Internal organs and cancer sites are now being treated with PDT using endoscopes and fibre optic catheters.

Even though some research papers about rosacea and PDT are available, as a rosacea treatment the usage of Levulan and light therapy combined is still experimental. Beware of possible adverse reactions if you are considering PDT as a skin treatment.

Fighting cancer with light

Though far more common in Europe, light-based therapy is gaining proponents in the United States.

Called photodynamic therapy, the technique represents part of medicine’s continuing quest for treatments that target tumours while sparing the rest of the body from unpleasant side effects. Though far more common in Europe, this light-based therapy is gaining proponents in the United States, where it has long been approved for treating certain lung and skin cancers.

… the therapy does have one significant side effect. The medicine that makes the tumor cells sensitive to light has a similar effect on the rest of the body. Regular cells excrete the medicine more quickly than do cancer cells, yet the kind of drug Correa received still had a fairly long impact. She would have to stay away from bright light for several weeks, or else suffer a bad sunburn.

…

In a randomized European study, photodynamic therapy had extended the life of patients with inoperable bile-duct cancer by more than a year, on average — in some cases several years. It worked so well that the trial was stopped early.

…

Correa received her infusion of the light-sensitizing medicine, called porfimer sodium, on Dec. 15. Two days later, she was placed under anesthesia, and Loren inserted an endoscope down her throat and into her small intestine.

Related Articles

• wikipedia: Photodynamic Therapy
• red face and photodynamic
• therapy (PDT)
• PDT shows promise for rosacea treatment
• be careful with Levulan (aminolevulinic acid)

When aminolevulinic acid (Levulan) is applied to the skin and it is activated by exposure to blue light or IPL, the treatment is called Photodynamic Therapy (PDT).

This study will assess whether using topical Levulan otherwise improves pulse dye laser treatment.

Further Reading ;

• PDT shows promise for rosacea treatment
• Photodynamic Therapy and ALA (ALA-PDT)
• Photodynamic Therapy works, but not by killing bacteria
• be careful with Levulan (aminolevulinic acid)
• pulse dye laser improves erythema
• pain, swelling and redness after pulse dye laser treatments
• pulsed dye laser and papulopustular rosacea
• 40 years of lasers in dermatology
• Lasers reduce `Substance P’ and PGP 9.5
• Is laser treatment right for your rosacea ?

Topical photodynamic therapy for treatment of facial erythema with acne
vulgaris, Eun Ju Hwang, MD, Modelo Clinic, Seoul, South Korea; Kyle Seo, MD, PhD, Modelo Clinic, Seoul, South Korea.

Background: PDT involves the application of a photosensitizing chemical which, when exposed to various lights, results in excitation of the photosensitizer and consequent production of a reactive oxygen species that leads to cytotoxicity. Although it is already being widely used for acne and epidermal cancers in practice, the treatment effects are not established for facial erythema including seboherric dermatitis, rosacea with acne vulgaris.

Objectives: Our study was designed to determine the effect for the treatment of facial erythema with seboherric dermatitis, rosacea.

Methods: Ten volunteers with moderate to severe facial erythema had been treated with the ALA (Levulan, DUSA, Wilmington, Mass) all over the face. An occlusive dressing followed all treatments. Two hours after ALA application, the face was irradiated for 40 ms with a fixed dose of 9 J/cm2 and 650-950 nm wavelength of IPL (Ellipse, DDD, Denmark). The effects were evaluated by clinical and chromometric examinations, H&E, Tunel staining.

Results: Rapid erythema improvements were seen in all facial erythema with variable causes including seboherric dermatitis, rosacea. In addition, acne counts were decreased significantly. More intense erythema was noted within 3 days especially in patients with erythema as opposed to those without it. In H&E and Tunel staining, there were epidermal necrosis and regeneration. Sebaceous gland were also degenerated after PDT.

Conclusion: This study demonstrated that ALA-PDT showed an excellent efficacy for the treatment of facial erythema with variable causes. These data supported the hypothesis that destruction of vessels and anti-inflammatory actions in ALA-PDT seem to cause improvement of facial erythema.

Commercial support: None identified.

Poster Abstract P3113, American Academy of Dermatology, 65th Annual Meeting February 2-6, 2007, Washington, DC. Published in Journal of the American Academy of Dermatology Volume 56, Number 2.

