The technique which we use varies depending upon the condition which is being treated. The two most common uses of ALA-PDT in our office setting are: (1) for photodynamic pho-torejuvenation, and (2) for the treatment of moderated to severe acne vulgaris. Both techniques are described below.
ALA-PDT for photodynamic photorejuve-nation utilizes the Levulan Kerastick, and the following light sources: blue light, the intense pulsed light source, and/or the pulsed dye laser. The preparation prior to the procedure is the same for each device. The areas to be treated are cleansed with a mild facial cleanser. For increased penetration of the ALA, in those with moderate to severe actinic damage, a vigorous acetone scrub or a microdermabrasion procedure is performed prior to application of the ALA. The ALA is prepared as described above. ALA is applied to the entire area being treated in an even distribution and allowed to incubate for approximately 1-h prior to laser/light therapy. Before the procedure is performed, the ALA is washed off the face with a mild cleanser. The choice of light source is up to each practitioner - head to head clinical trials have not been performed to determine if one light source is superior to another; in my experience, all work well and deliver the desired results. We explain to our patients that treatments are performed once a month for up to four treatments, with the actual number determined by the patient's response to the therapy.
For the treatment of moderate to severe acne vulgaris, the procedures previously outlined are once again utilized. For our acne patients, we typically treat patients every other week for up to four visits, all dependent on the patient's response to the therapy.
■ Psoriasis Vulgaris and Disorders of Pigmentation Techniques
The two main light sources we currently utilize for psoriasis vulgaris and disorders of hypopig-mentation are the narrowband UVB source and the excimer laser. Multiple therapies with each modality are required and maintenance therapies will be needed.
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