Photodynamic Therapy

The use of the word photo in this context refers to light so phototherapy is essentially light therapy.

Phototherapy treatments generally refer to light-only therapies including the use of different coloured LED or Light Emitting Diodes, mainly red, infrared, and blue which is commonly used in the treatment of acne.

By applying the light, we can create a cascade of biochemical reactions within the skin. This can be used to energise skin cells, stimulate new collagen production to rejuvenate skin, reduce inflammation and aid with wound healing. This type of phototherapy is sometimes called photobiomodulation, and we use LED light treatment in combination with many of the treatments that we offer in clinic as light is such a useful tool when it comes to treating both medical skin conditions and ageing.

Photodynamic Therapy (PDT) uses light to activate naturally occurring photosensitisers that are present on the skin such as the coproporphyrin III that is produced by the C.acnes bacteria in cases of acne. We can also activate other photosensitisers that are applied to the skin before using the light. One of these active products that has been studied for well over twenty years is an amino acid called 5-Aminolevulinic Acid (5-ALA).

PDT can be used for anti-ageing treatments – treating sun damage and rejuvenating skin, and for treating non-melanoma skin cancers, and moderate to severe forms of acne.

Using dermoscopy to look at the pattern of pigment within a lesion we can help to identify and diagnose the lesion, as well as the potential for it to be benign (non-harmful) or malignant and cancerous.

Here are some short explanations of terms that you may hear.

Lentigos/Lentigines (freckles)

Freckles (ephelides) are a common occurrence and inherited characteristic, often in fair-skinned individuals, and especially in children and adults with red hair, where it is believed to be genetically linked. These are harmless and such individuals usually just need regular and high factor sun protection. The profusion of freckles may become more, or less obvious between summer and winter.

Lentigines or lentigos look very much like freckles but are caused by sun exposure or UV light from sunbeds – often meaning they are referred to as solar lentigines. Again, more common in fair skinned individuals, they also become very common in people after the age of 40 due to their lifetime exposure to the sun. Solar lentigos are brown, flat marks that are more defined than usual freckles, and do not fade in the winter. Solar lentigos can evolve into one or more seborrheic keratoses and do have the capacity to become malignant (lentigo maligna) so should be checked as they can be difficult to differentiate from a benign lentigo.

Seborrheic keratosis (age spots)

A seborrheic keratosis is a common skin growth seen as people get older, they are often brown, tanned, or black in colour, raised or flat, and called age spots or less kindly, senile warts. Seborrheic keratoses are benign and noncancerous; their cause is unknown, but they can come from a solar lentigo. Often people develop several.

Although they are not associated with being precancerous, they can be difficult to tell apart from a skin cancer such as a melanoma, basal cell carcinoma, or squamous cell carcinoma, so should be checked.

Actinic keratosis

An actinic or solar keratosis is caused by sun damage and is a dry, scaly patch of skin, that may be itchy. They are usually benign, but can be precancerous so it is important to have them checked, especially if the lesion has altered in any way recently – started bleeding, increased in size, changed colour etc.

Naevus (moles)

A mole is a melanocytic naevus that is a common and benign, or harmless skin lesion. They can appear in babies and children, even being present at birth (congenital) or be acquired later in life, often related to sun exposure. Most of us will have at least one mole, but usually can pinpoint several located in various places on the body. Those with fair skin tend to have more moles. They come in all shapes and sizes, mostly round or oval, raised or flat, varying in colour, and are categorised accordingly – junctional (flat mole), dermal (raised nodule), compound (a raised area on top of a flat patch), or combined (two distinct types of moles within the same lesion).

If the size, shape, or colour of a mole changes, or it starts to itch, crust, or bleed, or a new mole suddenly appears and you are over 40, it is important to have it checked as it may be evolving into a malignant melanoma.

Most moles are harmless, but you may wish to have them removed as a cancer prevention, or if they are in a location that causes irritation with clothing or jewellery, or when shaving for men, or if you feel that they are cosmetically unsightly. See our page on mole removal.

Basal cell carcinoma

A basal cell carcinoma (BCC) is a non-melanoma skin cancer. It is a type of locally invasive skin cancer, also called a rodent ulcer that develops in the basal cells found at the bottom of the epidermis, the outermost layer of the skin. Basal cells are responsible for producing new skin cells. BCC is the most common type of skin cancer.

This type of skin cancer is more common in elderly men but can also affect younger people and women. Sun exposure history including repeated sun burn, fair skin and red hair are all predispositions for BCC formation. BCCs come in various types but a nodular or lumpy lesion, often with a small central ulceration or crater (hence the name rodent ulcer) is the most common. Because they are a local skin cancer, they are rarely a threat to life, but should be checked and treated.