Further Reading:

• Photodynamic Therapy and ALA (ALA-PDT)
• photodynamic therapy for rhinophyma
• Photodynamic Therapy works, but not by killing bacteria
• PDT shows promise for rosacea treatment
• be careful with Levulan (aminolevulinic acid)
• Measuring Erythema (red face) after IPL
• IPL is excellent for rosacea
• treating rosacea with intense pulsed light (IPL)
• IPL Technology Primer (incl. Lumenis One)
• ktp laser good for red face and facial vessels
• eucerin good for rosacea & red face

The bacterial flora of the skin surface following routine MAL-PDT, J Dermatolog Treat. 2006;17(4):222-3. Bryld LE, Jemec GB.

Photodynamic therapy using methylated 5-aminolevulate (MAL-PDT) appears to have an effect on non-neoplastic skin diseases, for example acne vulgaris and rosacea, for which antibiotics are sometimes used, and a possible antibiotic effect of PDT has previously been suggested. It does, however, also cause local immunosuppression and post-treatment barrier defects, which may promote infection. At the same time, PDT-induced therapeutic skin damage is sometimes confused with secondary bacterial infection by non-dermatologists. The possible changes in bacterial flora associated with MAL-PDT were therefore studied in 47 patients undergoing treatment. Skin swabs were taken immediately before applying the MAL and instantly after light irradiation. Bacterial growth was identified in 18 cases. No statistically significant changes were seen, either in the specific species found or the estimated bacterial density on the skin surface. The observations do not support the notion that routine MAL-PDT affects the bacterial flora of the skin in a clinically significant manner. Therefore, the possible antibacterial effect of routine MAL-PDT is probably not the main explanation of its apparent effect on non-neoplastic skin disease

• Rosacea News: Rosacea, light and phototherapy
• Rosacea News: photodynamic therapy for rhinophyma
• Rosacea News: PDT shows promise for rosacea treatment
• Rosacea News: Photodynamic Therapy and ALA (ALA-PDT)
• Rosacea News: be careful with Levulan (aminolevulinic acid)

Journal of Drugs in Dermatology, 2006 Feb;5(2 Suppl):6-8

Authors: Katz B, Patel V

We report a case of a 45-year-old woman who presented with facial erythema, papules, pustules, and severe flushing consistent with rosacea. The patient had failed standard pharmacologic treatments. The patient’s flushing was so severe that she had undergone an elective sympathectomy. She received 6 sessions of photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA as Levulan Kerastick, Dusa Pharmaceuticals) given at 2-week intervals. Improvement was evident after the second treatment and was considered “excellent” after the sixth treatment. Improvement continued and no flares were observed 1 month after the final treatment.

• PubMed Extract

Nestor MS, Gold MH, Kauvar AN, Taub AF, Geronemus RG, Ritvo EC, Goldman MP, Gilbert DJ, Richey DF, Alster TS, Anderson RR, Bank DE, Carruthers A, Carruthers J, Goldberg DJ, Hanke CW, Lowe NJ, Pariser DM, Rigel DS, Robins P, Spencer JM, Zelickson BD.

Journal of Drugs in Dermatology, 2006 Feb;5(2):140-54

Authors: Nestor MS, Gold MH, Kauvar AN, Taub AF, Geronemus RG, Ritvo EC, Goldman MP, Gilbert DJ, Richey DF, Alster TS, Anderson RR, Bank DE, Carruthers A, Carruthers J, Goldberg DJ, Hanke CW, Lowe NJ, Pariser DM, Rigel DS, Robins P, Spencer JM, Zelickson BD

Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.

• PubMed Extract

• photodynamic therapy for rhinophyma
• Photodynamic Therapy and ALA (ALA-PDT)
• Rosacea News: be careful with Levulan (aminolevulinic acid)

Quote From: Levulan (was IPL resource page).

Hi Eric,Although there’s nothing about Levulan in the RSRP as yet, there is a lot about it in the RS archives.

When aminolevulinic acid (Levulan) is applied to the skin and it is activated by exposure to blue light or IPL, the treatment is called Photodynamic Therapy (PDT). Basically, it’s an acne treatment that might help some of those suffering from pustular rosacea and/or rhinophyma, but is probably not a good choice for the flushers.

