Aminolevulinic Acid with Photodynamic Therapy (commonly referred to as ALA or PDT) is a laser based dermatology treatment for various skin conditions including acne. ALA/PDT is a good option for those acne patients that choose not to utilize other types of lasers or are non-responsive to other types of acne treatments. Although many of our acne patients experience good, consistent outcomes with ALA for acne, there are possible negative side effects that must be fully considered when an acne patient makes the decision with their practitioner to use photodynamic therapy with ALA for acne.

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Within our practice, 10 to 15% of our acne ALA patients experience what is referred to as post-inflammatory hyperpigmentation (PIH) after their treatment. This is a dermatological term that describes a temporary discoloration to the skin related to inflammation from the acne treatment process. The color may be pink, red, or brown depending on the skin type. This reaction is unpredictable but is more common in those that are medium to dark skin types. This reaction is almost always short-lived and resolves within several weeks. In rare situations, the discoloration from photodynamic therapy may last as long as six months. For those that are not wanting to wait for the pigmentation to resolve, there are several options to accelerate the fading. Although the percentage of those that fall into this category is quite small – it is a possibility that requires consideration when determining if photodynamic acne therapy is right for you.

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Temporary Hyperpigmentation from photodynamic therapy acne treatments.

Another common negative side effect of photodynamic therapy for acne is a cluster of closed comedones (whiteheads) that appear shortly after ALA/PDT and usually found around the mouth and jaw area. No one quite knows for certain what causes this reaction; however, it is so common that it is almost expected. Some speculate that this may be related to the regeneration of hair follicles following photodynamic therapy treatment. Regardless of the cause, most will see this reaction self-resolve within 1-2 weeks following acne treatment without intervention.

Be certain to discuss all of the possible negative side effects and risks associated with photodynamic therapy for acne (ALA/PDT). Patient and practitioner should be confident that the benefits outweigh the possible negative outcomes.


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