Treating Acne with Photodynamic Therapy

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

Photodynamic Acne Treatment.
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.)

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.

Photodynamic Acne Treatment Procedure

The Levulan, which is a clear painless solution, is applied to your skin and left on for 15-60 minutes. It is then activated with a specific wavelength of light called BLU-U or Clear-Light. This takes about 8-10 minutes.

The Levulan is absorbed by active cells like acne sebaceous gland,. making the targeted acne cells more sensitive to the light. This combined interaction of the solution and the light is what gives rise to the term "photodynamic therapy." The Levulan will also target sebaceous hyperplasia (which are those small (1-3mm), benign bumps under your skin) and the papules of acne rosacea.

The treatment reduces skin oiliness and minimizes the appearance of pore size. The entire skin texture improves following a Photodynamic Acne Treatment.

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 by Jane Iredale (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.