Levulan® Photodynamic Therapy of Acne
Acne Before and After Photodynamic Therapy Treatment
Acne is a genetic, hormonal disease characterized by overproduction of oil by the sebaceous glands, plugging of the sebaceous glands to form micro- and macro- comedones (blackheads) and, finally, action of skin bacteria on oil trapped underneath the skin, to produce red inflammatory cystic lesions.
Traditional therapies for acne involve keralytic agents, such as the retinoids, which thin the top layer of skin and unplug the oil glands; topical antiseptics and antibiotics, which diminish the number of bacteria in the skin; and oral antibiotics, which similarly diminish the bacteria. More severe cases of acne can be treated with Accutane, which is a systemic retinoid. All of these treatments have their benefits, but also have their limitations of being inconvenient, and occasionally toxic.
There has been some interest and some research in photodynamic therapy of acne. With photodynamic therapy, a drug that is activated by light is applied to the skin. After a certain period, the drug is then washed off and the skin is exposed to light. That light energy causes the release of singlet oxygen molecules, which have the biologic effect of killing P. acnes, the bacteria responsible for acne. The light also seems to cause involution of the sebaceous glands. Treatment involves a several-step process, done in the office:
First, the skin is scrubbed off with acetone and then Levulan® is applied to the skin. After a thirty minute waiting period, the Levulan is washed off and the skin is exposed to a light source which, in the case of acne, may be blue light. The skin is then carefully washed after the treatment. It is important to guard against sun exposure for forty-eight hours after the treatment because some of the photodynamic agent may still be in the skin. Some patients notice skin irritation for twenty-four to seventy-two hours; however, generally this treatment is well-tolerated.
Data at this point is anecdotal, however there have been some reports of excellent response to single treatments as well as a series of treatments. Generally, we are recommending treatment every other week for a total of four to five treatments.
In summary, photodynamic therapy represents an entirely new modality of treating acne, which seems to be well-tolerated. It may, in fact, become the best treatment for mild to moderate, or even severe, acne.