Photodynamic therapy

Photodynamic Therapy (PDT) has earned a reputation as a revolutionary way to treat certain types of skin cancers, pre-cancerous lesions and photodamage. Photodynamic therapy may also be used in a cosmetic setting as a method of ‘photo-rejuvenation’.

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Combining the use of a special photosensitising agent (ALA), photodynamic therapy is a non surgical and well tolerated treatment. This chemical is activated with a specific wavelength and intensity of light. It is a two-part treatment. First, the drug is administered to the skin via cream. An incubation period (wait time) of 90-180 minutes is need for absorption of the cream. This is followed by exposure under a specific light source for eight minutes. Once the skin is exposed to the light treatment, the photosensitive drug starts to react by destroying damaged and cancerous cells leaving normal skin tissue unaffected.

PDT is applied to the affected area and surrounding tissue and is known as a ‘field treatment'. Virtually any area can be treated with PDT, including the face, scalp, hands and chest.  There is evidence to suggest that photodynamic therapy can have photorejuvenating effects such as reducing pigmentation, capillaries and improving skin texture.

In general PDT is well tolerated and in many cases an anaesthetic is not required.

Slight burning and stinging during the procedure can often be felt. The administration of panadol one hour before illumination helps to increase a patient's comfort. A cool spray of nitrogen during the procedure will also decrease the stinging. If necessary an anaesthetic cream such as EMLA can be used to alleviate any discomfort during the procedure. As a guideline, 95% of patients do not require an anaesthetic. We recommend an over the counter pain killer such as Panedine to be taken after the procedure if the treatment are was large such as the face or scalp.

Due to the photosensitivity of the drug used, patients may feel sunburned and occasionally swollen after the treatment. Depending on the extent of PDT and the severity of the treated condition, this usually subsides within 1-3 days. Peeling and redness usually occurs for 3-6 days after treatment. Patients will need to avoid sun exposure for 48 hours after the treatment.

Preparation of the area for PDT normally takes  between 10 to 15 minutes. This may involve degreasing the skin or in severe cases a laser assisted micropeel. The cream is then placed on the target area for 1-3 hours. This allows adequate absorption of the ALA cream to the target areas. The second part of the treatment (activation of the cream with a specific light source)  takes approximately 7-9 minutes to complete.

How much time off work will always depend on the site and extent of treatment received. As a guide the downtime for full face PDT is approximately 6-7 days, which compares favorably with Efudix treatment (downtime of 3-4 weeks). Regions that are smaller, such as the nose or upper lip typically heal within 4 days.

Your dermatologist will assess how your skin will react to PDT and how much time off work you will need.

With PDT there is:

• Less potential for scarring
• Less down time and quicker recovery (typically days, not weeks/months)
• High cure rates.

Note: Not all lesions are suitable for PHOTODYNAMIC THERAPY, a specialist dermatologist will be able to assist in advising you what treatment is appropriate.

Sunspots or solar keratosis is a common pre-cancerous lesion seen in the Queensland population. They are normally rough, dry, red and scaly lesions on sunexposed areas of the face, ears, scalp, and hands. Smaller regions can be treated with freezing, whilst a ‘field treatment’ such as Efudix or PDT is recommended for larger areas.

Efudix treatment involves application of a cream twice a day for a period of 3-6 weeks. Downtime is significant - approaching 4-7 weeks, however it is incredibly effective.

Because of Brisbane's weather conditions (high humidity and UV index), the treatment is limited to the cooler months of the year.

PDT in contrast to Efudix, is a one off treatment for Solar keratosis. It only takes hours, and downtime is only to 6-7 days. PDT is not limited to the cooler months and can be performed at any time.

More on treatment options for sun damage

Developed by laser dermatologists, this combination of laser and short incubation PDT gives superior results than either treatment alone. Essentially, this procedure combines laser resurfacing with PDT for the treatments of sunspots, pigmentation and ageing skin. Recovery from this treatment is 7-9 days.

For patients seeking a solution for their sundamage, and who would also benefit from laser rejuvenation this treatment is ideal. This procedure gives cosmetic benefits in addition to treating sundamage skin.

• If patients are not concerned in regards to cosmetic outcome and can tolerate a downtime of 4 weeks, Efudix is the treatment of choice. Downtime 3-4 weeks. This is the most cost-effective treatment, and should ideally be undertaken during cooler months of the year.
• If patients are only concerned in regards to premalignant sunspot treatment, and can only have a downtime of 7-8 days, PDT is the treatment of choice. This treatment can be conducted throughout the year, and patients will have a much quicker healing time compared to Efudix treatment.
• If patients exhibit only mild photodamage, a series of glycolic acid /AHA peels can rejuvenate the skin.  Little or no downtime is associated with chemical peeling.
• If patients wish to address other signs of photoaging such as pigmentation, decreased skin tone, wrinkling and understand a downtime of 7-9 days can be expected, the treatment of choice is laser.
• If sundamage consist mainly of uneven skin pigmentation, then photofractional rejuvenation is the treatment of choice.

The costs will depend on the extent of solar damage. The severity and area will be assessed and determined by your dermatologist.

For solar damage/ sun spots, patients will typically require one treatment.

For Basal cell cancers and Intraepithelial cancers, patients will require two treatments as standard protocol.

• Half face PDT Cheeks, temples, forehead: $1,550 - $2200 (depends on area)
• Nose/ upper lip: $ 700 - 900
• BCC: $350 - $370 per treatment (two treatments advised)

Prices include all aspects of treatment including:

• Photography and site documentation,
• Histology if required,
• Microabrasion of skin/ microlaser peel if required,
• Application of ALA- Metvix
• Activation of ALA-Metvix
• Local anaesthetic creams if required
• Dressings
• Subsequent follow up after large area PDT

Note: PDT is NOT covered under Medicare. Some health insurance companies do provide a partial rebate for this procedure. We advise patients to check with their cover prior to undertaking this procedure.

As we are a specialist group of doctors, a referral from your GP is advisable. Call us directly on 3871 3437 to make a booking or enquire about the referral process. A consultation is required prior to the consideration of PDT. Your dermatologist will thoroughly assess your condition and provide you with treatment options and a plan prior to the procedure.

Enquire about PDT treatment

moreDr. Davin S. Lim

Dr Davin S. Lim, Consultant Dermatologist

Photodynamic therapy is a highly effective targeted treatment that destroys cancer and precancerous cells without harming the surrounding healthy tissue. The chemical used is a naturally occurring light sensitive substance, activated by high intensity red light. The downtime and convenience of this procedure compared with Efudix makes PDT a more viable option for busy professionals.

For more information on PDT click here