Squamous cell carcinoma

A (cutaneous) squamous cell carcinoma (SCC) is the second most common type of skin cancer. It is a non-melanoma skin cancer also called a keratinocyte cancer because it is formed from the cells in the skin that make keratin for skin, hair, and nails. SCCs develop in the squamous cells in the middle and outer layers of the skin. It is an invasive skin cancer, meaning that it can spread, but is usually not life-threatening unless left untreated.

This type of skin cancer is common in the same people as other forms of skin cancer, but the risk of developing an SCC is greater in those with a previous BCC or melanoma. Sun exposure, an outdoor occupation, smoking, and certain medications to treat autoimmune diseases can increase the risk of developing an SCC.

SCCs tend to be scaly or crusty in appearance, often tender or painful, and evolve from actinic keratoses. Such lesions should be checked and treated swiftly to avoid further complications.

Melanoma

Melanoma or malignant melanoma is the third most common type of skin cancer and is very serious. The charity Melanoma UK notes that around 2,500 people die from malignant melanoma every year in the UK, so it is vital to get any suspicious moles checked immediately.

Melanoma is an uncontrolled growth in melanocytes which are the pigment cells within the skin that produce melanin (the response that makes us tan to protect our skin by absorbing UV radiation from the sun). As humans, we all have the same amount of melanocytes, but those with darker skin types (black and brown) produce more melanin than fairer, white skin types so they are less likely to experience skin damage from UV radiation.

Non-cancerous growths in these melanocyte cells are what produce freckles (ephelides and lentigines) and moles (benign melanocytic naevi). If a cancerous growth occurs in the melanocytes, arising from normal-looking skin or through changes in a freckle or mole, this is a melanoma. These can be localised, but can also be invasive, spreading in the skin, or to other parts of the body that can prove fatal if not discovered soon enough.

Unlike other skin cancers that can be more common in the very elderly, malignant melanoma tends to occur in a younger population from their 30s through to their 60s. The main environmental cause of melanoma is sun exposure, with increased risk within populations in areas of high solar radiation and with fair skin types, including Europe, American, Australia and New Zealand. A high rate of sunbathing, tanning and sunburn incidents, fair skin, high density of freckles, red or blonde hair, blue or green eyes, and multiple moles, including multiple atypical moles (that appear different to the others) make a person more at risk of melanoma. The presence of non-melanoma skin cancers like actinic keratoses approximately doubles the risk of developing a melanoma.

This type of skin cancer is often regarded as the most common in men after prostate and colorectal cancers, and the most common in women after breast and colorectal cancers. A previous history of melanoma also increases the risk of developing future melanomas.

The first sign of a malignant melanoma is when an existing mole or freckle starts to change; it is important to detect them early, so if you have noticed any changes your moles should be checked.

Acne is a common skin problem for both men and women. It affects most teenagers, meaning that it is predominantly viewed as an adolescent problem, however, it can persist into adulthood.

Acne is identified by blackheads (open clogged pores with no inflammation) and whiteheads (closed clogged pores with no inflammation) that are collectively called comedones caused by overstimulation of the sebaceous glands which produce excess oils or sebum. By adding a proliferation of acne causing bacteria to the mix, suffers can have red, raised, pus-filled spots known as pustules – the typical acne spot – or small, raised bumps under the skin called papules.

Acne-causing bacteria known as Cutibacterium acnes or C.acnes (these used to be known as Propionibacterium acnes or P.acnes) live on everyone’s skin and usually cause no problems. But for those with acne, the build-up of sebum is an ideal environment for the bacteria to multiply causing inflammation which leads to the formation of red, swollen, or pus-filled spots.

More severe types of acne develop cysts or nodules that have a risk of causing permanent acne scarring. Acne most commonly occurs on the face, typically on the cheeks and forehead, but in many cases also occurs on the neck, chest, and back.

There is much science behind the interaction of acne and light. The acne-causing bacteria, C.acnes naturally produce porphyrins (coproporphryn III) which make the bacteria visible under ultraviolet light. These porphyrins are naturally sensitive to light so by using blue LED light we can cause a natural photodynamic response creating protoporphyrins which results in destruction of the C.acnes and an overall reduction in their presence, without damage to the skin. The light also reduces inflammation caused by the acne helping to heal the skin.

The addition of photo-sensitive agents like 5-ALA can increase the photodynamic effect and has been proven using clinical trials to be an effective treatment for inflammatory acne.

