PHOTODYNAMIC THERAPY (PDT)
WE
all love the sunlight, but excessive exposure to UV rays from sunlight can damage our skin.
Due to the skin’s lack of self-protection, fair-skinned people are particularly at risk for skin changes caused by UV radiation.
The more they are exposed, unprotected, to the UV rays over the years, the higher the risk of getting serious skin damage.
The most common skin change caused by UV-radiation is actinic keratosis (AK).
What is actinic keratosis (AK)?
Actinic means caused by radiation and thus indicates the cause of the disease.
An AK is a chronic damage to the cornified epidermis caused by sunlight, in which excessive cell growth takes place. This occurs when certain cells, the so-called keratinocytes, change genetically due to longterm exposure to UV rays and grow uncontrollably.
Actinic keratosis is a chronic disease, which requires repeated treatment.
To treat AK most successfully, the photodynamic therapy (PDT) is currently the overall gold standard.
Which areas of the body are particularly at risk?
Actinic keratosis mainly develops where sunlight hits the skin.
In particular, our so-called “sun terraces”, such as the forehead, bridge of the nose, ears, face, hairless scalp, neck and chest are particularly at risk, as they are often exposed to UV radiation.
AKs can occur quite differently, such as in patches or as patches of skin with a rough or scaly surface. The affected areas are usually reddish, sometimes reddish-brown, yellowish or skin-coloured.
As the top layer of skin thickens over time, it feels like sandpaper.
The diameter of an actinic keratosis is usually between one millimetre and two centimetres.
It is very important to know that keratoses can often be much larger below the visible surface. Therefore, it makes sense not just to treat the keratosis, which is visible to the eye, but the entire area.
If you suspect that you have been affected, you should book an appointment with your dermatologist.
Who belongs to the potential risk group?
While actinic keratosis used to occur in earlier times mainly in older people from the age of 50, nowadays also younger people are increasingly affected. One in 10 Europeans over the age of 40 is affected by this disease, men twice as much as women.
Not only are sun-worshippers and solarium visitors at risk, but also recreational athletes and people who work outside such as farmers, roofers or road builders.
Furthermore, people with sun-sensitive skin and people whose immune system is permanently impaired also belong to the risk group.
Numbers will continue to increase in the coming years, with new cases in the UK and Germany alone rising steadily.
Why do I have to have an AK treated?
AKs are an early form of nonmelanoma skin cancer.
When your dermatologist diagnoses an AK, you should start your therapy as soon as possible in order to prevent the development of a so-called squamous cell carcinoma (SCC).
This second most common type of malignant skin tumour can be life-threatening. Actinic keratoses are the main cause of development of SCC.
The progression from AK to SCC takes an average of two years. Also, a grade 1 AK can directly develop into SCC. For this reason, actinic keratosis is classified by dermatological societies as a tumour disease requiring treatment. Therefore, consistent treatment is recommended immediately.
How can I protect my skin from an AK?
Consistent sun protection at any age by using sunscreen (SPF50) or suitable clothing is the best therapy for preventing actinic keratosis.
What therapy is the gold standard to treat AK most effectively?
The innovative Photodynamic Therapy (PDT) is by far the most effective treatment for mild to moderate actinic keratosis, for flat/ superficial basal cell carcinoma (max. 2mm depth of penetration) and intraepidermal carcinoma in situ (Morbus Bowen).
PDT is the recommended therapy by the European Medicines Agency.
It combines the use of a specific light source (cold LED red-light) with a lightactivated substance. Thus, the highest healing rates could be recorded in clinical studies, since the diseased cancer-prone cells are killed in a targeted manner, while healthy tissue is spared.
In combination with a fractional CO2-Laser (“Power PDT“), we are going to achieve synergistic results for improved outcomes.
Another positive “side effect” of PDT is skin rejuvenation through the formation of new collagen (collagen remodelling) in the dermis. In combination with skin boosters (deep hydration of the skin from inside), patients achieve synergistic results.
How is the PDT procedure?
The affected skin area is first freed from scales and excess calluses, cleaned and degreased.
Then a special photosensitizing gel is applied, which has to penetrate into the skin for three hours. You can use this time to run errands or simply wait in the waiting room.
However, it is important to ensure that the skin is not exposed to the sun during these three hours. It’s also not recommended to let the skin cool down excessively, as this could have a severe impact on the efficacy of the therapy. For this reason, the treated area is covered with a bandage or protective film.
After the three hours, the skin is exposed to a cold redlight lamp for seven minutes per cycle. With each cycle, the patient receives the same amount of dosage (37 J/cm2) every time, which makes the PDT treatment very predictable and reproducible.
Because of the specific wavelength (630 nm) of the lamp (Aktilite) in combination with the photosensitizing gel, the tumour cells will be targeted and destroyed very selectively by protecting and sparing the healthy skin. As already mentioned, at the same time, a collagen neogenesis is taking place in the deep layer of the skin by stimulating the fibroblasts. These increased levels of new collagen formations lead to a long-term, visible “rejuvenation” of the skin.
What do I need to consider after PDT therapy?
Pain may be more or less pronounced during and shortly after PDT.
This is caused by the targeted destruction of the diseased cells and it’s an indicator of the effectiveness of the therapy.
The treatment leads to inflammation of the affected area of skin, which can last for one to two weeks. These inflammatory processes are the result of the skin’s cleansing and regeneration processes, which are triggered by the death of diseased cells.
During healing, healthy cells take the place of dead ones.
The PDT, therefore, usually leaves no scars and a significantly improved complexion. This is part of the active principle of PDT and shows that the therapy was successful.
However, it is very important that you do not scrape off any crusts or scales that appear.
Furthermore, particular attention should be paid to ensuring that the treated skin area is not exposed to direct sunlight for 48 hours as the skin is still very sensitive.
After two days, you can use special care creams for the inflamed skin.
Occasionally after PDT, treated skin areas are more or less pigmented than the surrounding skin. Usually, the pigmentation evens out within a few days or weeks after the treatment.
In general, PDT is a proven and extremely well-tolerated therapy with the highest healing rates overall.
Does my health insurance pay for this form of treatment?
PDT is not a service covered by national/general health insurances. Therefore, national health insured patients have to pay for the costs themselves. Private health insurance companies usually cover the costs completely.
Actinic keratosis has been recognised as an occupational disease by the professional associations since January 1, 2015.
Your treatment can be reimbursed under certain conditions. If necessary, check with your doctor whether you meet these criteria. The cost of the treatment depends on the number of areas to be treated.
For further information, contact the German Specialist Center Carvoeiro. Our dermatologist Shirin Samimi-Fard is specially trained in this effective treatment method.