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Levulan© Photodynamic Therapy of Acne

Acne is a genetic, hormonal disease characterized by overproduction of oil by the sebaceous glands, plugging of the sebaceous glands to form micro- and macro- comedones (blackheads) and, finally, action of skin bacteria on oil trapped underneath the skin, to produce red inflammatory cystic lesions.

Traditional therapies for acne involve keralytic agents, such as the retinoids which thin the top layer of skin and unplug the oil glands, topical antiseptics and antibiotics which diminish the numbers of bacteria in the skin, and oral antibiotics which similarly diminish the bacteria.  More severe cases of acne can be treated with Accutane, which is a systemic retinoid.  All of these treatments have their benefits, but also have their limitations of being inconvenient, and occasionally toxic. 

There has been some interest and some research in photodynamic therapy of acne.  In photodynamic therapy a drug which is activated by light is applied to the skin.  After a certain period, the drug is then washed off and the skin is exposed to light.  That light energy causes the release of singlet oxygen molecules, which have the biologic effects of killing P.acnes, which is the bacteria responsible for acne.  The light also seems to cause involution of the sebaceous glands.  Treatment involves a several-step process, done in the office:

First, the skin is scrubbed off with acetone and then Levulan© is applied to the skin.  After a thirty minute waiting period, the Levulan is washed off and the skin is exposed to a light source which, in the case of acne, may be Blue light.  The skin is then carefully washed after the treatment.  It is important to guard against sun exposure for forty-eight hours after the treatment because some of the photodynamic agent may still be in the skin.  Some patients notice skin irritation for twenty-four to seventy-two hours; however, generally this treatment is well-tolerated.

Data at this point is anecdotal, however there have been some reports of excellent response to single treatments as well as a series of treatments.  Generally we are recommending treatment once a week for three to four weeks.

In summary, photodynamic therapy represents an entirely new modality of treating acne which seems to be well-tolerated.  It may, in fact, become extremely useful in treating mild to moderate, or even severe acne.

How does Photodynamic therapy (PDT) work?

In photodynamic therapy a photosensitizer is applied to the skin.  This is absorbed preferentially by certain structures in the skin, such as hair follicles, oil glands, bacteria, or rapidly growing cells.  Illumination with a high-intensity light or laser causes a reaction in the skin, resulting in destruction of the targeted tissue.

What types of conditions can be treated with PDT?

Photodynamic therapy has been effective in the treatment of actinic keratosis (pre-cancerous spots), sundamaged skin, acne, warts, and many other diseases.

How does PDT treat acne?

Photodynamic therapy seems to improve acne by decreasing the bacteria on the skin and by shrinking the oil-producing or sebaceous glands.

Is PDT uncomfortable?

During PDT the skin is washed several times and the activated substance is applied.  Either of these may cause stinging.  Following treatment there may be some transient itching and burning.


After PDT, a small amount of activated substance remains in the skin for 24 to 48 hours.  Sunlight and even indoor light may affect this and cause redness and itching.  Use of sunscreen and a hat may diminish the undesired effects.


Most people experience mild burning or itching for about one hour after the procedure, although this can last a day or two.  Mild to moderate redness may be experienced for 24 to 48 hours.  Only gentle emollients should be applied to the skin.


Areas most likely to swell are around the eyes.  This will subside within several hours.  Application of ice or cold packs may help.


Peeling of treated skin may occur several days after the procedure and can be alleviated by gentle washing and application of a slightly thicker moisturizer.

Please let us know if any of these side effects seem severe or cause significant discomfort.


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