Photodynamic Therapy (PDT)

Summary

Photodynamic Therapy is becoming an increasing popular alternative choice to surgery for the treatment of: basal cell carcinomas, Bowen's Disease and solar keratoses when either an excellent cosmetic result is desired or a surgical wound might heal poorly.
It is also a useful means of rejuvenating skin, especially where there is marked sun damage.
Usually, two treatments are needed 2-6 weeks apart.

FAQs

What are the advantages of Photodynamic Therapy?

What are the disadvantages of Photodynamic Therapy?

How does Photodynamic Therapy work?

Which areas respond best to Photodynamic Therapy?

Is Photodynamic Therapy safe?

Does Photodynamic Therapy hurt?

How should I prepare for Photodynamic Therapy?

What is involved during Photodynamic Therapy?

How will I look immediately after Photodynamic Therapy?

Is there any important Photodynamic Therapy aftercare?

How long after Photodynamic Therapy will I notice an improvement?

How much does Photodynamic Therapy cost?

How many Photodynamic Therapy treatments will I need?

What side-effects does Photodynamic Therapy produce?

Who shouldn't have Photodynamic Therapy?

What are the advantages of Photodynamic Therapy?

The cell damage produced by Photodynamic Therapy is concentrated in the abnormal cells, leaving many of the surrounding normal cells undamaged and able to help the skin heal. Therefore, Photodynamic Therapy will usually leave a shallower wound than surgery that heals more quickly to leave a better cosmetic result.

What are the disadvantages of Photodynamic Therapy?

Photodynamic Therapy takes longer to perform than surgery and has a long term cure rate of that is about 10% lower than surgery. It can also only be used on fairly flat skin cancers or pre-cancers unless the lesion is debulked prior to treatment.

How does Photodynamic Therapy work?

A cream containing aminolaevulinic acid (ALA) is applied to the skin. Over a period of three to six hours the ALA is selectively taken up by skin cancer or pre-cancer cells and converted inside the cell into a photoactive, pink coloured, porphyrin. When the strong beam of light is shone the cells, the porphyrin molecules are broken down triggering a photochemical reaction inside the cell that destroys it.

Which areas respond best to Photodynamic Therapy?

All areas of skin response to Photodynamic Therapy but it is mainly used on the face and upper trunk, when an excellent cosmetic result is required and on the lower leg in individuals whose surgical wounds might take a long time to heal.

Is Photodynamic Therapy safe?

Yes, it is a well researched and safe treatment. The long term cures rates are now well know and short term complications are transient and well documented.

Does Photodynamic Therapy hurt?

It can be uncomfortable but, if properly supervised, it should not be painful. Better equipped units will have machines that cool the skin under treatment with ice-cold air and, if that does not work, the discomfort can be relieved with an injection of local anaesthetic.

How should I prepare for Photodynamic Therapy?

Buy a bottle of "After Sun" creams to soothe the sunburn-like reaction that Photodynamic Therapy can produce.

What is involved during Photodynamic Therapy?

Most Photodynamic Therapy treatments require two treatment sessions spaced one to eight weeks apart. At the first session, the skin is injected with local anaesthetic so that a small sample of the pre-cancer or cancer can be taken and sent to the labs for analysis. Then, the cream containing ALA is applied to the area(s) and covered with a waterproof and lightproof dressing. Three to six hours later, you return to hospital to have the light treatment. This takes about twenty minutes and varies depending upon the type of light source that is used. However, in general, during the light treatment, cold air is blown onto the treatment site to relieve any discomfort. If the treatment becomes painful, an injection of local anaesthetic can be given to relieve the discomfort. The second treatment session is identical, except there is no need to inject the skin with local anaesthetic before applying the ALA cream.

How will I look immediately after Photodynamic Therapy?

Usually, you will leave the first Photodynamic Therapy session with a small dressing over any wound(s) left by taking a biopsy to confirm the diagnosis or covering the wound left by debulking the lesion. After the second session of Photodynamic Therapy, often no dressing is needed. The skin is often a bit red immediately. This redness often settles for a few hours until the sunburn-like reaction starts. The sunburn-like reaction lasts for around one week.

Is there any important Photodynamic Therapy aftercare?

You will need to follow any wound care instructions and apply "After Sun" to the sunburn-like reaction.

How long after Photodynamic Therapy will I notice an improvement?

The treated area usually disappears after the first Photodynamic Therapy session to leave an area of flat, pink skin. The pinkness usually clears after six weeks but can last up to one year on the chest.

How much does Photodynamic Therapy cost?

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How many Photodynamic Therapy treatments will I need?

Most people will need two sessions of Photodynamic Therapy. The second session increases the cure rate. When treating solar keratoses, sometimes only one session is needed. Occasionally, a third session is needed to treat an basal cell carcinoma.

What side-effects does Photodynamic Therapy produce?

During the first Photodynamic Therapy session, the initial injection of local anaesthetic stings a little. During the second Photodynamic Therapy session, you may feel a mild, initial stinging when the ALA cream is applied to the skin. During the light treatment, there is a burning, stinging or hot sensation. This is relieved by the stream of cold air. If this does not work, an injection of local anaesthetic will be given. Afterwards, there is often a sunburn-like reaction around the shallow wound left by the lesion itself. Occasionally, the shallow wound will weep or even bleed for a few days.

In the long term, the treated area may be white after Photodynamic Therapy. However, the depth and extent of the whiteness is less than that seen after surgery.

Who shouldn't have Photodynamic Therapy?

Photodynamic therapy should not be undergone during pregnancy or breast feeding or by people taking photosensitising medications.