT. He was, in fact, one of the early adopters of Photo Dynamic Therapy for acne and has found it to be an extremely useful tool in the treatment of resistant acne.
High Dose PDT is not for the faint of heart. In order for the treatment to reach the acne-causing glands and actually cause destruction of those glands for desired results, the patient must be willing to withstand a certain level of treatment discomfort, social disruption and downtime.
How is High Dose PDT administered?
Your treatment will preferably be scheduled as near the end of the day as possible to avoid sunlight following the procedure (more of the why on this later).
You will be prepped with a degreasing solution to remove any oils on the skin. We will apply a photosensitizing solution to the entire affected area and then occlude the skin with plastic film to assist in the penetration of the solution. Prior to the active phase of the treatment, lidocaine will be applied as well to lessen the treatment pain levels and further enhance the treatment effectiveness. This preparation process takes about 1 1/2 hour.
You will then be placed under a special red medical light which “turns on” the solution.
What’s happening during this phase? The red light activates the Levulan, which begins the destruction of the acne bacteria at an upper level while disabling and killing off the larger oil glands responsible for acne cysts and pustules. While the light is on, you will feel a substantial level of heat. This phase lasts from 10 to 30 minutes depending on your acne level. Total treatment time is around 2 hours.
What does it feel like? As heat (burning) sensations can be intense during the time under the light, Dr. Pilest can provide pain medication if desired. You will also have access to a cold air blower (called a Zimmer) to provide additional comfort. Sensations recede once the light is turned off.
Once treatment is complete, the nurse may apply sunblock if there is still light outside and you may elect to use a protective face shield to block UV rays. You may also wish to bring a wide brimmed hat to provide additional sun protection on your ride home. Post care instructions will be repeated and given to you to take home.
IMPORTANT! Following the treatment, you will be required to stay indoors for the first 48 hours. Sunlight will reactivate the residual Levulan in the skin and could cause a multiplied effect resulting in undesirable side effects. It is mandatory that you stay indoors, so you will need to make sure there will be no reason for you go outside –not for the mail or the newspaper or any other reason.
How will I look following treatment?
Expect swelling, considerable redness and crusting. You will also likely experience a “flare” of what is termed sterile pustules in the first several days. This is normal, although visually unpleasant. Plan on about 5 days during which you will likely prefer to stay inside as your skin recovers.
How many treatments will I need?
The typical treatment regimen is 4 sessions, spaced 2 to 4 weeks apart. Expect a similar 2nd post treatment side effect mix. Fortunately the 3rd and 4th treatment side effects are more like sunburn.
High Dose PDT was developed by Dr. Rox Anderson, professor of dermatology at Harvard Medical School, Boston, and director of the Wellman Center for Photomedicine at Massachusetts General Hospital.