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Levulan Photodynamic Therapy - Acne Skin Care Treatment Acne Skin Care treatments using Levulan Photodynamic Therapy (PDT) is the most recent advance in acne therapy. We are one of the first centers in the U.S. to offer this revolutionary acne skin care treatment. We have been getting excellent results treating men and women of all ages from all over the northern California area. Photodynamic acne therapy involves the application of Levulan (5-aminolevulinic acid), a photosensitizing agent, which is then activated with blue-light. This results in significant improvement in moderate to severe cystic acne. Blue Light Levulan acne treatment involves three mechanisms of action against acne. Levulan treatment inactivates the bacteria that trigger acne, exfoliates the skin to unclog pores, and the most exciting mechanism is that Levulan treatment shuts down the sebaceous glands in the skin. This is exciting because sebaceous glands are the root cause in the formation of acne so it has a long lasting effect even on severe acne. Levulan acne therapy can even work in patients who have failed accutane. Accutane also targets the sebaceous gland but Accutane has fairly significant side effects. Levulan is a very safe alternative to Accutane treatment. Levulan Photodynamic Therapy - Skin Rejuvenatuion Photorejuvenation using Blue Light is now the gold standard of non-ablative skin treatments. The most recent advance in photorejuvenation is photodynamic therapy (PDT) combined with Blue Light known as photodynamic skin rejuvenation. Photodynamic skin rejuvenation involves the application of Levulan, a photosensitizing agent, which is then activated with blue-light. This results in significant improvement in precancerous conditions such as AKs, actinically damaged skin, sun damaged skin, moderate to severe cystic acne and potentially superficial skin cancers. Additionally it improves wrinkles, pore size, skin texture, pigmentation, rosacea, sebaceous hyperplasia, and potentially prevents the development of skin cancer. Levulan is revolutionizing how we perform skin rejuvenation and how we treat sun damaged skin. Levulan Photodynamic Therapy for: Removing precancerous skin lesions Preventing skin cancer Improving wrinkles Improving pores Improving skin texture Improving pigmentation Treating moderate to severe cystic acne Treating sebaceous hyperplasia  Procedure: A nurse or aesthetician will apply the medicine. After 30-45 minutes Levulan will be activated blue-light. You will be given special goggles to wear to protect your eyes during the treatment. During the treatment you may feel stinging, tingling, prickling, or burning of the lesions, but this should go away after the treatment. You should stay out of the sun and bright light as much as possible for the next 24- 48 hours The skin will turn red and slightly swollen in the following 2-4 days Some crusting may be noted There should be some discomfort, but no significant pain. After 1 week, there might be some residual redness that will subside after a few days and can be covered with make up. Photodynamic Therapy Conventional type I IPL photorejuvenation for rosacea, telangiectasia: 550 nm filter, 2.4 msec - 2.4 msec double pulse, 10 msec delay, 24-34 J/cm2. Photos courtesy of Mark S. Nestor, M.D., Ph.D. Photodynamic skin rejuvenation (type III) for chronic actinic damage, actinic keratosis: 550 nm filter, 2.4 msec - 2.4 msec double pulse, 10 msec delay, 24 J/cm2 -34 J/cm2. First three IPL treatments included light microdermabrasion followed by a 30-minute application of ALA. Photos courtesy of Mark S. Nestor, M.D., Ph.D. Extensive actinic keratoses and photodamage treated with 1-hour application of ALA followed by IPL at conventional photorejuvenation parameters of 2.4 msec - 4.0 msec double pulse, 10 msec delay, 32 J/cm2. Photos courtesy of Mitchel P. Goldman, M.D. Before and after treatment of squamous cell carcinoma in situ treated with application of ALA for 1 hour followed by IPL at conventional photorejuvenation parameters. Photos courtesy of Mitchel P. Goldman, M.D.   Photodynamic skin rejuvenation for severe cystic acne with three treatments, which included light microdermabrasion followed by ALA application for 30 minutes to 60 minutes , followed by IPL and/or pulsed dye laser (2.6 J/cm2). Photos courtesy of Mark S. Nestor, M.D., Ph.D. Conventional type 1 IPL photorejuvenation for pores and texture: 560 nm filter, 4. 0 msec - 6.0 msec double pulse, 10 msec delay, 22 J/cm2 - 30 J/cm2. Photos courtesy of Mark S. Nestor, M.D., Ph.D.   Photodynamic Therapy (PDT) Guide What is Photodynamic Therapy? Photodynamic therapy (PDT) is a special treatment performed with a topical photosensitizing agent called Levulan (5-aminolevulinic acid or ALA) activated with the correct wavelength of light. This is also known as "ALA/ PDT treatment" or Levulan photofacial or Photodynamic Therapy. These treatments remove sun damaged precancerous zones and spots called actinic keratoses. Sun damage, fine lines, and blotchy pigmentation are also improved because of the positive effect of Levulan and the light treatment. ALA/PDT treatment also has the unique ability to minimize pores and reduce oil glands, effectively treating stubborn acne vulgaris, acne rosacea, and improve the appearance of some acne scars. Photorejuvenation using intense pulsed light (IPL) is now the gold standard of non-ablative treatments. The most recent advance in photorejuvenation is photodynamic therapy (PDT), IPL, known as photodynamic skin rejuvenation. Photodynamic skin rejuvenation involves the application of Levulan, photosensitizing agent, which is then activated with IPL. This results in significant improvement in precancerous conditions such as Actinic Keratose (AK'S), actinically damaged skin, moderate to severe cystic acne and potentially superficial skin cancers. Additionally it improves wrinkles, pore size, skin texture, pigmentation, rosacea, sebaceous hyperplasia, and potentially prevents the development of skin cancer. Levulan is revolutionizing how we perform skin rejuvenation to treat damaged skin. Photodynamic Therapy with Levulan for: • Removing precancerous skin lesions • Preventing skin cancer • Improving wrinkles • Improving pores • Improving skin texture • Improving pigmentation • Treating moderate to severe cystic acne • Treating sebaceous hyperplasia How much improvement can I expect? Patients with severe sun damaged skin manifested by Actinic Keratoses, texture, and tone changes including mottled pigmentation and skin laxity may see excellent results. You may also see improvement of large pores and pitted acne scars. Active acne can improve dramatically. How many treatments will it take to see the "best" results? To achieve maximum improvement of pre-cancerous (actinic keratoses) sun damage, skin tone and texture, a series of 2-3 treatments 2-4 weeks apart is most effective... Some patients with just actinic keratoses are happy with one treatment. More treatments can be done at periodic intervals in the future to maintain the rejuvenated appearance of the skin. What are the disadvantages? Following PDT, the treated areas can appear red and swollen with some peeling for 2-7 days. Some patients have an exuberant response to PDT, and experience marked redness of their skin. Temporary swelling of the lips and around your eyes can occur for a few days. Darker pigmented patches called liver spots can become temporarily darker and then peel off leaving normal skin. (This usually occurs over seven to ten days.) Repeat treatments may be necessary as medicine is not an exact science. What are the advantages? 1.  Easier for patients than repeated topical liquid nitrogen, Efudex (5-Fu), or Aldara because the side effects are minimal and there is rapid healing. 2.  The ALA/PDT treatment is relatively painless versus liquid nitrogen, 5-FU and Aldara. 3.   Reduced scarring and improved cosmetic outcome compared with cautery, surgery and Efudex. 4.   Liquid nitrogen can leave white spots on skin. 5 .  Levulan improves the whole facial area treated creating one color, texture and tone rather than just spot treating with liquid nitrogen, cautery and surgery. In summary, PDT matches the "Ideal treatment" for actinic damage: • Well tolerated (essentially painless) • Non-Invasive (no needles or surgery required) • Excellent cosmetic outcome (particularly in sensitive areas of the face)