GlycoAla is the world’s only photodynamic or light-activated gel that combines 5-Aminolevulinic Acid (5-ALA) with hyaluronic acid inside nanoparticles called glycospheres making it easier to deliver stable, high concentrations of 5-ALA into the skin more quickly and safely. The hyaluronic acid also has a hydrating effect on the skin.

Designed to be used in PDT treatments for the improvement of ageing and sun-damaged skin, rejuvenation, and skin conditioning, and to reduce the size of pores in the skin and improve oily skin types and acne formation.

Jan Birch, dermatology specialist consultant nurse and founder of the Blemish Clinic is not only a pioneer in the use of PDT, with over twenty years’ experience, but she has also been at the forefront of the clinical studies and use of GlycoAla in clinical practice, training UK medical practitioners in its use.

Phototherapy and photodynamic therapy (PDT) treatment is suitable for both men and women of all skin types and colours.

During your consultation with our dermatology specialist consultant nurse, Jan Birch who has a specialist interest in photobiology and decades of experience in the study and use phototherapy and photodynamic therapy, a full medical history will be taken to determine your suitability for light therapies. We will check for any underlying health concerns, medications, or allergies that may contraindicate treatment.

If you have a sensitivity to light, such as epilepsy, porphyria, albinism, or are taking medicine that causes photosensitivity (e.g., the antibiotic Tetracycline or certain steroids) then you will not be suitable for light therapy, and we will suggest alternative treatments. If you are allergic to hyaluronic acid, you will not be a candidate for the use of GlycoAla for PDT therapy, but phototherapy may still be an option.

Similarly, we will check if you have been using any vitamin A skincare products such as retinol, as we must leave a gap between the use of vitamin A and the commencement of PDT.

If you have an area of active skin infection – bacterial, viral, fungal, etc. – or broken skin in the area to be treated, you will not be suitable for PDT treatment and will be required to wait until that is resolved and healed.

If you are currently pregnant or breast feeding, you will not be suitable for light therapy treatments including PDT and will be advised to wait.

Photodynamic therapy is performed across several treatment sessions, usually a series of 3 that are spaced 4 weeks apart, but it will depend on the underlying skin condition that we are aiming to treat. A bespoke treatment programme of light therapy will be created for you, and PDT may be recommended in combination with other treatments.

The use of light therapy with LED (Light Emitting Diodes) is reported to be very relaxing with a warm sensation; some patients do fall asleep during treatment.

It is not painful because no heat is generated from the procedure so it cannot burn. With the application of photosensitising serums, such as GlycoAla, you will notice a tingling sensation when the light is first applied, but this quickly fades.

Light therapy using LED lights has been used for many decades and is a very safe procedure. You will be asked to wear special protective eyewear during treatment to protect your eyes from the bright light.

PDT treatment involves the use of additional photosensitisers such as 5-ALA in GlycoAla that are applied to the skin. This increases the photosensitivity of your skin, therefore the main risk from treatment comes from after treatment as your skin will still be sensitive to light which predominantly risks the sun. You will be advised to avoid sun exposure and going outdoors for 48 hours following treatment, and to wear a high strength SPF sunscreen and a wide brimmed hat to cover your face and neck should you have to venture out.

After treatment you can expect redness to persist on the skin for 24-48 hours. There may also be some mild skin peeling. We will advise on appropriate aftercare for your skin for you to use at home.

The results from photodynamic therapy treatments are not immediate as we must wait for the biochemical changes that have been stimulated within the skin to happen and for the cells to remodel, renew and heal.

It can take a month for changes to become noticeable, and therefore we wait 4 weeks in between treatment sessions to access your response and the effect on your underlying skin condition, be that sun damaged or pigmented skin, or acne severity and breakouts.

Results from photodynamic therapy can be long-lasting, depending on the skin condition being treated, however, they are not regarded as permanent, and future maintenance treatments are recommended.

We have achieved some remarkable results for our patients from using PDT with GlycoAla. This can have a life-changing effects for people in terms of increased self-confidence and less skin discomfort that truly makes a difference. We are thrilled to be able to share that journey to better skin health with our patients.

Although you can expect significant improvements to sun damaged and ageing skin, the natural effects of future sun exposure and ongoing ageing will mean that maintenance treatments will be recommended at least once per year.

Similarly, those affected by acne, particularly more severe types will usually require an ongoing programme of repeat PDT sessions depending on the type and severity of acne and how well breakouts can be managed with a programme of medical, topical, and light-based acne treatments.

We believe in being transparent with our prices and want you to be fully aware and comfortable with the cost of your treatment. A full list of our prices can be found here. We will always agree a final price with you though before treatment commences.