Photodynamic Therapy (BLU-U PDT)

ALA (Levulan; Aminolevulinic acid 20%) is a naturally occurring compound that has been approved by the FDA to treat pre-cancerous skin lesions called actinic keratosis. Levulan is applied to the skin and then “activated” by specific wavelengths of light. This process of activating Levulan with light is termed Photodynamic Therapy (PDT). The purpose of activating the Levulan is to treat actinic keratosis and improve other signs of sun damage.   In addition to being a first line actinic keratosis treatment, PDT is a popular treatment for cosmetic photorejuvenation.  It also can improve acne, oily skin, and rosacea.

• Actinic keratosis treatment (destruction of pre-malignant actinic keratoses which may decrease your chances of skin cancer).
• PDT is also useful for other applications including acne therapy and for photorejuvenation.

• Most patients experience stinging and burning during photodynamic therapy treatment, usually plateauing by 6 minutes into treatment.
• Anticipated side effects of Levulan include discomfort or itch (usually mild), burning (usually mild for 3-7 days, rarely longer), redness which can last for a few weeks (but usually less than 2 weeks), swelling (this is most noticeable around the eyes the morning following the treatment), and possible skin peeling (which can last for up to a week).
• Pigmentation changes (increase or decrease of color) may occur in 1% of patients with most resolving in one month.   Scarring and permanent pigment changes are extremely rare.
• Infections and activation of cold sores is uncommon.

There are several other options for actinc keratosis treatment including topical creams: imiquimod, fluorouracil, and ingenol.   The advantage of photodynamic therapy is that the treatment is done in the office under a controlled setting yielding, in our experience, better results with more predictable side effects and higher patient satisfaction.

Photodynamic therapy usually needs to be repeated in order to achieve maximal results (initially 2 treatments spaced 4-6 weeks apart).   Your doctor will help you determine how often you will need to repeat treatments to maximize results.

Patients who have a history of photosensitivity, lupus, porphyria, or other light sensitive disorders should NOT undergo PDT.   Patients with active cold sores or who are pregnant or nursing should also avoid this therapy.   If you take hydrochlorothiazide (HCTZ), sulfa products, doxycycline, or other photosensitizing drugs, advise your physician

• You should budget 2 – 3 hours of time for your PDT appointment
• Please bring the following to your appointment:   Sunscreen (SPF 30+), a broad-brimmed hat, sunglasses; optional: personal music headset or iPod may also provide relaxation and help pass time during your PDT session.
• Avoid sunburns, sun tanning, or tanning sprays/creams for 2 weeks prior to treatment
• Stop use of exfoliating products to treatment area for 1 week prior to treatment
• On the day of treatment, make sure your skin is clean and free of all makeup, moisturizers, and sunscreens
• In nearly all cases, patients are usually able to drive after the procedure and do not usually need a driver
• If you are having arms/legs treated, please bring a long-sleeved shirt or long pants, respectively
• If you have a history of previous cold sores, you should ask for a prescription for oral Valtrex.
  • One 500 mg tablet is taken twice daily for 5 days, starting the night before or the morning of your PDT treatment.
• We recommend taking Tylenol immediately prior to your appointment to decrease stinging during the treatment.

If you wish to contact your insurance company to verify your coverage, the treatment (CPT) code is 96567, the medication code is J7308, and the diagnosis code is 702.0 (Actinic Keratosis).  Typically, insurance covers PDT only for actinic keratosis treatment (and not treatment of other conditions).  *Please note: If your doctor prescribes more than one area to be treated with PDT, and you wish to do both areas on the same day, insurance may not cover the 2nd treatment area. Please check with your insurance before scheduling.

Step 1: Your skin will be washed with a solvent (e.g. alcohol) to remove oil and dirt

Step 2: ALA will be applied to your skin and then you will wait for approximately 1-2 hours in waiting room

Step 3: Sit under blue light for approximately 16 minutes

• There will be a fan to minimize your discomfort.
• Your eyes will be covered with special protective goggles.

Step 4: Wash your face with water, apply sunscreen and wear hat. Go directly home.

• Most patients are able to return to work or school in 24-48 hours after photodynamic therapy
• Days 1-2 after treatment: Redness and swelling are to be expected and can be lessened by intermittent application of an ice pack. Swelling may be more common for procedures around the eyes or lips. Sleeping propped up on a few pillows or in a reclining chair may help decrease swelling after treatment of the head and face area. Take Tylenol as needed.
• Days 3-7 after treatment: It is possible to have continued redness and swelling which may be accompanied by peeling, scaling, itching. Continue Tylenol and ice packs as necessary.   If itching or peeling is troublesome, it is okay to use over the counter 1% hydrocortisone cream or ointment two to three times daily for one week. Do not manually “peel” the skin as this could induce scarring and hyperpigmentation (brown spots).
• Days 8-14 after treatment: The skin may have a pinkish hue

• Avoid sunlight (including from windows) and bright indoor lights for 48 hours!   Stay indoors – sunscreens will not protect enough. Excess exposure can cause a severe sunburn-like reaction.
• Avoid hot water, extreme temperature, and other skin irritants; avoid alcohol consumption for 72 hours
• Use a mild cleanser such as CeraVe hydrating cleanser, Cetaphil Gentle Skin Cleanser, or Dove soap to wash twice daily. Apply a gentle moisturizer such as CeraVe Cream or Aquaphor (both over-the-counter) as many times as necessary for comfort. Do not to pick off any scabs, exfoliate, or scrub your face to remove scabs or scale.
• If going outside, wear a hat and sunscreen containing zinc or titanium as an active ingredient (e.g. Blue Lizard or Vanicream). It is also permissible to use moisturizing cream/ointment over the sunscreen.
• Makeup (mineral-based formulations preferred) may be applied if no open areas are present (usually after 72 hours). Apply moisturizer before applying makeup. It is also okay to shave when irritation has subsided.
• Wait 1 week before resuming any prescribed or anti-aging topical products.
• If pain starts to increase 24 hours AFTER your procedure or you experience fever or any other unexpected reaction, call the office for a same-day appointment.   You may also call Dr. Cummins by choosing the emergency page function on our office voicemail.
• Make sure to have a follow-up appointment with your dermatology provider within 3-4 months after treatment