Pre-treatment Post-treatment   Pre-treatment Post-treatment   Pre-treatment Post-treatment

Blue Light Treatment for Acne

We are proud to offer this new treatment for acne utilizing DUSA Blue Light. Patients sit in front of the DUSA Blue Light System for approximately 8-10  minutes wearing special eyewear. When used in conjunction with a topical medicine called Levulan®, the Levulan® is applied before the treatment and left on the skin about 30 to 45 minutes. The Levulan® is then washed off and then the patient sits in front of the DUSA Blue Light for approximately 8 to 10 minutes. This is usually referred to as Photodynamic Therapy (PDT).

The DUSA Blue Light is 400mm wavelength light but looks and feels like standard fluorescent lighting. The DUSA Blue Light usually does not cause any discomfort during or after treatments. For some patients, the blue light will feel only slightly warm during treatment. If Levulan® is used, patient may feel a mild stinging of a mild burning sensation during treatments. The skin may turn slightly pink for a couple of days after treatment but this usually only happens if Levulan® is used in conjunction with the Blue Light. If Levulan® is used in conjunction with Blue Light, mild crusting may occur in the days after treatment and occasionally the acne will look worse for a few days before improvement begins. However, if you use Levulan® you will probably optimize the reduction in your acne over time.

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What does DUSA Blue Light treat?

