Photodynamic therapy in dermatology

Photodynamic therapy is a dermatologic treatment for various pathological or cosmetic conditions affecting the skin, including: acne, lesions due to photodamage or skin aging, actinic or solar keratoses, pre-tumor lesions, and cancerous lesions.
Photodynamic therapy is based on light energy and the application of a photosensitizing substance in the form of a cream. When applied to the skin, the cream triggers an oxidative reaction only in pathological epidermal cells, resulting in their elimination and prompting their replacement with new cells.

What is it and what is it used for?

Photodynamic therapy is the treatment of choice for solar or actinic keratoses and, in general, for all photoinduced lesions (induced by the sun or UV lamps), including solar aging. For the treatment of various oncological or aesthetic conditions, photodynamic therapy uses irradiation on small areas of skin.
Photodynamic therapy has many other valid applications especially in inflammatory diseases where it can help inflammation disappear.
In the field of oncology , for which the therapy originated, it can be used to treat pre-tumor and tumor lesions, in cases of basal cell carcinoma or squamous cell carcinoma (Bowen’s disease).
The effectiveness of the therapy has made it a reference for the treatment of other skin pathological conditions.

Which conditions could benefit from photodynamic therapy?

The main applications of photodynamic therapy in dermatology are for cases of:

• Actinic Keratoses
• Superficial basal cell carcinoma
• Bowen’s disease
• Actinic porokeratosis/ porokeratosis of Mibelli
• Morphea in active phase
• Lipoid necrobiosis
• Ulcers and bedsores
• Acne (teen and adult)
• Photoaging
• Lichen Planus
• Lichen sclerosus (active phase)

How does it work?

Photodynamic therapy consists of applying an aminolevulinic acid (ALA)-based cream to the lesion. The area of application is immediately covered with a bandage to allow the substance to be rapidly absorbed and for it to reach the damaged cells. The molecule used within the cream interacts exclusively with the most unstable or damaged cells by triggering an oxidative reaction that activates upon illumination with red light (630 nm) from an LED source. The photodynamic reaction is so active that it can eliminate both cancer cells and cells damaged by inflammation.

Pros and cons of photodynamic therapy

• The dermatologist will be able to evaluate the benefits and possible risks of treatment. Photodynamic therapy is effective in treating many conditions and has a low risk of side effects, compared to other treatments that have a greater impact on the body.
• Avoids surgery or use of drugs with possible side effects.
• Can treat a large area of skin in a single session
• It’s important to note that, while minimal, side effects include the reddening of the skin at the treatment site that may last from a few days to up to one week. This may be accompanied by an initial sensation of heat/burning upon exposure to LED light, however this can be remedied by cooling from outside the skin.

Who can have photodynamic therapy?

• Photodynamic therapy is generally effective and tolerated by all individuals.
• It may also be used on patients with photosensitivity, porphyria or xeroderma pigmentosum; and in those who have received retinoic acid treatment in the previous month.

Preparation for treatment

Patients should avoid the use of cosmetics, makeup, lotions, creams and deodorants on the affected area for the three days before treatment.
Immediately ahead of treatment, aminolevulinic acid cream is applied to the area, which is then quickly bandaged. Once this is completed, the patient must wait for about two hours to allow the cream to penetrate the skin and interact with the damaged cells. During this period, the patient should not engage in any physical activity and should not be exposed to the sun.
The following red light exposure takes between six and ten minutes depending on the LED lamps used.

Post treatment care

At the end of the photodynamic treatment, the dermatologist will apply restorative ointment or PEG Ointment. The same ointment should be applied by the patient at home in the evening until any reactions or side effects from photodynamic therapy have subsided and the skin has returned to normal. During this period, the skin should be cleaned only with water, and all facial treatments, creams and make-ups must be suspended until the skin has fully repaired.
Should it be necessary, there is no limit to the number of phototherapy treatments a person can undergo.
For further reading, see also:
https://dermaclub.it/malattie-della-pelle/vincere-lacne-senza-farmaci-e-possibilehttps://dermaclub.it/schede-dermatologiche/fotoinvecchiamento//
https://dermaclub.it/malattie-della-pelle/cheratosi-solari-o-attiniche-terapie-efficaci-per-contrastare-i-segni-del-sole/