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Acne Photodynamic Treatment

Hard-to-treat acne and acne scar treatment may require "power-level" solutions. 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 Therapy. Dr. Taheri is a pioneer in the use of Photodynamic Therapy and his patients show consistent major improvements.

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.

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.


Different types of acne

Moderate Acne Sebaceous Hyperplasia Actinic Keratosis


What causes 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.

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, 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, 1-3 mm, benign bumps under your skin) and the papules of acne rosacea. An important part of the treatment program is medical extraction of blackheads and acne pustules. This procedure will expedite the improvement in your skin condition by cleaning the pores of hardened sebum and infected debris. The treatment reduces skin oiliness and minimizes the appearance of pore size. The entire skin texture improves following a photodynamic acne treatment.

What are the advantages and downside of PDT?
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. There is reduced scarring and improved cosmetic outcomes compared with cautery, surgery, and Efudex. Liquid Nitrogen can leave white shots of your skin. The procedure is easier for patients than repeated topical liquid nitrogen, Efudex (5fu), or Aldara because the side effects are minimal and rapid healing. Additionally, the ALA/PDT treatment at our clinic is less painful than liquid nitrogen, d-FU, and Aldara. Furthermore, Levulan® improves the whole facial area treated, creating all one color, texture, and tone rather than just spot treating with liquid nitrogen, cautery, and surgery. We advise 2-3 treatments at 2 to 3 week intervals to obtain optimal results.

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 (available in our office) will hide most of the redness. 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. This usually occurs over seven to ten days. Repeat treatments may be necessary as PDT medicine is not an exact science. 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.

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 therapy with Levulan® is indicated for:
Removing pre-cancerous actininc keratoses
Preventing skin cancer
Improving wrinkles
Reducing pore size
Improving skin texture
Improving pigmentation
Treating moderate to severe cystic acne
Treating sebaceous hyperplasia

How much improvement can I expect?
Patients with severe sun damaged skin manifested by actinic keratosis, texture, and tone changes including mottled pigmentation and skin laxity may see excellent results. You may also see improvements of large pores and pitted acne scars. Active acne can improve dramatically.

How many treatments will it take to see the "best" results?
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. Some patients with only actinic keratoses are happy with just one treatment. More treatments can be done at periodic intervals in the future to maintain the rejuvenated appearance of the skin.

PDT matches the “ideal treatment” for photodamaged skin:
Well-tolerated
Easily performed in a specialty clinic environment
Non-invasive (no needles or surgery required)
Excellent cosmetic outcome
(particularly in cosmetically sensitive areas of the face)

During your office consultation you will be provided with a detailed plan of the treatments that will benefit you most. Please contact us with any questions you may have or schedule an appointment online for a consultation. Click here to send this page to a friend.

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