PDT for Sunspots
- Best Results1-2 sessions
- Treatment Recovery3-6 days
- Procedure Time15-40 minutes
- Skin SpecialistDermatologist
- Duration of Results2-6+ years
- AnaestheticLocal, sedation
- Back to Work3-7 days
- CostFree (DVA)- $$
PDT for Sunspots
PDT, also known as PDT for Sunspots therapy, is one of the best treatments for actinic keratosis. This treatment uses a chemical known as a photosensitiser & a light source. The photosensitive topical is preferentially concentrated in abnormal skin cells. Light sources include lasers, LEDs or day light. PDT has a much shorter downtime compared to Efudix or Aldara.
FactsFacts on PDT for Sunspots
- PDT is one of most effective methods to treat solar keratosis & sun damage
- Efficacy ranges from 60 to 90+% with just one treatment
- Laser assisted PDT has the highest efficacy
- Downtime is much less compared to traditional solar keratosis treatments
- PDT can be employed to treat sunspots as well as superficial skin cancers
- Light sources include red & blue LEDs, vascular lasers, as well as solar spectrum
What types of skin conditions are treatable with PDT for Sunspots?
In the context of skin cancer & skin cancer prevention, lesions that can respond to PDT include-
- Solar keratosis or actinic keratosis, non-pigmented, non-hyperkeratotic.
- Superficial basal cell cancer.
- Thin intraepidermal cancers including Bowen disease.
PDT has been used on many other skin conditions including erosive pustular dermatosis, sebaceous hyperplasia, adjunctive therapy to nodular BCCs in low risk areas, recalcitrant rosacea, & acne. Further information in relevant sections on this website.
What is daylight PDT?
This uses natural sunlight to activate the ALA or mALA. This cuts down in-clinic time & pain associated with illumination. Your dermatologist will give you a guide as to how to perform this procedure. Refer to the section on daylight PDT for application instructions.
What is laser assisted PDT & is it better than normal PDT?
Laser assisted PDT has the highest clearance rates of solar keratosis. The use of fractional CO2 assisted short contact ALA *(30 minutes) with blue light activation resulted in a clearance of 89% of solar keratosis.
- CO2 fractional laser with red light activation or daylight activation
- Erbium fractional laser with red/blue/ daylight activation
- Non-ablative lasers such as Fraxel, 1927, 1940, 1440, 1550 with ALA
*3-month follow-up
**Short contact PDT is thought to be mediated with intracellular mechanisms, possibly mitochondrial & not via the absorption of ALA by dysplastic (abnormal) keratinocytes.
What is vascular laser PDT?
This treatment uses a vascular laser to activate porphyrins (photosensitiser). I did use this method over a decade ago to treat both sun damage & broken capillaries, followed by conventional illumination. The downside of this treatment is discomfort to the patient.
Studies have confirmed that using lasers in the wavelength of 585 to 595 nm is not as effective as illumination with daylight or a lamp (typically with lasers we deliver between 12 to 18 mj, compared to 37 mj with a lamp). Modification of this technique includes pre-treatment with vascular then daylight PDT.
View our Treatment Gallery
How does PDT compare with Efudix or Aldara?
All three are excellent ways to treat solar keratosis or actinic keratosis. PDT has the fastest recovery of 3-6 days. Efudix has a recovery time of 4 weeks, whilst Aldara takes 6-10 weeks (depending on your regime).
If cost is a factor (excluding time off work), Efudix is cheap & nasty, but it does work.
If photo rejuvenation & reduction of sun damage is the aim, high density fractional laser (with or without PDT) is the best.
What is the recovery following PDT?
About 3-7 days, depending on your skin’s sensitivity, the preparation, method of illumination, & burden of solar dysplasia (abnormal lesions). Your dermatologist will guide you through the recovery process, & may give you anti-inflammatory medications to speed up recovery.
Patients with sensitive skin including rosacea may experience a flare up. Vascular lasers post PDT can settle down any flare ups. In this group, I prefer high density fractional lasers. You must sun protect for one week following PDT.
Is PDT painful?
Yup, it can be, especially if traditional illumination is performed. Therefore, most dermatologists nationally & internationally perform dPDT or daylight PDT.
To alleviate pain your dermatologist may –
- Give you gas such as nitrous oxide
- Perform a ring block or local anesthetic
- Provide cooling with a Zimmer or cryo
- Give you pain relief such as Endone, or another opiate
- Give your breaks during illumination (typically 7 minutes 30 seconds)
- Do nothing
Evidence states that daylight PDT is equally as effective as traditional PDT. Be guided by your dermatologists as their view may differ according to what (or if) they read journal articles. My personal viewpoint is that in-clinic PDT is more effective.
What is the downside of photodynamic therapy?
3 main disadvantages of PDT.
- Inability to treat pigmented solar keratosis (brown sunspots). This is because melanin blocks transmission of light. If you have a higher percentage of pigmented actinic keratosis, PDT is not recommended. There are ways around this- 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. mALA costs more than ALA. Add to this nursing time & PDT ranges between $450 to $2490.
- 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.
Though effective, I prefer to use small spot lasers at 90%+ density to treat sunspots & actinic keratosis. Lasers give excellent outcomes.
What are the side effects of PDT?
Firstly, we need to define side effects as unexpected outcomes following PDT. Redness, swelling, discomfort 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.
Will photodynamic therapy treat all sunspots?
No. All field treatments will have a failure rate. There are no treatments that can address all sunspots with absolute certainty. We work on a percentage gain or clearance. As a guide, photodynamic therapy has one of the highest clearances of field cancerization, approaching 80-85%. This means if you have 100 sunspots, PDT will not treat 10 to 15 spots.
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.
What is the meaning of combination field treatments for sun spots?
The current literature supports the use of combination therapy for sunspots. Examples include Aldara, or Efudix following field treatments such as PDT, laser assisted PDT & fractional laser resurfacing.
An example is twice a week application of Aldara for a total of 12 weeks to isolated solar keratosis, starting 4 weeks after laser assisted PDT. Efudix can be employed in a similar manner.
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.
What are other methods to treat solar keratosis?
The expense of PDT may not sit well with your budget as field treatments start from $1590. Other more cost-effective solutions include-
- High density thulium laser.
- Aldara.
- Efudix.
- Chemical peels.
- Solaraze
Davin’s Viewpoint on PDT for actinic keratosis
I have been using this procedure for nearly two decades, initially with normal PDT, namely illumination with the Galderma red light with 37j/cm squared, time of seven & a half minutes. A decade ago I started using laser assisted PDT, namely with an erbium laser, either as a micropeel (ten microns) or moderate density fractional at around 30%, 20-50 microns deep.
Fast forward to 2022, the majority of dermatologists are now using very superficial lasers, primarily CO2 at around 6 to 10 mj in a higher density. This reduces pain, & importantly increases the efficacy of PDT. Additionally, daylight is the preferred light source to illuminate aminolevulinic acid. Laser assisted PDT has other benefits including reducing the number of pigmented solar keratosis as well as hypertrophic SKs to enhance penetration of ALA. In my practice, my most frequent laser combination is with either 1927 thulium or CO2 laser. The former is used for aggressive solar damage as I spit the intervals over 2-4 weeks. With CO2, PDT is conducted after high pass, low joule setting. Illumination is either daylight or low-level laser emitting diodes in a clinic. Thinking about Efudix?
