While most beauty treatments offered in dermatology offices are not covered by insurance or Medicare, photodynamic therapy, or PDT, is one of the rare treatments that often is. This is because PDT treats superficial types of skin cancer and precancerous lesions, explains Dr. Anna Chacon, MD. One of the bonus benefits of photodynamic therapy is that it can also be used for rejuvenation, she adds.
The treatment is usually performed in a dermatologist’s office, and while it’s often performed on the head, scalp, and neck, Chacon says it can be used on other parts of the body as well. Dr. Beth Goldstein, MD, explains that PDT is great for treating precancers without much risk of scarring, as well as for treating acne and improving skin cosmetically.
Ahead, we’ll break down everything you need to know about photodynamic therapy.
Meet the Expert
What Is Photodynamic Therapy?
“PDT is a noninvasive way to take care of many harmful precancerous lesions and superficial skin cancers,” Chacon says. It’s notable for not hurting as much as other treatment options like cryotherapy. It is also usually covered by insurance plans, including Medicare, and is more affordable than other treatment options.
Photodynamic therapy is a two-part procedure: First, your provider will apply a topical medication to sensitize abnormal tissue so that it is destroyed when it is exposed to a certain wavelength of light, says Goldstein. Then the light will be applied, targeting the pre-treated areas.
Benefits of Photodynamic Therapy
- It’s a form of “field therapy,” meaning it allows for a larger area of skin to be treated versus spot treatments.
- Not much risk of scarring.
- Usually covered by insurance and Medicare.
How to Prepare for Photodynamic Therapy?
Before you even get started prepping, Goldstein says you’ll have to tell your provider if you have a history of cold sores or have any medications that could make you light-sensitive (for example, antibiotics, blood pressure medications, or topical retinoids), or if you have any other active infections.
“The first step is to prepare to be away from sunlight for 24 hours,” says Goldstein. And when we say being away from sunlight, we don’t mean “avoid the beach, but being in the sun is fine.” Goldstein says that “even sitting by windows can cause the medication to continue to react and be painful.” Your clinician may also pre-treat the areas to be treated with medications, to help prepare the skin for even more penetration of the topical medication to be applied in the first part of PDT.
Chacon says that it’s best to schedule a time for PDT when you have at least two days to fully rest indoors.
What to Expect During a Photodynamic Therapy Treatment
When you go in for your treatment, your clinician will start by prepping your skin with either alcohol or acetone, followed by the medication intended to treat the areas, Goldstein explains.
The medication will then be left on your skin. The amount of time—also called incubation time—will depend on the area you’re treating, skin preparation, and skin tolerance, though Goldstein notes that the medication is typically left on for one hour in the U.S. The area may also be wrapped with plastic wrap or treated with heat in order to help the medication penetrate.
Sometimes the clinician will remove thicker areas of precancers or skin cancers with a curette or sandpaper-like tape in order to help the topical medication better penetrate your skin.
Next, you’ll have to don some safety goggles before the actual light treatment can begin. Then, the light treatment (which will be either blue or red) will last between 8 and 16 minutes. There is also the option for intense pulsed light (IPL), which is much faster (seconds compared to minutes), but Goldstein notes that insurance does not cover IPL, so bear that in mind.
The treatment may sting and feel like a chemical peel, Chacon notes. Some machines may have built-in fans to help make things more comfortable, but you can also ask your clinician for an ice pack, analgesic, topical numbing, or even an injection of lidocaine to help, Goldstein says.
Photodynamic Therapy vs. Topical Chemotherapy Creams
Both Chacon and Goldstein say one of the most comparable treatments to PDT would be topical chemotherapy cream field treatments like Efudex, which are applied to precancerous lesions. However, because the treatment of Efudex is spread out over three to six weeks, it can actually be more uncomfortable for patients (especially those living in sunny climates or with outdoor exposure), Chacon notes.
While a cream also seems like it might be less invasive than an in-office procedure, Goldstein says the use of topical therapies cause significant irritation, have a little bit higher risk of infection, and are equally problematic as they heal. Interestingly enough, Goldstein also notes that “usually insurance will cover the PDT, sometimes with less out-of-pocket [costs] than the topical medicines.”
Potential Side Effects
“PDT may be uncomfortable, particularly if someone has low pain tolerance and is not used to the therapy,” Chacon says. As for afterward, redness and swelling are often experienced for a few days.
It’s unpredictable, as some people have very little reaction to PDT, but Goldstein says it is possible to look like you’ve had severe wind or sunburn as you heal. For this reason, try not to plan anything important for five to seven days to provide yourself some indoor healing time.
Because most insurance plans and Medicare cover this option, it’s usually minimal, according to Chacon. However, if you treat multiple areas, it could add up. The coverage also varies by insurance plan. And keep in mind that “usually, patients undergoing PDT may need to do another session in six months, depending on their treatment outcomes,” says Chacon.
The absolute most important thing after treatment is—and Goldstein put this in all caps, so you know it’s important—to not expose yourself to any light for the first 24 hours, as you will be very sensitive to sunlight.
If you have redness, swelling, and peeling (which Goldstein says can sometimes happen), using thermal spring water, Avene Cicalfate, or Aquaphor can help speed healing and, along with OTC pain meds, help you feel more comfortable. Freezing wet washcloths can also help, Goldstein suggests.
Stick with gentle cleansers such as Cerave or Cetaphil and avoid scrubbing, peeling, or shaving for a few days. If you absolutely must go outside, Goldstein also says to apply a heavy coat of zinc oxide sunscreen and wear a hat.
The Final Takeaway
When it comes to treating precancerous lesions, there are other alternatives to PDT. But PDT can be a much more attractive option than alternatives like chemo creams, which can actually be more of a hassle to follow through with. “Photodynamic therapy is my favorite and definitely my treatment of choice,” Chacon says about the treatment.
It may not be as painless and gentle as other treatments like VBeam Perfecta, but considering it’s targeting precancerous or cancerous spots, bettering your skin, more gentle than cryotherapy, and likely to be covered by insurance, PDT is definitely worth looking into should you need.