PHOTO DYNAMIC THERAPY
You have been prescribed PDT or Photo Dynamic Therapy. PDT is a non-surgical treatment of skin cancer or pre-cancerous lesions. This is a treatment for non-melanoma skin cancers.
It is effective and has several benefits over conventional treatment approaches:
- It is as effective as surgery but superior to cryotherapy
- It is selective for cancerous tissue
- It is non-invasive and non-scaring
- It can be used repeatedly if necessary
- Cosmetic results are superior to all comparable treatments.
So you could either have Solar Keratosis or a Basal Cell Carcinoma (BCC) or a Bowens (very superficial squamous cell carcinoma). Solar Keratosis is usually red and scaly and occurs most commonly on the face, the head (in balding men) and the forearms and hands. Initially they come and go but finally they are there all the time. If left untreated ± 1% to 20% of those lesions turn into skin cancer per year – that’s why we treat them!
A BCC or Bowen is already skin cancer and BCC’s occur most commonly on the face and back while Bowen’s is usually found on the arms and legs. Skin cancer is the most common form of cancer worldwide and in particular in our country. Almost everybody has had enough sun damage in their lives to develop skin cancer when we get older.
The most common treatment for Solar Keratosis is Liquid Nitrogen (freezing them), while skin cancers are usually removed surgically. This obviously leads to scarring, which can be subtle if well done but nevertheless as skin cancers are almost always multiple this can be a major cosmetic problem. This is why PDT was developed in Europe: To find a treatment which is equally effective but doesn’t leave you with scars.
First we apply a cream, which is called “ALA” or Levulanic acid, a compound related to Bilirubin and Porphyrins (substances found in your liver). All cells in the body need this compound, but abnormal cells absorb it faster than normal cells. After we apply the cream we cover it with plastic occlusion to allow it to be absorbed. After a period of 1 to 4 hours we take the dressing off and apply a light. This light is not infrared or laser, just a very strong visible (635nm) infrared light. The energy from this light activates the cream and this produces Oxygen radicals. Those radicals destroy all cells that have absorbed the cream – so it destroys only abnormal cells.
The cancer cells get destroyed and die (and it is worst during the 8 to 16 minutes of treatment depending on which lamp we use). It may be painful. We prescribe Lyrica tablets to manage the pain. Local anaesthetic may also be injected in to the lesions.
In the following 24 hours it will feel like very severe sunburn: the skin will turn red, sometimes swollen, some crusting and oozing can occur if the lesions were deep. In those first 24 hours it may be necessary to take Lyrica or Panado. After that the area usually heels within 1 to 2 weeks. It is important that you keep the area well moisturized all the time (apply Nutraderm cream 3 to 4x/day) and if there is crusting/oozing then you should us Bactroban 2x/day for 3 to 4 days. The skin will then peel off (like in sunburn) and heel completely. Although it will be very unsightly for those 1 to 2 weeks the end results are always good. Two treatments are required 4 to 6 weeks apart.
One more word regarding the pain: the pain depends on the amount of sun damage. It is difficult to know beforehand exactly how bad it is going to be. However it is always manageable with the Lyrica or Panado. The reddening – which is seen after the healing – can also take up to 6 weeks, sometimes even months to disappear. Again this is an individual reaction but is never permanent. The clearance or cure rate with this treatment is comparable to that of surgery but the cosmetic outcome is always better. If you would like to know more, don’t hesitate to ask!
- Photodynamic Therapy is easier for patients than repeated topical liquid nitrogen, Efudix or Aldara because the side effects are minimal with rapid healing.
- Photodynamic Therapy reduces scarring and gives improved cosmetic outcome compared with cautery, surgery and Efudix. Liquid nitrogen can leave white spots on your skin.
- ALA PDT improves the whole facial area treated creating one colour, texture and tone, rather than just spot treating with liquid nitrogen, cautery and surgery.
IN SUMMARY: ALA PDT matches the “Ideal Treatment” for actinic damage, because it is:
- Well tolerated
- Easily performed at our specialty clinic environment
- Non-invasive (no surgery)
- Excellent cosmetic outcome, especially in sensitive areas of the face.
NB: NO SUN EXPOSURE FOR 48 HOURS AFTER TREATMENT. So: Avoid ALL electronic equipment with screens i.e.: TV, Computer screens, Laptops, Iphone, Ipad,etc
- Metabolic disorders, which can give rise to light-induced rashes.