DUSA Blue Light is used to treat either acne or actinic keratoses. For severe cases of these diseases, your practitioner may recommend Levulan or ALA (amino levulinic acid) be used in conjunction with the Blue Light Acne Treatment. Actinic keratoses (AK) is a pre-cancerous skin lesion, which left untreated, may develop into a skin cancer.

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Why use Blue Light Acne Treatment instead of conventional acne medication?

Many patients are not comfortable with the potential adverse effects of long-term use of medication. Antibiotics in particular may lead to resistant strains of bacteria leaving certain antibiotics useless in preventing and combating disease when they are needed most. This may become increasingly the case when we allow our teenagers to be put on long-term antibiotic therapy for acne.

Some medications like Accutane®, which is used for severe cases of acne, are so potent that the patient’s blood levels must be monitored during treatment. It would be nice if these types of medications could be avoided.

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How does DUSA Blue Light work?

Bacteria multiplying in the sebaceous glands that surround hair follicles cause acne. The results range from the common pimple to severe acne. The key is to get rid of the bacteria while not harming the skin. Some people use topical creams, special cleansers, or even opt for oral medication. However these solutions do not work for everybody for a myriad of reasons. The Dusa Blue Light is an amazing treatment that eliminates the bacteria that causes acne. When the skin is exposed to DUSA Blue Light, the light enters the sebaceous glands that harbor the bacteria. In turn the sebaceous gland create oxygen molecules that then destroy the bacteria and help the healing process. With the bacteria gone, the acne begins to clear up and the skin begins to heal.

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What should I expect after treatments?

After the initial treatment your skin may be slightly pink for an hour or so. In the first week your acne may look no better or slightly worse. As the treatments progress, you should start to see a slow, methodical improvement in your acne condition. If Levulan® was used in conjunction with DUSA Blue Light, or if was used alone, scabbing may occur as the acne lesions heal, but this will end when the treatments are completed.

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PRE-TREATMENT INSTRUCTIONS

Please visit us on the day of your Blue Light Acne Treatment wearing no make-up. Please do not use creams, lotions, serums, and self-tanners or any other skin care products on the areas to be treated as the blue light may interact with these.

The following should be stopped at least one week prior to your Blue Light Acne Treatment:

Retin-A® (tretinoin), Renova®, Kinerase®, all topical retinoids, other exfoliating drugs

Electrolysis

Waxing

Depilatories

Masks/Facials

Hair dying treatments

*Please let us know if you have any permanent cosmetics. We will cover areas prior to Blue Light Acne Treatment since there is a slight risk of the permanent cosmetic lightening.

*Please let us know if you have any facial tattoos, as these will be covered prior to treatment.

*All facial piercings will have to be removed for the treatment.

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POSSIBLE EXCLUSIONS TO BLUE LIGHT ACNE TREATMENT

• Active Herpes Simplex
• Accutane® (Isotretinoin) use within last 6 months
• Recent chemotherapy or radiation
• Sunburn/Insufficient solar protection

*IF YOU ARE RECEIVING LEVULAN® WITH YOUR TREATMENT you must bring a hat with you (wide brimmed or a baseball cap) and a pair of sunglasses.

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POST-TREATMENT INSTRUCTIONS

WITH LEVULAN®

• Patients should avoid exposure of the areas treated with Levulan® to sunlight or bright indoor light (including sunlight from windows) for 24 hours.
• Exposure to the sun may result in a stinging and/or burning sensation and may cause redness or swelling.
• Patients MUST wear some type of head covering (wide brimmed hat or baseball cap and a pair of sunglasses) for the first 24 hours.
• Patients MUST apply sunscreen containing everyday.
• Wash your face with mild cleanser such as Cetaphil® and Aquqnil. Splash water on face when rinsing and gently pat dry with soft towel. DO NOT RUB FACE.
• Apply moisturizer as many times as necessary. May use Aquaphor®, Cetaphil®, or Eucerin.
• Wait four to seven days before resuming any prescribed topical products or any OTC acne products.
• You may apply OTC Hydrocortisone 1% ointment for itching and redness for one week only.
• If pealing occurs, DO NOT pick, scratch, or rub the skin off. This may cause more irritation.
• Scabbing may occur as the acne lesions heal, but this will end when the treatments are completed.
• Patients generally may expect a breakout of acne after treatment that can erupt within four days and last up to two weeks.
• You may apply make-up after 24 hours if the skin has returned to normal.

WITHOUT LEVULAN®

• Wash your face with mild cleanser such as Cetaphil® and Aquanil. Splash water on face when rinsing and gently pat dry with soft towel. DO NOT RUB FACE.
• Apply a bland moisturizer such as Cetaphil®.
• Apply sunscreen daily, at least SPF 30.
• Do not apply make-up until the pinkness of the skin has subsided.

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