Photodynamic Therapy - Art of Skin

Photodynamic Therapy

What is Ameluz Photodynamic Therapy?
Ameluz is a cutting-edge topical prescription medication used in photodynamic therapy to treat actinic keratosis, a common precancerous skin condition caused by sun damage. This innovative therapy involves the application of Ameluz cream to the affected skin areas, followed by exposure to a specialized light source. The combination of Ameluz and light activation provides targeted treatment for actinic keratosis, supporting effective and precise skin rejuvenation.

Benefits of Ameluz Photodynamic Therapy:
– Precision: Ameluz photodynamic therapy targets affected areas with exceptional accuracy, minimizing impact on surrounding healthy skin.
– Efficacy: The specific interaction between Ameluz and light therapy promotes the elimination of actinic keratosis, supporting skin health and renewal.
– Minimally Invasive: Compared to more aggressive procedures, Ameluz photodynamic therapy offers a minimally invasive approach with favorable cosmetic outcomes.
– Convenience: The application of Ameluz cream and light activation can typically be completed within a single office visit, making it a convenient treatment option.

Ameluz Photodynamic Therapy Procedure:
The procedure begins with the application of Ameluz cream to the targeted areas of the skin. Following a designated incubation period, the treated areas are exposed to a specific wavelength of light, activating the therapeutic effects of the medication. The precise deployment of light energy enhances the interaction with Ameluz, initiating the desired skin rejuvenation process.

Post-Treatment Care:
After Ameluz photodynamic therapy, patients may experience temporary skin redness and sensitivity. It is essential to follow post-treatment care instructions provided by the healthcare provider to ensure optimal healing and recovery. This may include guidance on skincare products, sun protection, and any specific measures to support the skin during the rejuvenation process.

Experience the Transformative Power of Ameluz Photodynamic Therapy:
Discover the remarkable benefits of Ameluz photodynamic therapy for effective and targeted treatment of actinic keratosis. Our expert team is dedicated to providing advanced skincare solutions, delivering exceptional results with a focus on patient comfort and satisfaction.

Photodynamic Therapy (PDT) consists of a topical application of Ameluz (aminolevulinic acid) and a light source, such as red-light. Ameluz is a substance that occurs naturally in the body in small amounts. Ameluz is absorbed into actinic keratosis (pre-cancerous cells), sebaceous (oil) glands, melanin, and small blood vessels and when absorbed is converted into a photosensitizer known as protoporphyrin. Certain lasers and lights activate the protoporphyrins leading to selective destruction of the pre-cancerous cells and reduction in sebaceous glands, melanin, and small blood vessels. Some patients will improve after just one treatment, but most patients may need up to 3 treatments to improve severe acne, rosacea, or actinic keratoses. Treatment sessions are performed at 1-month intervals.Most patients require 2-3 treatments for total clearance of the precancerous lesions. Doing more than 3 treatments can result in continued improvement. Periodic treatments every 1 to 3 years can maintain your results.

What else does PDT Treat?

1) Actinic Keratoses: Actinic keratosis (AK) is a common premalignant skin condition and can appear as rough, scaly pink spots on the skin. The concern for untreated AKs is their rate of transformation to cutaneous squamous cell carcinoma (SCC), a type of skin cancer. Individual or a small number of AKs can be treated locally with procedures such as liquid nitrogen or curettage. Treatments aimed at treating the entire area, known as “field therapy,” may be more appropriate when multiple lesions are identified. PDT is a type of field therapy. Many insurance companies pay for the Ameluz medication and sometimes red-light therapy. A prior approval process may be needed prior to your procedure.

2) Photoaging The influence of long-term sun exposure along with the normal aging process can lead to increased brown spots, broken blood vessels, redness, roughness, and fine lines. These skin changes are collectively called photoaging. Many patients with AKs also find their skin also presents signs of photoaging. By adding intense pulsed light (IPL) treatment, we can alsoimprove many signs of photoaging. If PDT is performed for AK treatment and photoaging, there is an associated out-of-pocket cost to the patient for the additional usage of the IPL.

