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Photodynamic Therapy: Treating Actinic Keratoses and Acne

If you haven’t been diagnosed with actinic keratosis (AK) or acne, you might not have heard of photodynamic therapy (PDT) which treats pre-cancerous cells and significantly reduces acne. While modern photodynamic therapy has been around for over 20 years, the beginnings of PDT can be traced to the year 1900!

First, what is actinic keratosis and how is it diagnosed?

Actinic keratosis (AK), sometimes called solar keratosis or, is a pre-cancerous area of rough, scaly, or crusty skin (“feels like sandpaper”). Lesions may have symptoms like being sensitive, or more commonly don’t have any symptoms at all. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by chronic ultraviolet (UV) light/radiation exposure. These growths are more common in fair-skinned people and those who are frequently in the sun due to work (e.g. farmer) or hobbies (e.g. gardening). If left untreated, a small percentage of them will turn into a type of skin cancer called squamous cell carcinoma (SCC) which can be locally destructive, but also has the potential to spread (“metastasize”) leading to death.

Assessment and treatment by your dermatologist is recommended. Many times, a few individual lesions will simply be treated with liquid nitrogen (“cryotherapy”) which creates a localized controlled frostbite to kill the bad cells. For those with more extensive involvement, and where lesions are frequently recurring, “field therapy” should be considered to treat the entire area (e.g. scalp, or face, or both; or chest, or forearms or legs) so as to both treat lesions that are present, and also prevent new lesions from forming. Field therapies include photodynamic therapy, ablative laser resurfacing (e.g. ProFractional laser), medium-strength chemical peels (e.g. TCA), as well as home chemotherapy treatments such as 5-FU (EfudexÒ) or Imiquimod (e.g. ZyclaraÒ or AldaraÒ). Often a combination of these therapies will be used over the years to control these lesions. Your doctor may also recommend you take Niacinamide supplements to help prevent AKs too.

Let’s move on to acne!

Ok, so we all know what acne is, but I feel that cystic or hormonal acne, with or without inflammation seems to garner the greatest results. With that said, even those who experience a significant amount of oil production, even without papules, will find relief with PDT when oil production quickly reduces to a minimum.

PDT consists of two parts: medication and activation. Metvix is now the favored topical medication in dermatology due to its ability to treat deeper and more efficiently than its previous counterparts; it is also activated by the deeper red light spectrum, as opposed to the original more superficial blue light. First, the skin is quickly & easily prepped, Metvix is applied and then it has to “ incubate” for 2-3 hours, at which time the patient feels absolutely nothing from the medication. Metvix is light-activated, so until the patient is exposed to a light source, be it the Aktilite device, IPL/BBL, or even just the sun, the Metvix sits securely in the skin grabbing onto only the cells it needs to “fix”.

The patient needs to stay in low level lighting for the next two days and avoid going outside during the daytime. When treating either AKs or acne, there may be some crusting where the lesions were, but they fall off leaving the skin healthier, smoother and far more attractive (both medical & cosmetic benefit!).

What is awesome about PDT is it is typically only 1-3 sessions per year (varies ofcourse between people), may be fully or partially covered by your drug plan or benefits, and that it has a very high success & satisfaction rate. We have extensive experience treating countless patients over the past decade.

If you think you may have AKs or acne that you are frustrated with, a visit to TDC to see if PDT is right for you might just be the best decision you have ever made!

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre

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