Photodynamic Therapy (or PDT) is a great treatment for anyone who has sun damage, precancerous spots, acne and/or rosacea. It involves the use of both light and a medication that makes your skin sensitive to the light. As well as it works to improve and/or correct these underlying skin conditions, it is considered an aggressive treatment. If you’re considering having PDT, there are a few things that you need to think about before your treatment. At Celibre, our PDT consultations include a discussion about each of the following:
Your acne might look worse before it looks better
Our experience has been that many patients who have PDT (for any reason) typically have a breakout of small whiteheads around the mouth and chin area. This usually appears within several days of having treatment and its cause is not known. While it is completely temporary and reversible, we like to prepare our patients for it up front, before it happens. We also think it’s an important factor to consider before deciding to have PDT as it can affect your recovery.
You MUST avoid the sun (even windows) after your PDT treatment
This one is a big one. Even sun exposure through a window in your home or car can cause a problem. The light-sensitizing medicine that we use for PDT, aminolevulinic acid or ALA, needs time to wear off and metabolize out of your skin. Even after treatment in our office, continued sun exposure can reactivate ALA on your skin and trigger redness, weeping, peeling and rawness in your skin for days until this process is complete. We discuss this with our patients prior to PDT and make sure that they make the necessary arrangements to avoid this in their recovery afterwards.
PDT can trigger darkening and increased pigmentation in your skin
This can unfortunately happen even under the very best of circumstances even when you’re following all the directions we’ve given you for your recovery. It’s called post-inflammatory hyperpigmentation (or PIH), and about 15% of all PDT patients get it. It tends to be more common in those with dark or olive skin tones because they produce more pigment in their skin very easily. Although PIH after PDT can last a few days to several months, it is important to note that it is temporary and will go away. We also have found that this type of skin discoloration tends to respond very well to treatment done in combination with good sunscreen use. There is no test to tell who will get PIH, so we counsel all our patients that it is a possibility that they must consider before treatment.
When all things are considered, we believe that the potential benefits of having PDT far outweigh the risks of any of these unwanted side effects. Still, it is our job to educate and inform you of them so that you can truly make the decision for yourself.
 
Most Common FAQs
1. Is it normal to have no peeling after PDT?
Yes, it is completely normal to experience no peeling after PDT. Some patients notice visible peeling, while others do not. Both responses are common and do not mean the photodynamic therapy treatment was ineffective. Results can still occur beneath the skin without obvious peeling.
2. Does no peeling mean my photodynamic therapy didn’t work?
No. The success of photodynamic therapy does not depend on whether or not you peel. Peeling is just one possible skin response. Even without peeling, PDT is still targeting acne, sun damage, or precancerous cells at a cellular level.
3. How long after PDT acne treatment does peeling usually start?
For patients who do peel, it typically begins within 2–7 days after the procedure. However, in PDT acne treatment, some people notice only redness or temporary breakouts instead of peeling. Both responses are normal.
4. Why do some people peel and others don’t after photodynamic therapy?
Your skin type, sensitivity, and the severity of your condition all play a role. Some patients have dramatic peeling after photodynamic therapy, while others notice little to none. Both outcomes are part of the normal healing process.
5. Can PDT acne treatment still clear my skin if I don’t peel?
Absolutely. The effectiveness of PDT acne treatment is not measured by whether peeling happens. Even if there is no peeling after PDT, the treatment is still working by reducing oil glands, killing acne-causing bacteria, and improving skin tone over time.
