- Best Results1-2 sessions
- Treatment Recovery3-5 days
- Procedure TimeVariable
- Skin SpecialistDr Davin Lim
- Duration of Results2-5+ years
- AnaestheticNil required
- Back to Work2-6 days
- Cost$$
Daylight PDT For Sunspots
Daylight PDT uses the solar spectrum to activate a chemical called aminolevulinic acid. This chemical is preferentially concentrated in dysplastic or abnormal cells. A chemical reaction with visible light creates a chain reaction that destroys cancerous & precancerous cells. Daylight PDT is equally as effective as LED PDT, however it is much less painful. Laser assisted delivery can improve the outcomes of PDT.
FactsFacts on Daylight PDT
- PDT is a combination of a photoactive chemical with a light source
- The blue & red spectrum of light starts the chemical reaction
- The chemical reaction destroys abnormal & pre-cancerous cells
- Light delivery can be with a LED device, a laser, or simple daylight
- Daylight PDT uses the solar spectrum as a natural light source
- Daylight PDT is as effective as LED illumination
- Daylight PDT is much less painful than LED illumination
What is daylight PDT?
This form of PDT uses the solar spectrum, namely blue & red light to active chemicals called porphyrins. Porphyrins are selectively concentrated in abnormal skin cells known as solar keratosis.
What type of skin cancer does PDT treat?
PDT is a highly effective treatment for solar keratosis (actinic keratosis), superficial BCCs & in-situ SCCs known as Intraepithelial carcinoma or Bowen disease.
In the context of daylight activation, most dermatologists use this activation method for treating large areas of sun damage, namely solar keratosis.
How does daylight PDT compare with normal PDT?
Daylight PDT has a similar efficacy of clearing sunspots compared to in-office PDT, namely 70%-90+% efficacy. Daylight PDT has many advantages over traditional PDT, including less pain, & the convenience of doing this procedure at home.
*Some patients may require in-office preparation, especially to hypertrophic or raised/thick areas of solar keratosis.
How to perform daylight PDT?
Application will differ slightly depending on your treating dermatologist. Here is my protocol-
Application area will be described during your consultation. Refer to the photos I have taken on your phone. Pick a time in the morning or in the late afternoon to complete your treatment.
- Scrub area with gauze provided.
- Apply Metvix that I have provided to the areas. Thin coat.
- Sit in the shade (not direct sunlight). Give 2 hours for the chemical to be fully activated.
- You can take toilet breaks as required.
- Wash off the remaining Metvix after the procedure.
- You may be sun sensitive for 48 to 96 hours post PDT.
Your dermatologist may ask you to apply sunscreen pre-treatment. Sunscreen protects against UVB & UVA, & not visible blue & red lights. For my protocol, you do not need to apply sunscreen. Opaque sunscreen with physical blockers may, in some cases reduce visible light transmission via reflectance.
View our Treatment Gallery
What is the recovery following daylight PDT?
Typically, 3 to 6 days, +/- 48 hours. Faster recovery in patients with mild sun damage, longer recovery (including prolonged redness) if photodamage-sun damage is severe & or patients have sensitive skin, including rosacea.
I will discuss downtime in detail, following a clinical examination.
Is daylight PDT painful?
You will experience some mild discomfort, namely tingling & slight burning during the treatment. The pain scale should not be more than 2-3 out of 10. Post procedure you may have sun sensitivity of 3-4 days (exposure causes burning).
Off label thulium 1927, one session only. 20mj 22 passes to achieve 92% coverage
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🔫Laser: Fraxel 1927 in HD or high density settings. At 92% it is still non-ablative
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👍🏻The wavelength, even with the less ‘powerful’ diode cf. thulium is pretty special. Just finished comparing histology with the 1940 & low & behold it is around 200 microns across the board .. from 3 different laser companies. The dermal remodeling from such superficial penetration is so much more than bulk heating, probably related to cytokine release we have yet to fully understand, same goes to the non selective effects this wavelength has on the vessels 😱😱😱
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
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#laserdermatologist #fraxel #fraxeldual #thuliumlaser #laserresurfacing #fractionallaser #laseMd #fraxpro #laserrejuvenation #skinscience
TCA peels are a simple way to rejuvenate skin. This picture is over a decade old, but I still enjoy peels over lasers (more tactile). It’ much like driving a older vintage car, it’s slower to get to your destination but the drive is more enjoyable🚘
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🔬Skin science: TCA can be applied as a superficial, medium (most common) & deep peel. In this case I employed it as a medium depth peel, to the upper papillary dermis. In some cases I combine it with Jessner for deeper penetration
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👉Downtime: 5- 8 days depending on the strength and coats
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😢Pain: Tolerable with topical application of numbing and skin cooling. I do give oral conscious sedation if deeper peeling
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👍🏻Good for: Skin type 1-2+, pigment, freckles, sun damage, solar keratosis, mild to moderate wrinkles, lentigos/ age spots
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👎🏼Not good for: Darker skin, deep wrinkles, melasma
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#chemcialpeels #TCApeel #jessner #jessnerTCA #skinrejuvenation #skinlightening #skinbrightening #davinlim #dermatology #skinscience
How does PDT compare to other types of sunspot treatments?