3) Acne Research shows that PDT reduces severe acne by up to 70% and clears complexion like few other procedures. PDT is not painful. We recommend 3 treatments spaced 3 to 4 weeks apart. The procedure works best for moderate to severe acne and removes cysts and red bumps better than it removes blackheads and whiteheads. For acne, photodynamic therapy is not often covered by insurance.

Preparation:

Please let us know:
- If you have a history of cold sores (Herpes simplex virus),
  - We will prescribe you a medication to help reduce the possibility of an outbreak following treatment.
  - Valtrex 500 mg 1 capsule 2 x per day 5 days before, 5 days after
- If you are pregnant or have contraindications such as Lupus, photodermatoses, porphyria, known allergies, or known hypersensitivity to Ameluz (includes soybean phosphatidylcholine), porphyrins, or PDT in the past.
- If you are on blood thinners (Asprin, NSAIDS, Warfarin, Coumadin)
- Please inform us if you are taking any of the following medications, as they may intensify your reaction and increase side effects:
  - St. John’s Wort , Griseofulvin,
  - Thiazide diuretics.
  - Sulfonamides (such as sulfamethoxazole/trimethoprim compounds like Bactrim or Septra).
  - Phenothiazines (anti-psychotic medications ending in “azine”).
  - Tetracyclines (including doxycycline, tetracycline, and minocycline).
  - Quinolones (including alidixic acid, ciprofloxacin, levofloxacin and moxifloxacin)

Please arrive with clean skin, ensuring the area is washed beforehand. Make sure the treatment area is free of makeup, moisturizers, sunscreens, perfumes, and lotions.
We recommend that you wear comfortable clothes to your appointments, or you can change into a gown if your chest is being treated. . If you tend to get chilled from air conditioning, bring a sweater or light jacket to wear while you are waiting for the cream to take effect. Bring a good book, iPad or Kindle is also recommended.
Pre-Treatment photos will be taken prior to application of the Amulez cream
Please ensure you bring the following items to your appointment and have them available at home for aftercare:
- For face and scalp treatments: Bring a wide-brimmed hat and sunglasses to cover the treated area (we can provide a hat if needed!).
- For neck, chest, or back treatments: Bring a scarf and clothing that can cover the treated area.
- For arm or leg treatments: Bring clothing that can fully cover the treated area (yes, even in the summer!).
- For hand treatments: Bring gloves and sleeves to cover your hands and wrists, especially for driving home!

Additionally, have the following items ready:
- A gentle cleanser like CeraVe, Cetaphil, or Vanicream, free of active ingredients and fragrances.
- A high-SPF sunblock (at least SPF 50) containing zinc oxide and/or titanium dioxide (Blue Lizard and Elta MD is our favorite!)
- A thick moisturizing cream such as CeraVe or Vanicream , without active ingredients or fragrances.
Men, if treating the face, please trim your facial hair short (or hair over the area to be treated). You do not need to shave all the way but if you choose to, you can do this at least one-two days prior (not the morning of to avoid irritation).
Stop using any topical tretinoin (Retin-A), Differin, Epiduo, and Tazorac three weeks before your PDT treatment. You can resume these medications once your skin is fully healed from treatment

What to expect:

Plan to spend approximately 1.5-2 hours inside our office (30-60 minutes for the AMELUZ gel to incubate and 10 minutes per area of active treatment – about 20 minutes treatment total). You can bring things to do during this time.
Alcohol will be applied to your skin which removes surface fats from your skin and thus allows the Ameluz medication to penetrate more efficiently. Your healthcare provider will select the amount of incubation time your Ameluz will remain on your skin; this is typically between 30- 120 minutes, depending on the condition(s) and area(s) to be treated.
During the treatment, you will sit in an exam chair, and we will place a protective covering over your eyes before shining the light on the pre-treated area.
Following this incubation period, the patient will sit under a red-light for approximately 20 minutes (10 minutes right side of face, 10 minutes left side of face) If treating scalp it’s a 10 minute red light session . Insurance only pays for one area per session. Either face, scalp, arms or chest per session.
You might experience itching, tingling, burning, or a warm feeling on your skin. We have a fan running to help alleviate any discomfort that may arise. The more damaged the skin, the more potential for discomfort. We will be there with you every step of the way to ensure the most comfortable experience possible.
After your treatment is complete, we will apply a thick layer of sunscreen on the area, you will put on your protective clothing, and go right home.
Redness, dryness, tenderness, peeling, inflammation, and mild discomfort can occur especially in the first week after treatment. If at any point you experience any severe pain or develop a fever, please let us know immediately!

