Photodynamic Therapy

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Photodynamic therapy (PDT) is a minimally-invasive treatment for certain types of superficial skin cancers and premalignant lesions. By combining topical drugs called photosensitising agents and specific wavelengths of light, PDT destroys abnormal cells without the incisions, downtime and scarring associated with surgical treatment of skin cancers. PDT is also used in cosmetic settings for the rejuvenation of sun-damaged skin. PDT treatments are well tolerated, quick to perform and have a high cure rate in superficial non-melanoma skin cancers.

What Is Photodynamic Therapy Used For?

PDT is primarily used to treat the following skin concerns:

• Superficial Basal Cell Carcinoma (BCC)
• Squamous Cell Carcinoma in Situ (SCC in situ)
• Skin cancers in cosmetically sensitive areas
• Photodamage

How Does Photodynamic Therapy Work?

There are several stages of treatment with PDT. First, the photosensitising agent (aminolevulinic acid or methyl aminolevulinate) is applied to the treatment area in the form of a cream. The drug is absorbed by the abnormal cells over a prescribed amount of time. A specific light source (visible light, LED and/or laser) is then applied to the treatment area to activate the cream, causing the photosensitive drug to selectively destroy the damaged or cancerous cells with minimal damage to the surrounding tissues.

How Many PDT Treatment Do I Need?

The number of PDT treatments required to yield a desirable outcome depends on the skin concern being treated. To improve the cosmetic appearance of sun-damaged skin, only one session is needed.

To treat low-grade skin cancers, plan to undergo two sessions scheduled one to two weeks apart. A second treatment ensures the highest chance of cure when using PDT to treat superficial non-melanoma skin cancers.

Is PDT Painful?

PDT is well-tolerated by most people. Day light PDT is usually tolerated by most without much pain. PDT with red LED light or laser can be more painful. To increase patient comfort, a cool spray is used during the treatment and pain relief medication can be taken one hour before illumination. An anaesthetic cream can be applied to further alleviate discomfort if needed. Occasionally, the clinicians administer local anaesthetic to maximise pain relief.   They recommend taking over-the-counter pain medication after the procedure if the treatment covers a large or especially sensitive area.

How Do I Prepare My Skin Prior To PDT Treatment?

For those with thicker solar keratosis (sun spots), the clinicians recommend you using Urederm cream (10% urea cream from Hamilton Skin Care) – twice daily to the affected areas for 2-4 weeks prior to treatment. This will help to reduce the thickness for the solar keratosis (precancerous sun spots), or the low grade skin cancers to be treated.

Your dermatologist may prescribe a cream to help to prepare your skin prior to treatment as well.

Sun protection is always recommended.

What Does Photodynamic Therapy Treatment Involves?

The clinician will prepare your skin with cleansing, applying a chemical sunscreen to block out the unwanted UVA and UVB lights, gently remove the crusting over the skin surface and apply the medicated cream (photosensitising cream). For those undergoing treatment for low grade skin cancers, the treatment area will be covered with a dressing.

Once the skin is prepared and the creams are applied, you can leave the clinic.

For those who are undergoing daylight PDT, you are required to stay outdoors for 2-4 hours in order for the visible light to activate the cream.

For those who are undergoing red light PDT or laser PDT, You are required to come back to the clinic after 3 hours. The clinicians then active the cream with the red LED light, laser or a combination of both.

What Happens After Treatment? Are There Any Side Effects From PDT?

It is common to feel a burning sensation soon after a PDT session. This discomfort usually subsides over the next few days.

Other common side effects are similar to a sunburn, including swelling, bruising and peeling skin. These effects rarely last for longer than a week. Some patients develop pustular whitehead rashes, but this is a more unusual side effect of PDT.

The treated skin will be light-sensitive at first and should be carefully protected from the sun.

Optimal results are seen several weeks after a session when the treated lesions have been eliminated and the skin is rejuvenated. Results continue to improve for months after a PDT treatment.

How Do I Care For My Skin After PDT?

Appropriate aftercare should be discussed with your dermatologist.

Cleanser:

You will need to use a gentle cleanser such as Cetaphil wash or salt water twice daily.

Moisturise:

Moisturise throughout the day to help to alleviate the tightness and peeling of the skin. Use Cetaphil cream, Cicaplast (La Roche Posay) or Vaseline.

Pain relief:

Take a regular paracetamol for the first couple of days post treatment if you are experiencing discomfort.

Keep a wet towel in the freezer, and use this to help to alleviate the burning sensation intermittently.

Keep your moisturising cream such as Cetaphil, Cicaplast or Vaseline in the fridge so that you can apply to the peeling areas on the skin.

Sun Protection:

Protect your skin from the sunlight by wearing a broad brimmed hat, use zinc based SPF 50+ sunscreen regularly and reapply every few hours post treatment. You will be extra sensitive to the sunlight for the first 2 days after treatment.

Anti— inflammatory cream:

If you are experiencing lots of redness/burning post treatment, you can use 1% Sigmacort ointment (an over the counter mild steroid ointment) twice daily to settle down the inflammation. For more excessive inflammation, your doctor may prescribe an anti inflammatory ointment to be used twice daily for 5 days to settle the reaction.

Make up:

You can resume your usual make up after 2 days of treatment

Skin care/ cosmeceutical creams

Use Cetaphil, vaseline only for the first 1 week post treatment. You can restart on your usual skin care including cosmeceutical creams after the first week. Do not introduce these if your skin is still feeling sensitive. Always protect your skin with sunscreen.

Regular check-up appointments are recommended to ensure that any new concerning lesions are detected and treated as soon as possible. PDT is often repeated in 12-24 months if lesions return or new lesions appear.

When Do I Need To Come Back For A Review After My PDT Treatment?

If you are experiencing excessive redness, burning, or pustules, please do not hesitate to come back within the first week after treatment for the doctor to review you.

Otherwise, your treating dermatologist will review you after 6 weeks of treatment to ensure you have achieved clearance.

What Are the Advantages of PDT Treatment?

Patients have many options when it comes to treating superficial non-melanoma skin cancers and photodamage. PDT offers the following advantages:

• Safe and effective
• Minimally invasive
• Little or no scarring
• Reduced downtime
• Good cure rate for BCCs and SCCs in situ
• Can treat large areas at one time
• Can be performed in any season

Can Sun Damage or Skin Cancers Reoccur After PDT Treatment?

Results of PDT treatment are variable depending on the degree of damage your skin has sustained over the years. Most patients are happy with the results after just one or two treatments. However, sun damage or skin cancer can reoccur and may require additional treatment sessions in the future.

What’s the Specialist Dermatologist’s Perspective on Photodynamic Therapy?

Photodynamic therapy is a valuable treatment option for low-grade skin cancers and actinic keratoses. Using a naturally-occurring, light-sensitive chemical that is activated by light, PDT destroys abnormal cells while leaving the surrounding healthy tissue unharmed. It is a minimally invasive and highly effective targeted treatment that, compared to other methods, involves a more rapid recovery period and little to no scarring. The convenience of this treatment makes PDT a more suitable option for individuals with a busy professional or social schedule.

A consultation with a consultant dermatologist is required prior to the consideration of PDT. During this evaluation, your dermatologist will thoroughly assess your concerns and provide you with appropriate treatment options. Call Northside Dermatology on 03 8582 8688 to book an appointment today.