A new revolutionary treatment is available for acne, precancerous and cancerous skin conditions. The treatment utilizes a light sensitive chemical (Levulan™) manufactured by DUSA. The chemical is added to the skin and allowed to soak in. After a period of time, the light laser (Pulsed Dye laser) is applied. Application of the laser activates the chemical. This generates an active form of oxygen in the skin that kills abnormal skin cells and leaves normal skin cells alone. The active ingredient, alpha Levulinic acid, is approved by the FDA in 1999 for treatment of actinic keratosis (precancerous skin growths). Many doctors use the same process for the treatment of acne and certain types of skin cancer (off-label uses).

Dr. Galoob has been treating skin conditions using the Pulsed Dye laser for the past 15 years. He routinely uses this and other lasers in his practice. He has used Levulan as an adjunct to treatment of acne, precancerous skin lesions and selected non surgical treatment of skin cancers since 2006.

Questions and Answers:

Will my insurance pay for the treatment?

Many insurance companies will cover a portion of the treatment. Dr. Galoob's staff will contact your company to find out the extent of your coverage and benefits if you request.

How many treatments will it take?

The number of treatments will depend on the extent and amount of abnormal tissue that is present. Early precancerous conditions and moderate acne scars are more successfully treated than more extensive conditions, but both can be improved with Levulan and laser treatment. The number of treatments varies with extent of the condition and area of the body. The average precancerous skin condition and acne scar can be positively improved at least 50% with 2- 3 treatments.

Does the treatment hurt?

A light chemical peel is performed prior to the Levulan being applied and may cause some mild stinging for a few minutes. Application of the Levulan chemical is not painful. The laser is applied after a period of time (from 4 hours to 12 hours). Each laser pulse causes heat when it contacts skin. This discomfort can range from a mild snapping sensation to more discomfort. Most patients tolerate treatments without any topical or local anesthesia. Dr. Galoob can provide either topical or injectible anesthetic (like the dentist) to make you comfortable during treatment. Constant cold air is applied to the skin during treatment to make you more comfortable.

Will any of the abnormal skin condition remain after treatment?

Abnormal skin conditions such as precancerous lesions and acne develop over a long period of time. Multiple treatments are often required and may not completely remove all abnormal tissue. The goal is to gradually remove the abnormal skin and allow normal healing if possible. In the case of acne, 80% improvement after 2 treatments is common. For precancerous skin, dramatic reduction in lesions and 60% reduced development of new skin cancers occurs after 2-3 treatments. In treatment of selected fully developed skin cancers, treatment success may require multiple treatments. Dr. Galoob's experience has been very positive for removal of complex skin cancer conditions where there are wide areas of involved tissue or with patients who have had recurrences after prior surgery.

How often are treatments performed?

Treatments can be performed as often as every month or less frequently if desired. The skin treatment area continues to improve between each treatment. This interval allows skin healing and fading of abnormal tissue to maximize before the next treatment.

What can I expect after treatment?

The laser effect on the tissue starts the chemical activation process. Within 30-60 minutes, the skin will become extremely light sensitive. Patients should stay in dark surroundings for at least 48 hours. Even short exposure to sunlight or bright light can cause stinging and swelling. After 48 hours, the skin will begin to flake and peel, a process than can last for several days. Most patients can return to normal activity within 72 hours. Some swelling and redness continues for a few more days. Skin returns to normal within 7 days.

What type of post-treatment care is necessary?

Cool cloths, use of a fan and pain medication may be needed for the first few days. Hydrocortisone cream is often used in the first few days to reduce swelling. Avoidance of sun or bright light exposure is essential if the patient is to remain comfortable. A shower can be taken the same day, but patients should avoid scrubbing the treated area. If treatment of skin cancer is performed, post treatment biopsy is recommended even if the treated area appears normal. This is done to verify that complete removal of the cancer has occurred. Long term follow up and observation is strongly recommended.

Treatment

Special precautions are taken to protect your eyes and personnel who will be in the room. Everyone wears special glasses or eye shields. (Our practice meets the standards of the AAAHC (www.aaahc.org) for laser safety). Lasers are maintained and calibrated on a regular basis and a technician is available at all times during the procedure.

The procedure will either be performed by Dr. Galoob or one of his experienced staff. Initial laser settings are verified by Dr. Galoob prior to each treatment. It is common for him to apply a test pulse to himself as a last safety check before treatment. The laser is pulsed in multiple spots over the area for complete coverage (like turning a flashlight off and on each time). Each pulse feels like being snapped with a rubber band. Cold air is applied over the skin during the treatment to provide comfort and to protect the skin from heat produced when the laser light contacts the hair root. Afterwards, the skin may be slightly red. Occasionally irritation and blistering may occur. A soothing cream will be placed on the skin after treatment. Irritation may last for several days.

If you are interested in learning more about the use of Levulan and the Pulsed Dye laser treatments for treatment of acne, precancerous and selected cancerous skin lesions contact our office and we will be happy to answer your questions.