In order to improve the activity of a light-based skin treatment, photodynamic therapy uses drugs called photosensitizers.
It is a form of phototherapy or light therapy and, particularly for serious cases that do not respond to other treatments, it is becoming more common as an acne treatment.
For other skin conditions, such as sun-damaged skin, precancerous cells, and skin infection, photodynamic therapy (PDT) may also be successful.
Important facts about photodynamic therapy
- A review of more than 70 studies indicates that PDT for acne generally produces positive results, especially for individuals who do not respond well to topical or oral treatments.
- To see the effects of photodynamic therapy for acne, it can take many sessions.
- People with more severe forms of acne may experience the most significant improvements. Results tend to be semi-permanent, lasting for several months or longer.
- As photodynamic therapy is a relatively recent treatment for acne and other skin disorders, it is not reported to have any long-term effects.
How does it work?
There are three components required by photodynamic therapy:
- a photosensitizer
- a light source
- oxygen
Photosensitizers are topically applied solutions that allow light-absorbing molecules called porphyrins to be formed by certain types of abnormal cells. This change makes it possible for light treatment to target the irregular cells that lead to acne.
The use of photosensitizers distinguishes PDT from other types of phototherapy.
A medical light source is concentrated on the skin to activate it after applying a topical photosensitizer. Blue light, red light, or intense pulsed light can provide this light source (IPL). A physician must determine what light source is best for the individual. The light helps destroy acne cells and bacteria in conjunction with the photosensitizer and the presence of oxygen.
The size and function of the oil-producing glands on the skin, known as the sebaceous glands, also decreases photodynamic therapy.
Overactivity of these glands and inflammation contribute to the production of acne.
Is photodynamic therapy effective for acne?
For inflammatory, rather than non-inflammatory, acne, PDT tends to be more effective.
For instance, some study found that participants encountered a 68 percent decline in inflammatory lesions 12 weeks after PDT therapy, when compared with a control group, but no decrease in the amount of non-inflammatory lesions.
Other research shows that inflamed lesions decreased 16 weeks after the start of photodynamic therapy by more than 70 percent.
A number of photosensitizers, light sources, and other variables of treatment are, however, used in the studies. For this reason, a 2016 research review indicates that standard recommendations for PDT therapy in the treatment of acne should be established and tested.
Cost and insurance
Depending on many factors, the cost of photodynamic therapy differs greatly, including the severity of the acne and the part of the country where treatment is obtained.
PDT will cost between $100 and $400 or more per session from anywhere. Up to five sessions may be needed at a time. The effects are not immediate, so follow-up sessions are important for long-term management of acne symptoms. Skincare products post-treatment may also be needed and may cost extra.
Insurance coverage for PDT does not exist.
Advantages
Photodynamic therapy may bring advantages over other treatments. Its positive points include:
- Killing the bacteria that causes acne on the skin
- Affecting only target cells, helping to retain the integrity of the skin
- Reduction of sebaceous glands in size and activity
- Helping old acne marks disappear
- Not leading to scarring
- Treating other skin disorders, such as age spots and rosacea, that may co-occur alongside acne
- If required, it can be used along with drugs, except for isotretinoinin (Accutane)
Another significant advantage of photodynamic therapy is that the use of antibiotics or oral retinoids, such as Accutane, is not involved. For people who do not take such drugs, this makes PDT a viable treatment.
For individuals with extreme acne or those whose acne has not reacted well to other therapies, PDT may be particularly beneficial.
Things to expect before PDT treatment
Photosensitizers are prescribed drugs. Therefore, treatment with PDT must be done by a dermatologist or by another doctor.
The skin will be cleansed and cleaned with microdermabrasion or a scrub prior to treatment. This helps eliminate acne pustules and blackheads.
Depending on the position and severity of the acne and the skin type of the individual, the photosensitizer is applied to the skin for between 15 minutes and several hours. This gives the agent enough time for incorporation into the skin cells and the sebaceous glands.
During this portion of the procedure, some people may feel a stinging sensation, which should eventually subside.
Things to expect during treatment with PDT
Next, for 8-20 minutes, a medical light source is shone on the skin. The light triggers the photosensitizing agent to activate.
Some individuals can feel a stinging or burning sensation at this stage of the procedure, the severity of which varies.
Things to expect after PDT treatment
The skin is extremely sensitive after treatment. People must remain indoors, out of sunlight, for 48 hours following treatment. That’s because the photosensitizing agent makes the skin vulnerable to sunlight, so there is a possibility that sun exposure will cause serious burns.
In the time just after treatment, sunscreen does not provide sufficient protection.
People should speak to a physician after PDT about using topical acne lotions, makeup, and other skin items. People may, in particular, need to avoid products that contain oils or waxes for a period of time.
Follow-up sessions
The number of treatments needed depends on the type of skin of the person, the number of lesions they have, and the nature of those lesions.
For optimal results, anywhere between two and five sessions are needed at intervals of 2-4 weeks. After a single session, several individuals can find results.
Adverse effects of photodynamic therapy
Following PDT, several adverse effects can occur, including:
- mild to moderate pain
- peeling skin
- skin redness
- crusting of the skin
- tightness
- swelling
- itching
- acne flare-up
In the 48 hours after treatment, these effects are most severe and typically subside after a week.
Long-term effects and risks
To lubricate the skin and to shield it from microbes, the sebaceous glands excrete oil (sebum). Although individuals with acne appear to have larger and more active sebaceous glands, the long-term effects of reducing sebum production are not established, and reducing their activity can decrease acne.
PDT should be avoided in people with lupus, allergies to porphyrin, or a rare blood condition called porphyria that causes increased light sensitivity.
Some individuals can, in rare cases, experience an allergic reaction to the photosensitizing solution.
Before beginning therapy, discuss the advantages, consequences, and risks of PDT with a doctor.
