Photodynamic therapy (PDT) aftercare

Photodynamic therapy is an effective and convenient treatment for solar keratoses and some skin cancers, with a superior cosmetic result to most other treatments; it’s also an effective aesthetic treatment for sun-damaged and ageing skin. Unfortunately, side effects are common.

Careful aftercare can help them resolve faster.

What to expect after treatment

Days 1-2

In most cases, there is only mild discomfort following treatment, but some people experience stinging and pain, which can be bad enough to disrupt sleep and interfere with everyday activities. This usually lasts 12-24 hours. The treated area is very sensitive to light. Stay inside during daylight hours for the first few days following treatment.

“The treated area is very sensitive to light. Stay inside during daylight hours for the first few days following treatment.”

Days 3-5

The treated skin may become swollen, red and sore. There may be raw areas that weep. This is usually a normal part of wound healing and does not necessarily mean that the skin is infected. Don’t treat weeping skin with antiseptics such as Savlon, Dettol or Betadine. These antiseptics can be toxic to the cells involved in the wound healing process. If you think your skin is infected, contact your doctor as soon as possible.

Days 6-14

Swelling, redness and soreness settle, and surface crusts begin to separate. Don’t scrub or pick at these crusts. As the skin heals, it may feel itchy and tight.

Over the following weeks

The skin gradually becomes smooth and looks healthier and clearer than before treatment. Some redness may persist; it usually fades over a few weeks.

In some cases, PDT can cause increased pigmentation of the treated area. This sometimes settles over a period of several months. If it doesn’t settle, treatment with intense pulsed light or laser is usually helpful.

Downtime after PDT treatment

It’s very important to avoid sun exposure in the first few days after treatment. We recommend staying home for 3-4 days.

As the skin heals, it may peel or develop crusts. The peeling and crusts are sometimes unsightly and may affect your ability to work or go out for a while.

Pain, itch and swelling relief

Pain after PDT can often be managed with cold compresses (e.g. an ice pack or cool, wet towel).

If oral painkillers are required, take paracetamol 4 to 6-hourly. If we suspect you will experience an especially strong or painful reaction to treatment, we’ll prescribe strong painkillers.

Do not take anti-inflammatory medications such as ibuprofen, naproxen or diclofenac. The treatment relies on inflammation and these medications might reduce its effect.

If the treated area is itchy and swollen, antihistamines such as Telfast and Claratyne can help.

Recommended products

Applying petroleum ointment such as E45, Vaseline, Bepanthen, Infadolan, or petroleum/paraffin-based paw paw ointment to the treated area can also provide relief.

E45 cream and Allmedic post PDT lotion contain ingredients which can soothe the skin and accelerate healing. We also recommend LaRoche Posay Cicaplast balm for soothing non-broken skin (i.e. without blisters, sores or ulcers).

Sun exposure

Avoid sun exposure on the treated areas for 3-4 days following treatment. Stay indoors as much as possible for the first 3-4 days following treatment. If you are outside, cover the treated area with clothing or a dressing if possible. Use a non-stick dressing such as Melolin. If your face was treated, wear a broad-brimmed hat.

Side effects

Crusted and peeling skin

As the skin recovers, about 2-3 days after treatment, you may notice peeling and crusts developing. Do not pick at the scabs or peel the skin off. In some cases, there is a very strong reaction to treatment. This usually means that there is significant underlying sun damage to the skin. In such a reaction, you might experience:

• Pain, redness and swelling for 2-3 days.
• Small fluid-filled blisters or pustules (Note: this pus is not necessarily a sign that the skin is infected; it’s a known reaction to the inflammation caused by PDT. However, if you have a fever or if any of the pustules are especially tender to touch, this may be a sign of infection and you should contact us soon as possible.)
• Peeling of the top layer of skin.
• Development of a crust over the treated area.
• Itch of the treated area (this is a sign of healing).

The reaction sometimes takes 2-3 weeks to settle and there may be residual redness of the treated area for 2-3 weeks after this. If you experience a very strong or uncomfortable reaction to photodynamic therapy, please don’t hesitate to contact us for advice.

Unfortunately, we can’t always predict who is going to experience this type of strong reaction to treatment. It’s more likely if there is extensive sun damage to the treated area (e.g. many solar keratoses or a history of multiple skin cancers in the affected area).

Cold sores

If you have a history of cold sores on or around your lips, you may experience an outbreak after photodynamic therapy. If we are aware of a history of cold sores, we’ll provide a preventative dose of famiciclovir before your treatment and a prescription so you can continue for several days.

Follow-up

Our doctor or nurse may call in the days following your treatment to check on your progress, answer your questions and recommend treatments for pain and inflammation if required.

We may ask you to return to the clinic for review after 4-5 days and again about a month so we can:

• Check for treatment complications which may require treatment.
• Check to see how well the treatment has worked. Photodynamic therapy (PDT) is effective 80-90% of the time, which means that you may require a further treatment, or possibly treatment alternatives such as surgery.

There will normally be no out-of-pocket expense for your post-treatment consultation. If follow-up treatment is required, we normally charge a much reduced fee.