Aftercare:

During the first 48 hours after treatment, it is imperative that you avoid sunlight as much as possible.
If your scalp or face was treated, you should try your best to stay indoors for the first 48 hours, apply sunscreen regardless of being indoors or outdoors (preferably with Zinc oxide – Blue Lizard is our favorite), and stay away from being directly next to windows and bright lamps indoors.
If other areas were treated (like the arms or legs) it is important you keep these covered with clothing if outdoors (even in the summer!) and apply the same sunscreen underneath, but you do not have to stay indoors.

DAY 1/Same day of treatment:

- Go straight home with your protective clothing and sunscreen on.
- Your skin can start to turn mildly pink to red and feel “hot” like a sunburn during this time.
- You can start applying ice packs a few times daily for the first 24 hours afterwards. This can help with any swelling that may occur.
  - If the face was treated, you can start to see swelling most noticeably around the eyes and/or lips.
- You should not wash your face for the first 24 hours. Afterwards you can use gentle, unscented cleanser like Cerave or Cetaphil the next day.
- You can apply your thick moisturizing cream (unscented and gentle Cerave/Cetaphil frequently to keep your skin hydrated. (Pro Tip! You can put the moisturizer in the fridge to aid in cooling!)
- Elevate your head while sleeping to help with any swelling.
You may take Tylenol as needed. NO NSAIDS! No Advil or ibuprofen, Aleve or naproxen, aspirin etc…

Day 2:

Continue avoiding sunlight, wear sunscreen, and remain indoors as much as possible hours 24-48. If you must go outside you need to wear your hat, sunglasses, clothing etc…
After the first 24 hours, your skin may begin to peel. There can be some crusting and oozing, this is normal. Some patients might have little to no redness or peeling, while others can have significant redness and peeling that can last 5-10 days. Keep your skin moisturized and DO NOT pick at the peeling to minimize risk of infection. The peeling areas will come off as your skin heals underneath. During this time you should not wear makeup, shave or rub your skin.
You can keep applying ice packs and use Tylenol as needed.
You can shower and continue to use your gentle cleanser and moisturizer.
Keep avoiding sunlight and apply your sunscreen!

Days 3 on:

Avoid direct sun exposure as your skin is healing especially over the next 2 weeks, and practice diligent sun protection EVERY DAY with at least SPF 30 (still a sunscreen that has zinc oxide, we love Blue Lizard).
Your discomfort should be minimized by day 3.
You can continue to peel for 7-10 days. Your skin can feel tight and/or dry so continue to moisturize!
Once your peeling and any crusting resolves, you can go back to shaving the area and wearing makeup. You can also go back to using your tretinoin.
Even after peeling your skin can remain pink while it is fully healing but should look more even and clear. Again, a reminder to continue wearing sunscreen every day.
Once you are fully healed, we recommend you still have a daily skincare regimen that includes daily sunscreen wear, even under makeup, to prevent new skin damage.

CALL US IF YOU:

Develop a fever of 100.4 °F (38 °C) or higher, with or without chills.
Experience symptoms that become intolerable or persist for more than two weeks.
Notice mild flu-like symptoms that worsen or do not resolve.
Suffer from increasing pain or pain that does not subside.
Observe blisters, open sores, scaling, or crusting in the treated area.
Have any questions or encounter any unexpected issues Call 845-485-5000 or
Email [email protected]

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