PDT compares favourably with creams. Studies have shown that PDT, in particular laser assisted PDT with daylight, gives the highest clearance rates of any actinic keratosis treatment. As a guide-
Efudex: Clearance rate of up to 85%
Aldara: Clearance rate of 80%
Solaraze: Dismal at 25-35%
What is laser assisted photodynamic phototherapy?
This treatment uses a laser to enhance penetration of methyl ALA or ALA. I employ 2 types of lasers for this job, namely a thulium laser & a CO2 short pulse duration fractional laser. For patients with mild to moderate sun damage, high density thulium lasers will clear approximately 80% of sunspots. For severe photodamage, I combine ALA with either thulium or CO2.
The decision to use lasers will be based upon your clinical examination & history.
What are the advantages of daylight photodynamic therapy?
Daylight PDT delivered with fractional lasers have the highest clearance rate of 90-95%. A main advantage of PDT is the single application of cream, with a downtime of 5 to 6 days. Topicals such as Efudix are associated with 3-5 weeks downtime.
What is the downside of daylight photodynamic therapy?
Daylight PDT has several disadvantages, including-
- Inability to treat pigmented solar keratosis (brown sunspots). This is because melanin blocks transmission of light. If you have a higher percentage of pigmented sun spots your dermatologist may perform a superficial curette prior to ALA application.
- Costs. Depending on whether you get this done by a GP with an ‘interest’ in skin or a dermatologist. It also depends on the area treated & type of ALA.
- Limited photo rejuvenation. Unlike lasers, PDT does not address brown spots including solar keratosis, lentigos, seborrheic warts. Lasers address all of the above. A way around this is to combine superficial lasers with PDT. Be guided by your dermatologist.
- Limited control over exposure. In office PDT nukes your skin in 7 minutes 30 second, regardless of cloud cover. Daylight PDT is dependent on the weather.
What are the side effects of daylight photodynamic therapy?
Firstly, we need to define side effects as unexpected outcomes following PDT. Redness, swelling, inducing burning & skin recovery up to one week are not side effects, they are part of the healing process. Side effects include-
- Acute pustular reaction. Sterile neutrophilic reaction is seen in 5-15% of patients.
- Infection including cold sore virus.
- Prolonged redness & recovery, persistent erythema & rosacea.
In general daylight PDT has less inflammation than in-clinic PDT- think of daylight as slow cooking a roast, compared to turning up the oven for in-clinic treatment.
Does PDT prevent skin cancer?
If you view the numbers game, PDT does reduce skin cancer as it treats solar keratosis. Approximately 1 to 20% of solar keratosis transforms into skin cancer (in reality it’s much less than 3%). Hence by decreasing the burden, it will reduce the risks of certain types of cancer.
Another way to view PDT is that it ‘mows down the grass’ to see what lies underneath. This increases the pick-up rate for other skin cancers.
Will PDT clear up all my sunspots & actinic keratosis?
No. All field treatments will have a failure rate. There are no treatments that can address all sunspots with absolute certainty. The highest cure rate for severe sun damage (field cancerization) is with radiotherapy.
PDT has one of the highest clearance approaches 80-85%. Your dermatologist may elect to treat the remaining solar keratosis with liquid nitrogen, Aldara or pulsed Efudix, or they may take a biopsy to exclude underlying cancer.
Higher recurrence is seen in elderly patients, immune suppression & marked field changes.
What are other options for treating solar keratosis?
Be guided by your dermatologist, as some may not have access to lasers or PDT. Treatment options include-
- Efudix: great treatment. Bang for your bucks. 3–6-week recovery.
- Aldara: good treatment, 6-12 weeks. Cost effective.
- Solaraze: crap treatment, 8-12 weeks. Cost effective
- Glycolic peels: cost effective. 5-7 sessions.
- Jessner TCA: excellent treatment, one session. 8+ days recovery.
- Ablative laser: excellent treatment, one session, 10+ days recovery
Is PDT covered by Medicare?
No. PDT & other sunspot treatments are not covered under Medicare. Some health insurance companies cover a nominal amount (between 50 to 150 dollars).
The Department Of Veteran affairs or DVA covers PDT if you hold a white card or gold card. Some overseas insurance companies like BUPA International cover more.
Davin’s viewpoint on daylight PDT
This is my preferred application method of PDT as the scientific literature reflects the efficacy. Laser assistance using fractional resurfacing gives the highest clearance rates – typically over 90% with one treatment. Depending on the severity of sun damage, I may elect to use either a thulium 1927 or fractional CO2.
Laser delivery has several advantages. Firstly, increased absorption of aminolevulinic acid. Studies have shown that the optimal depth of laser penetration is actually very shallow, namely only a fifth of the thickness of epidermis. Hence lasers are used to just penetrate the cornified layer of the stratum corneum. There are many papers pointing out the short contact, laser delivered PDT gives just as good results compared to long contact, dispelling the current trend of long incubation periods.
As with all sunspots treatments, prevention of further solar keratosis post PDT is advisable. The foundation of management is with high factor SPF 50+ sunscreens. High risk patients are followed up by dermatologists who may employ retinoids, either orally or topically. Niacinamide or vitamin B3 at a dose of 500mg twice daily can reduce solar keratosis by as much as 35%.
My most common prescriptions include pulsed 5FU once to twice a week, retinoic acid peels every 2-3 months, or AHA (glycolic acid) in a step up 20-70% routine. Occasionally I get patients to spot apply Metvix to areas of solar dysplasia in between follow ups.
