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Hard-to-treat acne and acne scar treatment
may require "power-level"
solutions. A new procedure that treats resistant,
hard-to-treat active acne combines light and
a special light-activated solution that targets
and destroys acne activity. This treatment
also diminishes older acne scars, leaving
your skin smoother. The procedure is called
Photodynamic Therapy. Dr. Taheri is a pioneer
in the use of Photodynamic Therapy and his
patients show consistent major improvements.
Photodynamic Acne Treatment (PDT) is a process
by which a photosensitizing agent (Levulan®)
is applied to your skin. A Photosensitizing
agent is a special solution applied to the
skin that is activated by a specific wavelength
of light, which “turns it on.” Levulan®
has been used extensively for the treatment
of a variety of different skin conditions.
Levulan® is a 20% solution of Aminolevulinic
Acid (ALA). ALA is a “natural” product
found in all humans throughout the body.
Understanding acne
Acne results from the obstruction and inflammation of the sebaceous glands,
and it affects 80% of the human population. Acne typically begins in adolescence
with hormonal changes. However, there are many older individuals who suffer
from “adult acne.” There are different levels of acne ranging
from milder comedonal (blackheads and whiteheads) to moderate, pustular,
on to severe cystic acne. In many cases, several or all of these levels
of acne can be present on an individual simultaneously.
Different types of acne
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Moderate Acne
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Sebaceous Hyperplasia
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Actinic Keratosis
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What causes acne?
Acne is caused by overactive sebaceous glands in the skin. The sebaceous
glands, triggered by the hormone androgen, produce sebum (oil) in the skin.
Although androgen is a male hormone, it is present in both men and women.
Production of this hormone is highest during puberty, but it is always present
in the body. When androgen levels increase, the sebaceous glands release
sebum. Ordinarily this oily substance spills onto the skin. When cells from
the lining of hair follicles shed too quickly—clumping together and
clogging pores—sebum is trapped beneath the skin causing whiteheads
and blackheads. Sebum can then mix with the trapped cells and cause Propionibacterium
acnes (P. acnes)—bacteria normally found on the skin–to grow
in the clogged follicles. P. acnes can cause inflammation and pus and can
result in papules or pustules. When the follicles expand as much as they
can, bumps called nodules are formed under the skin.
Moderate acne may include blackheads and whiteheads in addition to papules—inflamed
lesions that appear as small, reddish or pinkish bumps that can be sensitive
to touch—or pustules—inflamed, white-centered bumps that can be
red at the base. Severe acne is characterized by nodules—large, painful,
solid lesions that appear as lumps under the skin—and cysts —deep,
inflamed, pus-filled lesions that can be very painful. Nodules and cysts
are inflammatory and can cause scarring.
Photodynamic acne treatment procedure
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The Levulan®, which is a clear
painless solution, is applied to your
skin and left on for 15-60 minutes.
It is then activated with a specific
wavelength of light called BLU-U or
Clear-Light. This takes about 8-10 minutes.
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The Levulan® is absorbed by active cells,
making the targeted acne cells more sensitive
to the light. This combined interaction of
the solution and the light is what gives rise
to the term "photodynamic therapy."
The Levulan® will also target sebaceous
hyperplasia (which are those small, 1-3 mm,
benign bumps under your skin) and the papules
of acne rosacea. An important part of the
treatment program is medical extraction of
blackheads and acne pustules. This procedure
will expedite the improvement in your skin
condition by cleaning the pores of hardened
sebum and infected debris. The treatment reduces
skin oiliness and minimizes the appearance
of pore size. The entire skin texture improves
following a photodynamic acne treatment.
What are the advantages and downside of PDT?
The advantages of PDT are rapid treatment
of acne lesions all over the face, no scarring,
no surgical excisions and no systemic side
effects. The skin appears refreshed and younger
following these treatments. There is reduced
scarring and improved cosmetic outcomes compared
with cautery, surgery, and Efudex. Liquid
Nitrogen can leave white shots of your skin.
The procedure is easier for patients than
repeated topical liquid nitrogen, Efudex (5fu),
or Aldara because the side effects are minimal
and rapid healing. Additionally, the ALA/PDT
treatment at our clinic is less painful than
liquid nitrogen, d-FU, and Aldara. Furthermore,
Levulan® improves the whole facial area
treated, creating all one color, texture,
and tone rather than just spot treating with
liquid nitrogen, cautery, and surgery. We
advise 2-3 treatments at 2 to 3 week intervals
to obtain optimal results.
The “downside” of Photodynamic treatment
(PDT) is that your skin will be red and have
some skin peeling (and crusting if you have
skin cancers) for several days after the treatment.
Usually, the first 1-2 days are the worst.
Pressed mineral base powder (available in
our office) will hide most of the redness.
Some patients have an exuberant response to
PDT, and experience marked redness of their
skin. Temporary swelling of the lips and around
your eyes can occur for a few days. Darker
pigmented patches called liver spots can become
temporarily darker and then peel off, leaving
normal skin. This usually occurs over seven
to ten days. Repeat treatments may be necessary
as PDT medicine is not an exact science. You
must remain indoors the day following your
treatment to avoid sun exposure, as you are
photosensitive for about 24 hours after PDT.
Topical acne lotions can be used in between
your Levulan® treatments once the redness
has settled down over a period of a few days.
Prior to Photodynamic Acne Treatment, the best available treatment option
for resistant and cystic acne was Accutane. However, with Accutane there
are many systemic* side effects including birth defects, liver abnormalities,
mood depression, and virtually all patients get dryness and night vision
changes.
* Systemic treatments are any medications that are taken orally,
injected or infused that affect the entire body system. PDT Acne Treatment
provides a viable alternative to all types of acne treatment without having
negative systemic effects..
Photodynamic therapy with Levulan®
is indicated for:
Removing pre-cancerous actininc keratoses
Preventing skin cancer
Improving wrinkles
Reducing pore size
Improving skin texture
Improving pigmentation
Treating moderate to severe cystic acne
Treating sebaceous hyperplasia
How much improvement can I expect?
Patients with severe sun damaged skin manifested by actinic keratosis, texture,
and tone changes including mottled pigmentation and skin laxity may see
excellent results. You may also see improvements of large pores and pitted
acne scars. Active acne can improve dramatically.
How many treatments will it take to see the "best" results?
To achieve maximum improvement of pre-cancerous (actinic keratoses) sun
damage, skin tone, and texture, a series of three treatments 2-4 weeks apart
is the most effective. Some patients with only actinic keratoses are happy
with just one treatment. More treatments can be done at periodic intervals
in the future to maintain the rejuvenated appearance of the skin.
PDT matches the “ideal treatment” for photodamaged skin:
Well-tolerated
Easily performed in a specialty clinic environment
Non-invasive (no needles or surgery required)
Excellent cosmetic outcome
(particularly in cosmetically sensitive areas of the face) |
During your office consultation you will be provided with a detailed plan
of the treatments that will benefit you most. Please contact
us with any questions you may have or schedule
an appointment online for a consultation. Click
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