Photodynamic Therapy

Photodynamic therapy is a recent and highly effective method for the treatment of superficial skin cancers, sunspots and solar keratosis. It is a minimally invasive treatment with little to no scarring. Compared with other methods, recovery is quicker with PDT.

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  • PDT is used to treat superficial skin cancers and sunspots
  • Treatments are well tolerated and quick to perform
  • For the treatment of sunspots, downtime is much less compared to older treatments such as Efudix
  • Less scarring compared to skin cancer surgery
  • PDT cosmetically rejuvenates UV-damaged skin

Photodynamic Therapy (PDT) has earned a reputation as a revolutionary treatment for certain types of skin cancer, pre-cancerous lesions and photodamage. Photodynamic therapy may also be used in a cosmetic setting for photorejuvenation.

Combining the use of a special photosensitising agent (ALA), photodynamic therapy is a non-surgical and well tolerated treatment. ALA is activated using a specific wavelength and intensity of light and is a two-stage treatment. Firstly, the drug is administered to the skin via a cream. An incubation period (waiting time) of 90-180 minutes is necessary for complete cream absorption. The second stage consists of exposure under a specific light source for eight minutes. Once the skin is exposed to the light source, the photosensitive drug reacts and destroys damaged and cancerous cells, leaving normal skin tissue unaffected.

PDT is applied to the affected area and surrounding tissue and is known as a field treatment. Virtually any area of the skin can be treated with PDT, including the face, scalp, hands and chest.  There is evidence to suggest that photodynamic therapy produces photorejuvenating effects such as a reduction in hyperpigmentation and visible capillaries, and an improved skin texture.

In general, PDT is well tolerated and an anaesthetic cream may not be required.

Slight burning and stinging during the procedure is often described. Administration of panadol one hour before treatment helps to increase patient comfort. A cool nitrogen spray during the procedure also decreases the stinging sensation. If necessary, an anaesthetic cream such as Emla can be used to alleviate any discomfort. As a guideline, 95% of patients do not require any form of anaesthetic. We recommend an over-the-counter pain killer to be taken after the procedure in cases of large treatment areas such as the face or scalp.

Due to the photosensitivity of the drug used, patients may feel sunburned and sometimes experience a degree of swelling after the treatment. Depending on the extent of PDT and the severity of the treated condition, this usually subsides within 1-3 days. Peeling and redness may occurs for up to 6 days after treatment. Patients will need to avoid sun exposure for at least 48 hours after treatment.

Preparation of the area for PDT normally takes between 10 to 15 minutes. This may involve cleansing the skin or, in severe cases, a laser-assisted micropeel. The cream is then placed on the target area a left to be absorbed into the target area(s).  The second part of the treatment (activation of the cream with a specific light source) takes approximately 7-9 minutes to complete.

How much time off work you need to take depends on the site and extent of treatment received. As a guide, the downtime for full face PDT is approximately 6-7 days, which compares favourably with Efudix treatment (3-4 weeks). Smaller areas such as the nose or upper lip typically heal within 4 days.

Your dermatologist will assess how your skin will react to PDT and how much time off work you will need.

PDT offers:

  • Less potential for scarring
  • Less down time and quicker recovery (days, not weeks or months)
  • High cure rates

Note: Not all lesions are suitable for photodynamic therapy; a specialist dermatologist will be able to advise you as to the most appropriate treatment.

Sunspots or solar keratosis is a common pre-cancerous lesion regularly seen in the Queensland population. These are normally rough, dry, red and scaly lesions on sun-exposed areas of the face, ears, scalp, and hands. Smaller regions can be treated with freezing, while a ‘field treatment’ such as Efudix or PDT is recommended for larger areas.

Efudix treatment involves the application of a cream twice a day for a period of 3-6 weeks. Downtime is significant – approaching 4-7 weeks; however, this method is incredibly effective.

Because of Brisbane’s weather conditions (high humidity and UV index), this treatment is limited to the cooler months of the year.

PDT, in contrast to Efudix, is a one-off treatment for solar keratosis. It is a rapid procedure with 6-7 days downtime. PDT is not limited to the cooler months and can be performed at any time.

Developed by laser dermatologists, this combination of laser and short-incubation PDT gives superior results than either treatment alone. The procedure combines laser resurfacing with PDT for the treatment of sunspots, hyperpigmentation and ageing skin. Recovery time is 7-9 days.

For patients seeking a solution for sun damage, and who would also benefit from laser rejuvenation, this treatment is the perfect choice.

TREATMENT TYPE

 TREATMENT

EFFICACY

 TREATMENT

DURATION

COSMETIC OUTCOME

TREATMENT

DOWNTIME

PDT +++++ 3 hours Good 6-8 days
Micropeel laser +++ 1 hour Excellent 7 days
Efudix +++++ 3-4 weeks Satisfactory 25 days
TCA peels +++ 30 minutes Excellent 7 days
Glycolic / AHA peels ++ 15 min, series of peels needed Good 1 hour (mild photodamage)

 

  • If you are not concerned about improved cosmetic outcome and can tolerate a downtime of 4 weeks, Efudix is the treatment of choice. With a downtime of 3-4 weeks, this is the most cost-effective treatment but should ideally be undertaken during cooler months.
  • If you are only looking for pre-cancerous sunspot treatment and can only have a downtime of 7-8 days, PDT is the treatment of choice. PDT can be conducted throughout the year and patients experience a rapid healing time compared to Efudix treatment.
  • If patients exhibit only mild photodamage, a series of AHA glycolic acid peels can rejuvenate the skin.  Little or no downtime is associated with chemical peeling.
  • If patients wish to address other signs of photoaging such as hyperpigmentation, decreased skin tone, facial lines and are prepared for a downtime of 7-9 days, the treatment of choice is laser.
  • If sun damage consists primarily of uneven skin pigmentation, photofractional rejuvenation is the best option.

Cost depends on the extent of solar damage. The severity of each specific area will be assessed by your Cutis specialist dermatologist.

For solar damage and sun spots, patients typically require one treatment.

For basal cell cancers and intraepithelial cancers, patients require two treatments as standard.

  • Half face PDT (cheeks, temples, forehead): please contact us for pricing information.
  • Nose and upper lip: please contact us for pricing information.
  • BCC (basal cell carcinoma): please contact us for pricing information.

The prices you will be given upon your consultation include, according to treatment:

  • Photography and site documentation
  • Histology, if required
  • Microabrasion of skin/microlaser peel, if required
  • Application of ALA- Metvix
  • Activation of ALA-Metvix
  • Local anaesthetic creams, if required
  • Dressings
  • Subsequent follow-up after extensive PDT

Note: PDT is not covered by Medicare, although some health insurance companies do provide a partial rebate for this procedure. We advise patients to check with their insurance company prior to undertaking this procedure.

As Cutis Clinic houses a group of specialist dermatologists, a referral from your GP is advisable. Call us directly on (07) 3088 6985 to book an appointment or to enquire about the referral process. A consultation is always required prior to PDT treatment. Your Cutis dermatologist will thoroughly assess your condition and provide you with treatment options and plan prior to any procedure.

Photodynamic therapy is a highly effective targeted treatment that destroys cancer and precancerous cells without harming the surrounding, healthy tissue. The chemical used is a naturally-occurring, light-sensitive substance, activated by high intensity red light. The downtime and convenience of this procedure compared with Efudix therapy makes PDT a more viable option for busy professionals.