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When undergoing ALA/PDT (AminoLevulinic Acid with Photodynamic Therapy) one must be mindful of potential negative side effects. Once you are aware of these potential side effects you (along with the practitioner) can decide if the potential benefits outweigh the potential negative side effects of photodynamic therapy for the treatment of acne.

The majority of photodynamic therapy patients will experience clusters of acne lesions that appear as small whiteheads around the mouth and chin area. These usually appears within several days after undergoing photodynamic therapy with ALA. Although we aren’t completely certain what causes this phenomenon, it is commonplace enough that it is almost an expected outcome. While not necessarily a side effect, we like to let our patients know of this common occurrence with photodynamic therapy so that they can weigh it in the decision making process.

Another potential side effect of photodynamic therapy related to patient non-compliance involves too much sun exposure following treatment. For several days after the photodynamic therapy treatment, the patient needs to stay indoors and away from sunlight. Being exposed to sunlight in the days after treatment while the Amino Levulanic Acid (ALA) is still active can cause a very exuberant response with weeping, peeling, redness and raw skin. Patient compliance with after care instructions will avoid this side effect.

Another potential side effect of photodynamic therapy with ALA is a temporary discoloration to the skin in response to the treatment. The term for this reaction is post inflammatory hyperpigmentation (PIH). This transient (temporary) side effect occurs when the inflammation and trauma from the procedure causes the skin to produce pigment as part of the healing process. The discoloration can last from a few days to several months and appears most often in those with olive or dark complexions that produce pigment easily. The skin may turn red or brown and approximately 15% of our darker skinned patients experience this reaction. There is no way to predict who falls into this small category and pre-testing is not possible. The encouraging news is that most acne patients benefit greatly from photodynamic therapy in spite of the PIH (post inflammatory hyperpigmentation). In addition, there are remedies to help fade the pigment more quickly when this side effect does occur. Most often, the body resolves the discoloration quickly on its own with diligent sunscreen usage.

Most of our patients agree that the potential benefits of photodynamic therapy with ALA for acne treatment greatly outweigh the potential negative side effects. Only you as the patient, equipped with thorough information, can make the best possible choice about whether or not it makes sense to consider PDT with ALA given the potential side effects.


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