Photodynamic Therapies

Photodynamic Therapy is effective and safe for treating:

• Actinic Keratosis (Solar Keratosis)
• Superficial Basal Cell Carcinomas
• Early stages of Squamous Cell Carcinoma, referred to as Bowen Disease or Squamous Cell Cancer in situ/IEC Cancer

Sunspots, Solar Keratosis, Actinic Keratosis

• PDT has a clearance rate of approximately 80% with remissions lasting from 6-18 months. Dr Fang combines Laser (Fractional resurfacing) to increase the clearance rates.

Superficial Skin Cancers

• Two sessions of PDT offer a remission rate of 60-85%, in some cases, Dr Fang will surgically scrap the lesion prior to achieve higher clearance rate.

1. Initially, the skin may be pre-treated (eg. scraped or needled)
2. A photosensitising drug will be applied to the lesion.
3. A waiting period (~2 hours) for the drug to concentrate in the cancer cells.
4. The area will then be exposed to a specific light source.
5. Finally, the treated area reacts similarly to a sunburn and heals within 5-7 days.

Before PDT

• Recent evidence suggests that using high-dose oral vitamin D for 7 days before the treatment may enhance the effectiveness of topical PDT.
• Creams like urea or salicylic acid can be used for a week to remove thickened skin and help the drug penetrate better

Application

• Your skin will be cleaned and prepped. Some thickened lesions may be scrapped. 
• Photosensitising agent (Aminolevulinic acid) is applied to the affected area.

Incubation

• The photosensitising agent will concentrate in the cancer cells, it usually takes 1 to 3 hours.

Activation

• • A laser or non-laser light is directed onto the treated area.
  • The treatment lasts for a certain duration, typically 20-30 minutes with artificial light or 2 hours with daylight.

• Shorter Downtime
  PDT typically requires just a single session. The recovery time averages between 5-7 days. This is significantly less than the 3-4 weeks for Efudix treatment and 4-8 weeks for Aldara treatment.
• Efficiency
  - Sunspots and solar keratosis: 1 PDT session is usually sufficient.
  - Superficial Basal Cell Carcinoma and IECs: 2 PDT sessions may be necessary, with a flexible scheduling range of 1 to 10 weeks apart.
• Versatile Follow-up
  For any residual areas: options include treatment with lasers, liquid nitrogen, or a second course of PDT.

Clearance Rates

PDT and Efudix have similar effectiveness for treating solar
keratosis, with clearance rates above 75%. Laser-assisted PDT can achieve even
higher clearance rates, around 85%.
Recovery Time: PDT boasts the quickest recovery period, approximately 6 days,
compared to Efudix which has a 4-week recovery timeframe.

1. Patients might need to avoid certain medications and supplements that could affect
   sensitivity to light.
   Antibiotics: Particularly fluoroquinolones (eg. ciprofloxacin) and tetracyclines (eg. doxycycline).
2. Non-steroidal Anti-inflammatory Drugs (NSAIDs): Such as naproxen and ibuprofen.
3. Diuretics: For example, hydrochlorothiazide and furosemide, which are used to treat high blood pressure and edema.
4. Psychiatric Medications: Certain antidepressants, including some tricyclic antidepressants (e.g. amitriptyline) and antipsychotics.
5. Antifungals: Such as voriconazole and itraconazole.
6. Chemotherapy Drugs: For instance, dacarbazine and fluorouracil.
7. Heart Medications: Including amiodarone, which is used for certain types of Irregular heartbeats.
8. Supplements: St. John’s Wort is particularly known for increasing photosensitivity.
9. Retinoids: Including acitretin and isotretinoin, used for psoriasis and severe acne, respectively.
10. Sulfonylureas: Oral hypoglycemic agents like glimepiride, used in diabetes management.

Side effects include light sensitivity lasting about 24 hours, burning/stinging sensations, swelling, redness, crusting, itchiness, peeling, blisters, and potential skin infections. The treated area must be protected from light to manage photosensitivity. While scarring is generally minimal, there is a risk of pigmentation loss which can sometimes be permanent.

Side effects may include -

• Burning/stinging sensation
• Swelling and redness
• Crusting
• Itchiness
• Peeling and blisters
• Skin infections.

The treated skin lesion may blister and ulcerate as the cancer cells die off. This may take 1-2 weeks to heal. The treated area must be protected from light to manage photosensitivity. While scarring is generally minimal, there is a risk of pigmentation loss which can sometimes be permanent.

Depending on the type of lesion being treated and the photosensitising chemical used, a 2nd cycle of treatment may be given 7–10 days later.

The cost varies depending on the number of treatments and the area.

General guideline:
$450 per lesion for BCC or IEC treatments. (Includes 2 treatments) 
$600 per area for treating solar keratosis.

Note: PDT is not covered under Medicare. Private health insurance only covers the prescription topical Aminolevulinic acid not the treatment.