Photodynamic Therapy (Levulan with Blue Light) for AKs Pre and Post-Care Instructions

What are actinic keratoses (AKs)?

AKs are areas of sun-damaged skin typically occurring on the face, ears, scalp, lips, forearms, and back of the hands.  They are caused by sun exposure over many years (e.g. tanning, sunbed use, outdoor work or recreational activities, living in a sunny climate).  AKs occur more often in older adults, and those fair skin, blue eyes, red/blonde hair, and who burn easily.

If left untreated for years, there is a small risk that an AK can progress into skin cancer known as squamous cell carcinoma (SCC).  For this reason we consider AKs to be a ‘pre-cancerous’ skin condition. People affected by many AKs or who have a history of skin cancer are at higher risk of developing SCC and other types of skin cancer.  People taking immunosuppressive drugs or who are immunocompromised are also higher risk.

AKs can be treated but tend to recur over time. Their presence indicates a background of sun damaged skin.  So while an individual AK can be cured, the affected patient is at risk of developing more AKs in the future.

What is photodynamic therapy (PDT)?

PDT is a technique used to treat some types of skin cancer and AKs/areas of sun-damaged skin that may become cancerous in the future.  A solution called Levulan ^® (aminolevulinic acid 20%) is applied to an area of skin followed by immediate incubation under a blue light.  At Derma Spa, we perform what’s known as “Painless PDT”.  Patients tolerate this procedure quite well and clearance rates for AKs are similar to waiting a prolonged incubation period.

Once Levulan ^® is applied to the affected skin, it turns into a powerful light sensitive chemical (known as “photosensitiser”) and visible light (such as daylight, or blue light) activates the photosensitiser, causing the skin to become inflamed. Only the skin that is exposed to both the photosensitiser and the light will be treated. After the inflammation has cleared, the area of affected skin will either be cured or improved.

PDT is effective for most patients.  It works by killing the abnormal cells in the affected skin area. However, sometimes the treatment may not be successful and alternative treatment will need to be discussed with your healthcare professional.

Why is photodynamic therapy (PDT) recommended to treat AKs?

Research shows up to 90% of face and scalp AKs will be cleared with PDT, with a one-year sustained clearance of about 80%.  Thick AKs can be more difficult to clear and may require multiple treatment sessions.  PDT also provides excellent cosmetic results for sun-damaged skin, and is shown to improve fine lines, skin roughness, complexion, and some hyperpigmentation.

Why do we recommend pretreatment with high dose vitamin D prior to PDT?

Vitamin D increases a chemical called protoporphorin9 in the powerhouse of our cells (the mitochondria) which enhances the killing capacity of PDT on cancerous skin cells.  Many adults in Canada are Vitamin D deficient, and research shows that pre-treatment with Vitamin D will improve clearance rates by over 30%.  Even for patients who have adequate levels of Vitamin D, clearance rates will still be improved.

If you have any of the following conditions and/or contraindications, please contact your provider to determine whether you can proceed with the treatment.

• History of cold sores
• Active acne in the area to be treated
• Recent flareup of eczema, psoriasis, sunburn or fresh suntan
• Currently pregnant or breastfeeding
• Use of isotretinoin (Accutane, Clarus, Epuris, Αbѕоricа) within the last 6 months
• History of radiation therapy in the area to be treated
• If you have been prescribed any medications that are photosensitizing (e.g. amiodarone, doxycycline, etc.)
• If you have hypersensitivity/allergy to aminolevulinic acid or porphyrins
• If you have known porphyria

Pre-Treatment Instructions:

• Avoid excess sun exposure, tanning beds, and self-tanning products for at least 4 weeks prior to Levulan treatment. Sunburned or tanned skin can increase the risk of complications.
• Take high dose Vit D 10,000IU for 2 weeks prior to your treatment
  • Do not take high dose Vit D if you have known hypercalcemia, kidney stones, kidney disease, hyperparathyroidism, sarcoidosis, Williams syndrome, or a malabsorption syndrome
• Stop any retinol-based or acid-based products 7 days prior to your treatment.
• Shave the treated area the night before or the morning of the treatment.
• Arrive with clean skin free of any makeup, creams, or lotions.
• Bring a wide-brimmed hat, sunglasses and a scarf to cover the treated area from the sun.
• Plan to go directly home after your treatment.

Post-Treatment Instructions:

• Prepare for some downtime as you will be extremely photosensitive for 48 hours. Avoid any UV exposure and bright indoor lighting including computer screens.  It’s best to stay indoors and away from large windows.
• You may experience redness, swelling, irritation/burning, sensitivity, dryness, flaking, crusting, and skin discoloration or pigment changes. Occasionally, milia or small pimples may occur. Rarely, you may notice open/leaking skin or blisters.  Most side effects will take about a week to subside.
• Apply soft gel cold packs to help reduce any inflammation, irritation, redness and swelling to your skin on and off until it settles.
• If needed, pain relievers like ibuprofen or acetaminophen can be used.
• Use a gentle cleanser twice daily, followed by a gentle moisturizer such as Glaxal or CeraVe cream. IS clinical Sheald or ZO Hydrating Cream are also great options available at Derma Spa.
• We recommend using a high quality mineral sunscreen of SPF30 or higher as your skin will be sensitive and prone to burning. This should be continued year-round.
• You may notice the AK’s (actinic keratoses) become more inflamed and scalier and can take about 4-6 weeks to resolve. Multiple treatments are generally recommended depending on the amount of damage.
• Avoid hot tubs/baths, saunas, exercise until the redness and irritation have subsided and the skin has fully sloughed. You can shower but keep the soap and shampoo away from the treated area.
• Avoid any products that may cause irritation such as retinols/retinoids and acid-based products until your provider says you can start using them again.
• Makeup can be applied once any crusting has resolved. Do not pick scabs.

When to call the Clinic:

• If you have pain that persists more than 24 hours
• If you are getting colored discharge, an increase in redness, pain and/or a fever
• If you develop a cold sore
• If you develop a rash with itchiness and an increase in inflammation
• If you have any questions at all about your healing