Photodynamic Therapy for actinic keratosis (AKs) is a treatment performed throughout the world and is considered the gold standard for treating pre -cancerous cells in many countries including Australia. It has gained popularity in the U.S. and Europe and now in Canada as the number of patients being diagnosed with AKs continues to rise.
So what is PDT? And how does it work? Actinic keratosis are pink scaly or rough lesions on the skin, most often found in areas that are often “sun kissed” such as the forehead, nose and upper cheeks, and on the scalp for men. Patients can experience AKs anywhere though, as we have treated legs, arms (especially back of hands), and chest as well. These lesions are not only an eyesore, but can be itchy and sometimes sore as well. At this stage, they are pre-cancerous cells and may or may not turn cancerous at a later date. PDT also works on Basal Cell Carcinoma (lesions that have already turned cancerous) when used with the medicine Metvix.
After diagnosis, the patient can start the treatment whenever they can schedule the time. Metvix is often covered by the patient’s drug plan, and occasionally the treatment is too. When you come in for treatment, you will be prepped for Metvix application by removing any crusty, scaly lesions so that the medication applied can seep in deeper into the skin. There is no discomfort when the medication is applied. For indoor activation, the area is occluded and the patient will relax here or at home for 2-3 hours while the medication incubates. In the summer, outdoor activation is an option where the patient goes and sits outside for the incubation period (2-3 hours).
The indoor activation is treated with a laser designed for this treatment. It takes about 10 minutes to do. The treated area gets very hot during this time, but a multitude of cooling options are applied for comfort. For the outdoor activation, the patient does not need the laser as part of the service, so after removing the medication, they are ready to go home. In both cases, the patient has sunscreen applied and is told to go home and stay in low level lighting for the next 48 hours. Exposure to bright lights or the sun during this time can reactivate the medication and cause side effects from over-treating, which of course is not recommended.
Redness and / or scaling after treatment will vary for each patient, but, to be safe, assume 5-7 days before the skin is completely back to normal. That doesn’t mean you can’t go out or work out or go to work. It does mean that for 2 days after treatment, you should avoid all bright lights, but after that, a little make up or concealer will usually help.
The current protocol is 1-2 treatment sessions, followed by an annual maintenance treatment in most cases.
This treatment is safe and very effective, and helps minimize the risk of skin cancers and surgery, scarring or long-term downtime. When performed at a professional dermatology facility such as Toronto Dermatology Centre, your treatment may be covered under a drug plan, or extended health plan, or both.
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~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre