Photodynamic Therapy for Actinic Keratoses
This technology employs the use of a chemical that is naturally present in our bodies along with certain wavelengths of visible light to affect abnormal skin lesions. It is FDA approved to treat actinic keratoses (AK), precancerous skin lesions that commonly occur after years of sun exposure. It also results in a rejuvenated appearance and can be used instead of liquid nitrogen cryotherapy, which is more painful; or topical 5-flurouracil cream, which needs to be applied daily and results in an unsightly appearance lasting several weeks. PDT has emerging use for acne, rosacea, superficial skin cancer, aging skin, and several other skin conditions, but is not yet FDA approved for these conditions.
How does PDT work?
Amino-levulinic acid is a precursor to the production of hemoglobin in the body. This solution, called Levulan®, is applied to the skin and is selectively taken up by abnormal cells and converted to protoporphyrin, which is like hemoglobin without iron in it. This substance is activated by certain wavelengths of light to destroy the abnormal cells.
How is the procedure performed?
This is a 2-step process. Our medical assistant or nurse first prepares the skin in the affected area by cleansing and scrubbing. The Levulan® solution is then applied. The solution is allowed to incubate on the skin for a specified period of time, usually one hour. The second step is the activation of the protoporphyrin in the skin by a light source, such as a bank of blue fluorescent tubes, known as the Blue Light or a laser/light source. The light activation takes only several minutes.
What will the procedure feel like?
About half of the patients treated feel varying degrees of tingling, burning of stinging during exposure to the fluorescent blue lights, which stops immediately after the light activation ceases.
How effective is it?
Studies have show that it has cleared 100% of AKs in about 2/3 of patients after 8 weeks. Many patients will benefit from a second treatment after 8 weeks.
What can be expected after treatment?
The skin may be slightly swollen and red, akin to a sunburn appearance followed by flaking and peeling. This is usually fairly mild and usually clears within one week. After the redness and scaling subsides, not only are the majority of AKs resolved, the skin in the treated sites also looks rejuvenated. It is very important to avoid exposure to strong sunlight or bright direct light for 24-48 hours after PDT treatment to prevent an excessive redness reaction. We recommend a wide brim hat and a reflective opaque sunscreen for this period, as well as staying indoors as much as possible.
PDT treatment for actinic keratoses is covered by Medicare and most health insurance plans. The use of PDT for acne, rosacea, anti-aging effect is not covered at present.
Moles & Pigmented Lesions
Moles are harmless skin growths that may be flat or protruding. They vary in color from pink flesh tones to dark brown or black. Everyone has moles; some of us have a lot, others have only a few. Rarely a mole can become cancerous. If you have a mole which is showing unusual growth or expansion compared to your other moles, you should have it checked immediately by your doctor.
What causes moles?
The number depends on our genes. Moles sometimes appear in crops; especially during the early teens. No one knows why we get moles. Pregnancy can cause moles to get bigger, but if one is getting bigger faster then the others, have it checked by your doctor.
How are moles treated?
Most moles are harmless and safe to ignore. Treating a mole for cosmetic reasons is a simple procedure. After numbing the skin, the projecting part of the mole is removed with scissors or a scalpel. the wound heals to leave a flat mole, but the color generally stays the same. Complete destruction of a mole requires removing the full thickness of skin. The resulting scar may be more noticeable than the mole was.
Moles sometimes grow annoying coarse hair, and it may be safely removed by shaving or plucking. Permanent removal of the hair, which has roots deep within the skin, requires electrolysis, laser removal, or complete surgical excision of the mole.
A mole that bleeds, itches, markedly changes color, has an unusual appearance, or changes in any way should be checked by your doctor immediately.