Photodynamic Therapy

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.

Once the local anaesthetic has worn off you may find that there is a mild discomfort. This is usually helped by taking Paracetamol. Follow the instructions on the packet.

Please do not take Ibuprofen or Aspirin because this can increase the risk of bleeding.

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

You 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.
2. Antibiotics: Particularly fluoroquinolones (eg. ciprofloxacin) and tetracyclines (eg. doxycycline).
3. Non-steroidal Anti-inflammatory Drugs (NSAIDs): Such as naproxen and ibuprofen.
4. Diuretics: For example, hydrochlorothiazide and furosemide, which are used to treat high blood pressure and edema.
5. Psychiatric Medications: Certain antidepressants, including some tricyclic antidepressants (e.g. amitriptyline) and antipsychotics.
6. Antifungals: Such as voriconazole and itraconazole.
7. Chemotherapy Drugs: For instance, dacarbazine and fluorouracil.
8. Heart Medications: Including amiodarone, which is used for certain types of Irregular heartbeats.
9. Supplements: St. John’s Wort is particularly known for increasing photosensitivity.
10. Retinoids: Including acitretin and isotretinoin, used for psoriasis and severe acne, respectively.
11. 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.

Post-treatment, the area should be kept covered to protect it from light. Any discomfort can often be managed with over-the-counter pain relief.

Patients are advised to follow specific aftercare instructions to support healing. This includes prescription topical anti-inflammatory cream and/or prescription antibacterial cream. Patients are encouraged to report any signs of infection or unusual side effects to the clinic. Zinc-based sunscreen will be provided after your treatment for the next 7 days for you to travel to places.