Photodynamic Therapy Photodynamic therapy (PDT) is an exciting new technology that can be used in the treatment of both non-melanoma skin cancer (NMSC) and precursors of NMSC such as actinic keratoses, superficial basal cell carcinomas and in-situ squamous cell carcinomas. It is also effective in promoting skin rejuvenation, healing sun damaged skin and acne treatment and is increasingly being used by skin cancer doctors and cosmetic physicians. PDT uses high purity lights such as specific wavelengths of LED lights that in combination with medical grade products, specifically targets diseased and damaged skin cells. It does not involve harmful UV or infrared light and incorporates the use of advance technology to destroy cancerous and precancerous skin cells. At Drummoyne Surgery & Skin Cancer Clinic we use a range of high quality skin preparation products in conjunction with medication such as 5-ALA or Metvix for our PDT. These high quality products have been scientifically developed to promote both the healing and repair of skin and are only available under the supervision of a doctor. Treatment steps are as follows: 1) An initial consultation to assess eligibility for treatment is required. If PDT is suitable, a pre-treatment skin plan will be designed which must be followed for the first 2 weeks. This involves the application of the Allmedic cleanser, exfoliator, body/face repair and sunscreen. The purpose of this regimen is to prepare the skin for the application of the light sensitive product 5-ALA or Metvix. It is these creams that when used in conjunction with specific light destroy the damaged skin cells. Patients who are susceptible to cold sores should start on a course of antiviral medication which will be started the day prior to treatment. 2) On the day of treatment, the skin is cleansed with pre-incubation cleanser and 2 applications of 5-ALA or Metvix are applied. Patients should arrive wearing no makeup or any other skin products and should remember to wear protective clothing and a hat. The topical medication used remains on the skin for 3-5 hours although may be longer depending on the area being treated. All sunlight and ultraviolet light (ie halogen lamps) must be avoided as it may pre-activate the medication. A dressing may be required to be worn to prevent exposure. Patients are not required to stay and therefore can go home during the incubation period. 3) On return, the area being treated is washed with warm water and PDT eze soothing spray is applied for 10 minutes prior to illumination. Protective eye-wear is worn and the treatment is commenced. Illumination is 20 minutes of BLUE LIGHT followed by 10 minutes of RED LIGHT. 4) Post treatment, a cool towel is applied to the treated area for 5 to 10 minutes. The area is pat dried and the Allmedic post treatment soothing lotion is applied. Patients are advised to continue applying the soothing lotion 2 to 4 times a day for the first 3 days. By days 4 or 5, less of the lotion is likely to be required but may still be used at least twice a day for a further week. Oral analgesia and ice compresses may also be used post treatment. Patients must avoid sun exposure and strong household lighting for the next 3 days/nights. 5) Two weeks post treatment, patients will be required to continue a maintenance regime which will assist in the continuation of skin repair and protection. Contraindications for PDT: * hypersensitivity to light; * patients with porphyria; * patients taking any of the following medications - Thiazides (used for BP control), Antibiotics (tetracyclines, fluoroquinolones, sulphonamides, griseofulvin), Sulphonylureas (used to manage diabetes), Phoenothiazines (used for personality disorders); * morpheaform BCC; * BCC or SCC >2mm in thickness; * pregnancy * under 18 years of age; * hyperkeratotic skin; * use of Roaccutane within previous 6 months Common side effects of PDT: During treatment Tingling, a prickling ant-bite feeling, heat and pain may be experienced whilst treatment is occurring which is normal. Patients will be asked at intervals their level of discomfort and if required, further sprays of PDT eze will be applied. Days 1 to 5 Acute inflammatory response such as redness, swelling, tingling, itchiness, a severe sunburn feeling are often experienced. These symptoms are normal and can be relieved with oral pain relief, ice packs and soothing lotion. Patients should not exercise (avoid sweating) and stay indoors for 3 days post treatment. If this is not possible, the treated area must be completely covered. Days 6 to 14 Symptoms of itchiness may continue as well as scabbing, flaking, sun sensitivity and tightness. The soothing lotion can continue to be used to ease these conditions. Other side effects Hyper or hypo pigmentation, hair loss (usually mild) and scarring (uncommon) Cost of PDT Depending on skin condition and areas of treatment, usually the doctor you see will discuss this with you during consultation. This is a not a Medicare rebatable service. Some private health insurance companies may cover part of the cost, however this would need to investigated by the individual. |
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