To get an idea of whether or not it is likely to work for your symptoms, I’ll give you a little run through the archives, but please note that I’ve never personally tried Levulan.

Bridget Jones, the English rose who graces us with her presence occasionally, posted an interesting press release about PDT and rosacea a couple of years ago:

RSG Message 57116.

The group had just started to get excited about PDT as a possible wonder cure for fighting pustular rosacea, excessive oil production and rhinophyma when we were informed that one clinic was no longer offering this service because “most clients did not have good results.”

RSG Message 60202.

However, some RS members tried it anyway. A few reported successes, but probably more were dissatisfied. Abe (“ab60472″) said it had made his skin “10x worse with constant red and papules” & “Levulan damaged my skin and it has taken me a year and thousands of dollars to reverse it. Please, don’t anyone go near this stuff. It’s comparable to glycolic acid on rosacea skin, possibly worse, in my opinion. I have been in contact with another member of this board who also had skin damage from it.”

RSG Message 72508.

RSG Message 76099.

Karen (“karenkc101″) “The first set of IPL/Levulan wrecked my skin. Stay away from Levulan – it’s evil!! (at least for rosacea skin).”

RSG Message 76255.

Sue (“cyberpaint04″) was unsure of the initial results: “It’s quite a bit more harsh than ipl alone. My treatment was levulan followed by blue light then ipl, all the same session. I did not have a positive result from using levulan (3x), unless some results show up months later… I have had reduction in burning sensations, but don’t know the exact cause, could have been levulan, the ipl, or temporary reduction in hot flashes. Also you need to be aware that levulan is NOT APPROVED for any use other than actinic keratosis. Anything else is experimental, though many derms are using it, I don’t think definitive studies have been done or at least completed. Also, acne and papules can get worse because of this treatment (hopefully temporarily).”

RSG Message 67726.

It would be helpful to hear back from anyone who has been treated with Levulan, so we can know what you thought of it in the long run.

Kind regards,
Aurelia

• Original Message: Levulan (was IPL resource page)

Related Articles

• Photodynamic Therapy and ALA (ALA-PDT)
• photodynamic therapy for rhinophyma
• PDT shows promise for rosacea treatment

Pubmed lists this paper, but it requires a bit more digging to find any more information.

Photodynamic therapy for rhinophyma, J Dermatol. 2004 Sep;31(9):771-2.

It turns out that this paper is a Letter to the Editor, so is unlikely to be as promising as hoped. `J Dermatol’ is The Journal of Dermatology from the Japanese Dermatological Association. The journal lists

key words: topical application; Aminolevulinic Acid, ALA; edema reduction, Photosensitizing Agents, rhinophyma

http://www.dermatol.or.jp/Journal/JD/2004/031090771.html

Reprint requests to:
Noriko Amari, M.D.,
Department of Dermatology,
Teikyo University Mizonokuchi Hospital,
3-8-3 Mizonokuchi, Takatsu,
Kawasaki 213-8507,
Japan.

See also from 2002. Photodynamic Therapy for the Dermatologist

Related Articles

• treating rhinophyma with x-rays
• rhinophyma myths: alcohol and cancer
• rhinophyma: dual mode erbium YAG
• rhinophyma: Erbium YAG + CO2 laser
• latest rhinophyma treatment: microdebrider + floseal

The Ever-Increasing Role of ALA-PDT, Part 2

The topical application of 5-amino-levulinic acid (ALA) and exposure to a variety of lasers and light sources and photodynamic therapy (PDT), has become a very popular dermatologic procedure for a variety of clinical concerns affecting our patients. Presently, 20% 5-aminolevulinic acid (Levulan) is the only FDA-approved formulation.ALA-PDT is fast becoming a standard treatment for photorejuvenation with and without actinic keratoses (AKs), acne vulgaris, rosacea, sebaceous gland hyperplasia and hidradenitis suppurativa.

See also

• The Ever-Increasing Role of ALA-PDT, Part 1 of 2

Related Articles

• PDT shows promise for rosacea treatment
• be careful with Levulan (aminolevulinic acid)
• photodynamic therapy for rhinophyma