PHOTODYNAMIC THERAPY (PDT) PATIENT GUIDE
|
WHAT IS PHOTODYNAMIC THERAPY? WHAT IS LEVULAN® USED FOR? HOW DOES PDT WORK? HOW DO WE TARGET PRECANCEROUS CELLS AND NOT NORMAL SKIN CELLS? WHAT LIGHT SOURCE IS USED FOR PDT? HOW LONG IS THE PDT TREATMENT? WHAT ARE THE ALTERNATIVE TREATMENTS FOR ACTINIC KERATOSES (AKs)? WHO SHOULD NOT BE TREATED WITH LEVULAN®? WHAT SHOULD I TELL DR. PRODANOVICH PRIOR TO THE TREATMENT? GENERAL PRECAUTIONS WITH LEVULAN® WHAT ARE THE DISADVANTAGES OF PDT? WHAT ARE SOME POSSIBLE SIDE EFFECTS OF LEVULAN®? WHAT ARE THE ADVANTAGES OF PDT? HOW MUCH IMPROVEMENT CAN I EXPECT? HOW MANY TREATMENTS WILL IT TAKE TO SEE THE "BEST RESULTS"? TREATMENT STEPS PHOTODYNAMIC ACNE TREATMENT Photodynamic therapy (PDT) is a novel treatment for cancerous and precancerous growths. It combines a photosensitizing substance (called photosensitizer or photosensitizing agent) with a specific type of light to produce oxygen radicals, which in turn destroy cancerous and pre-cancerous cells. PDT is used to treat cancer in many areas of medicine. In dermatology, a topical photosensitizing solution called LevulanŽ (20% aminolevulinic acid) is used for PDT.  Aminolevulinic Acid (ALA) Levulan Kerastick Levulan® has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of sun-induced, pre-cancerous skin lesions called Actinic Keratoses (AKs) on the face and scalp In December of 1999. In addition to Actinic Keratoses, Levulan® has been widely used for: Aminolevulinc Acid (ALA), the active ingredient of LevulanŽ, is the initial precursor compound of the pathway that leads to hemoglobin synthesis. ALA tends to preferentially accumulate in cancer cells more so than in normal skin cells. Once it enters the cancerous cells, it is converted to a photosensitizing substance, called Protoporphyrin IX. A blue light, or any other bright light, activates this photosensitizing substance to release active free oxygen radicals. These high energy molecules, in turn, trigger a variety of inflammatory events which contribute to the destruction of precancerous, and in some cases cancerous, cells while sparing the normal skin cells. These steps are depicted in the illustration below.HOW DO WE TARGET PRECANCEROUS CELLS AND NOT NORMAL SKIN CELLS? Specificity of treatment is achieved in three ways. First, Levulan is applied only to the tissue that Dr. Prodanovich wishes to treat. Second, the Blue Light is delivered only to the affected area(s). In the absence of light, there is no activation of the photosensitizer and no precancerous cell killing. Finally, ALA is taken up much more rapidly by metabolically active cells. Since malignant cells tend to be growing and dividing much more quickly than healthy cells, the ALA preferentially targets the unhealthy cells.
WHAT LIGHT SOURCE IS USED FOR PDT?
HOW LONG IS THE PDT TREATMENT? Levulan takes one hour to penetrate and incubate into your skin and the Blu-U light treatment takes 1,000 seconds (16 minutes and 40 seconds). Consequently, please plan to spend approximately one and a half hours in our office for this treatment. We will ensure that this is an enjoyable time for you.WHAT ARE THE ALTERNATIVE TREATMENTS FOR ACTINIC KERATOSES (AKs)? Actinic Keratoses (AKs) can be treated in many different ways and PDT is only one of the options. In addition to PDT, the following treatments have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of Actinic Keratoses:
WHO SHOULD NOT BE TREATED WITH LEVULAN®? You should not be treated with Levulan® if you have:
WHAT SHOULD I TELL DR. PRODANOVICH PRIOR TO THE TREATMENT? In addition to Levulan®, there are other medications that increase sensitivity to light. Tell Dr. Prodanovich if you are using any other medicines, and especially these medications:
GENERAL PRECAUTIONS WITH LEVULAN® The treated lesions are sensitive to light. Consequently, people being treated will need to avoid sunlight and sources of bright light for 48 hours (two days) after Levulan® treatment.WHAT ARE THE DISADVANTAGES OF PDT? Following PDT, the treated areas can appear red with some peeling for two to ten 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 within seven to ten days.Another disadvantage is that the patients need to avoid sunlight and sources of bright light for 48 hours (two days) after the PDT. WHAT ARE SOME POSSIBLE SIDE EFFECTS OF LEVULAN®? (This is NOT a complete list of side effects reported with Levulan®. Please visit www.dusapharma.com/levulan-kerastick.html for the more in-depth information and package insert.)Blue light treatment usually causes sunburn like sensation, including tingling, stinging, prickling, or burning feeling of the treated areas. These feelings should improve at the end of the blue light treatment and should end within 24 hours. Following blue light treatment, the AKs and, to some degree, the surrounding skin, will become red. Swelling of the affected areas may also occur. These changes should reach a maximum the day after BLU-U treatment. However, these changes are temporary, should improve markedly by the end of the first week, and should be completely gone by 4 weeks after treatment. Other side effects at the treatment sites may include:
WHAT ARE THE ADVANTAGES OF PDT? The main advantage of PDT is convenience. Comparing to Crytherapy (liquid nitrogen), 5-Fluorouracil (Efudex, Fluoroplex or Carac) or Imiquimod (Aldara), Electrodessication and Surgery many patients find PDT to be:
HOW MUCH IMPROVEMENT CAN I EXPECT? Patients with severe sun damaged skin manifested by actinic keratosis, texture, and tone changes including mottled (blotchy) pigmentation and skin laxity may see excellent results. You may also see improvement of large pores and pitted acne scars. Active acne can improve dramatically. Nevertheless, thick actinic keratoses (called hypertrophic actinic keratoses) may be resilient to the PDT treatment. These lesions usually require not only multiple PDT treatments, but also pre-treatments with microdermabresion prior to each PDT treatment.HOW MANY TREATMENTS WILL IT TAKE TO SEE THE "BEST RESULTS"? Although some patients may achieve very good results with just one treatment, 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. More treatments can be done at periodic intervals in the future to maintain the rejuvenated appearance of the skin.
Not exclusive to teenagers, many young adults, people in their 20's and 30's, have trouble with acne that is hard to control. The BLU-UŽ Treatment - using light without drugs or antibiotics - may be something for you to try. Ask Dr. Prodanovich about this innovative acne treatment. |
|||