- Photo-sensitive eczema
- Autoimmune disease e.g. Lupus Erythematosus.
- Chlorpromazine (Anti-Psychotic), also known as Largactil. Patient can be treated if the medicine has not been taken within the last 8 days.
- Griseofulvin (Anti-Fungal), also known as Fulcin, Grisovin. Patient can be treated if the medicine has not been taken within the last 5 days.
- Isotretinoin (Anti-Acne), also known as Roaccutane. Patient can be treated if the medicine has not been taken within the last 5 days.
- Tetracycline (Antibiotic), also known as Tetralysal, Terra-Cotril, Terramycin, Minomycin, Cyclimycin.
- Tetracycline HCL, Achromycin V, Tetrex, Doxycycline, Ciprofloxacin. Patient can be treated if the medicine has not been taken within the last 5 days.
- Methotrexate (Anti-Arthritis and Anti-Cancer), also known as Methotrexate Sodium.
- Amiodarone (Anti-Arrythmic), also known as Cordarone, Hexarone. Treatment can be administered at the physician’s discretion.
- Bisoprolol (e.g. Ziak,) Spironolactone (e.g. Aldactone), Amitriptyline (e.g. Trepilene), Metformin (e.g. Glucophage) – please do not take on day of PDT treatment.
- Tacrolimus (Immunosuppressant – organ transplant patients).
- Patients who have a history of recurring cold sores (Herpes simplex type 1) should use oral Zelitrex tablets, 500mg twice a day for 5 days, starting the evening before the PDT treatment. You need a prescription for this medicine.
- Please contact the rooms for the script.
- Make sure your skin is clean and free of all make-up, moisturizers and sunscreens before you come in for each treatment.
- BRING A HAT, SUNGLASSES AND SCARF with you on the day of your Rx.
- This is especially important for patients who need to drive a longer distance back home. The sun will continue activating the cream and, therefore, causing a more severe reaction.
- Photography may be done by the staff before the ALA is applied.
- Please sign the consent form allowing the staff to take photos.
- You skin will be cleaned to enhance the absorption of the ALA and to give more even uptake. In some patients, microdermabrasion or a chemical peel will be done immediately prior to the application of the ALA.
- ALA is applied topically to the whole area to be treated, such as the whole face, back of the hands, extensor part of the forearms and sometimes even the top.
- The ALA is left on for between 30 minutes and 6 hours before any treatment.
- The ALA is activated with the Mostleds machine. This unique spectrum of light activates the ALA.
- Please make sure that you receive the post-treatment instructions to care for your skin.
- If you have any discomfort, apply ice packs to the treated areas. This will help keep the area cool and alleviate any discomfort. It will also help to keep down any swelling.
- Swelling will be most prominent around the eyes and is usually more prominent in the morning.
- Remain indoors and avoid direct sunlight for 48 hours. This means that you should also not drive around in a car, sit near a window or be outside even if overcast. Sitting in front of a Computer / TV screen must also be avoided.
- Take Panado or Lyrica if necessary for pain.
- You may rinse with cool water, but not with ice water. If you want to use a cleanser, use Cetaphil Gentle Skin Cleanser..
- Apply EpiMax or Nutraderm cream as needed, but at least twice a day.
- Continue using the soft cleansers as instructed above.
- Your skin will feel dry and tightened. Continue using the moisturizers as often as necessary, but at least twice a day as instructed above.
- Avoid direct sunlight for one week.
- Use a total sunblock which is zinc oxide or titanium oxide based. Brand names include Bioderma PhotoDerm Max SPF50+, Heliocare Gel or Spray SPF50 or Xeroderm SPF34.
- You may begin by applying make-up once any crusting has healed. The area may be slightly red for 1-2 weeks. If make-up is important to you, please ask about the Bioderma Photoderm SPF50+ Tinted Cream or the Heliocare Oil Free SPF50 Compacts, which acts as a concealer with a sunscreen. It really helps to mask redness.
- If you have any further questions or queries, please don’t hesitate to ask before your treatment by contacting us on 012 460 4646/50 or E-mail us at firstname.lastname@example.org
HOME CARE INSTRUCTIONS for patients following Photo Dynamic Therapy
NB: NO SUN EXPOSURE FOR 48 HOURS AFTER TREATMENT. Avoid ALL electronic equipment with screens i.e.: TV, Computer screens, Laptops, Iphone, Ipad,etc