Photodynamic Therapy: Is it worth the hype?

Blu-light treatment

It seems like every Dermatologist is recommending photodynamic therapy (PDT) to their patients these days. Why the sudden explosion with this treatment? Is it really that good? Is it really the best? Is it really what we should be recommending to our patients?

The simple answer is yes and no. Photodynamic therapy has been around since the early 2000’s, but recently became popular. Why? Is it better now than before? Yes, it is better for both patient AND physician. The original method of PDT required patients to come into the office at the end of a day for the medicine to be applied to the skin. They returned the next day for the blue light treatment. Obviously, this is inconvenient for the patient. More importantly, the treatment was very uncomfortable. In the recent years, a newer regimen in which patients have the medicine applied and then have the blue light treatment one hour later. This is much more convenient and much less uncomfortable. The treatment does very well, although many patients experience redness, swelling, and a burning sensation during the light treatment and many will have some skin irritation afterwards than can be mild or moderate. Is this the reason why so many Dermatologists are offering this treatment, because it is fairly well tolerated and works well? One would hope so, as it is a good treatment. It is also an expensive treatment, which pays the Dermatologist well and in most cases, that is why it is recommended so frequently.

In short, PDT is a good treatment option for the treatment of actinic keratosis. It works well, but one must spend about 90 minutes in the Dermatologist’s office. The nice thing is that patients do not have to do anything at home–no creams or topical products to buy or use. It’s simple. But, this comes with a higher price tag than some other treatments and one must look at the costs involved as well. For example, imiquimod can be purchased for as little as $18, even when one has no health insurance, using savings plans like, which are free to use. Other treatments using 5-fluoruracil and calcipotriene can be compounded for as little as $30 if you shop around and only required 5-6 days of application with minimal irritation.

In summary, PDT is a good option for the treatment of actinic keratosis. It is best for patients who cannot apply creams or those who are not compliant. This treatment generally costs more than several other treatment options, which should be taken into account when choosing this option. Always ask about other treatment options, as this is not and should not be the only option discussed.

Robert S. Bader, M.D., Dermatologist