Video Production by Josh Melendez

Dr. Anderson explains photodynamic light therapy, shows what it looks like and what it treats. This treatment is also referred to as Blue Light Therapy or Red Light Therapy.

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Video Transcript:

This video is going to be talking to you about prevention of the consequences that happen from sun damage, once you’ve already started experiencing the consequences.

So you’ve had pre-cancers or actinic keratosis treated by your local dermatologists, and sometimes those treatments are either through freezing or creams, but there’s also another treatment called light therapy. And light therapy is broken down into blue light and red light. And with each types of light therapy there are different activators, but the procedure is the same. And the goals are the same, and the reasons why we’re doing it are the same.

So when we freeze just one or two pre-cancers on an area, like a face, and we don’t really see much else going on, often what we do is we just freeze them and watch them. But if you start exhibiting lots of pre-cancers in different areas on your face, or maybe on top of your arms, or maybe your head, we start to wonder how many more are lurking below the surface that we can’t see or feel. And then we usually recommend a treatment called a field treatment, or an area treatment, so the field of your face, or the feel of the top of your scalp, or the field of your forearms, that sort of thing.

Once you start having enough signs of sun damage, that show as either pre-cancers or maybe even cancers, we want to do something to prevent more from popping up in the future. There’s two basic modalities for that besides the sun protection, and all the other things that we’ve spoken about before. What this video is going to be talking to you about is how to prevent what’s already there. Whether we can see it, or we can’t see it. So for these procedures we use a very specific light source, and a very specific activator of that light source to cause preferential localized damage to the areas that are trying to turn cancerous.

A lot of people ask, “Well if you’re using a light source to do this, and the sun is a light source that’s caused all this in the first place, aren’t we causing more damage?” And the answer is not really. We’re causing damage to the areas that need to be damaged. The cells that are misbehaving, that are trying to turn cancerous. But we’re not causing any appreciable damage to the cells that are not trying to become problematic. The light therapy that we’re talking about treats a field. And what we do is we have you come into the clinic prepared for the area or for the field to be treated.

Now, what that means is that we do not want anything obstructing the special light that we’re gonna use from reaching your skin. So we want you to wash the area very well with the gentle cleanser, and pat dry, and then please don’t put anything on your skin. No moisturizers, no makeup, no sunscreens, nothing. So before you come in, wash the area thoroughly, pat dry. We’d also like if you’re gonna be having treatment in an area that has hair, we’d like you to shave that hair off two days prior to the procedure. Because light can’t penetrate through the hair to get to the skin where it needs to do the work.

One thing that’s really important to let your dermatologists know, is if you have any of the conditions listed here, because those conditions might make the light treatment not optimal for you. Another thing that you should let your dermatologist know, is if you get cold sores. Because if we’re treating an area like the face, and you happen to get cold sores, and we’re using a light source to activate the chemical that we put on, that activation could lead to a cold sore. So we’d like to put you on suppressive medications before you have this treatment, so that you’re not dealing with a cold sore afterwards.

Even though this procedure tends not to have as severe side effects or reactions as those creams do, you still can get a fairly significant reaction. One thing that you can try is for two days prior, for the day of, and two days after the procedure, you can take a daily dose of one of the non-sedating antihistamines, like Allegra or Claritin or Zyrtec. You start at two days before the procedure, continue at the day of the procedure, and two days after.

Now what’s gonna happen when you come into the clinic is we’re gonna make sure that the area is clean. So, please clean at first yourself, and then we will re-clean it. Then we’re going to take a special device called a curette, and basically it’s just a scraper. And for the really thick pre-cancers that we see, we’re gonna usually scrape off the top of those, so that the medication we put on top, doesn’t have a very thick layer it has to penetrate through. So what we’re doing right now is we’re scraping off the extra thick pre-cancers, and that’s so that the medication that we’re about to put on can get to the area it needs to get, because if you have a big thick crust in an area, then the medication might not penetrate down. And the great thing about this treatment is, it’s treating the whole area. So even the ones we can’t see or feel yet, it’s going to be helping to treat. Next we’re going to apply the medication to the area, and then you’re gonna wait for what we call the incubation period.

That medication has to soak in, and so there are different protocols. Sometimes you’ll be waiting in the lobby for 60, 90, 120 minutes. Sometimes we put the medication on and ask you to go home and come back the next day. After that incubation period, we bring you back into the room ,we put on goggles so your eyes don’t get any excess light source, and then we put you underneath the light for a prescribed period of time. Your dermatologist will talk to you about how long that is. But usually it’s a little bit less than twenty minutes.

Now when you’re under the light for the prescribed period of time, it’s gonna be hot and it’s gonna be irritating. It’s gonna feel like you’re getting a sunburn. Now we do have devices that can help decrease that sensation of the sunburn. Just talk to your local dermatologist if it’s getting too much, and we can always stop the treatment if you say that the sensation is too much. So the first four days after this procedure, we really need you to be careful with getting more activation from the chemical that was put on your face by regular light sources. That includes the sun, that also includes indoor lights, computer screens, those sorts of things.

So, please use lots of sunscreen. And your dermatologist will give you a handout for how to prepare or before, during, and after. And if you don’t have one, you can find one in the links below and you can use ours. Because while that might not be perfect for your individual dermatologist, the recommendations are probably fairly universal. Please remember with the topic of actinic keratosis or these pre-cancers, there’s a continuum from completely normal skin to squamous cell cancer. And we make judgment calls all day long with thousands and thousands of lesions that fall in this narrow area. So if we think it’s an actinic keratosis here, and we treat it like it’s an actinic keratosis and it goes away, then it was an actinic keratosis and everybody’s happy. But if we treat it as an actinic keratosis right here, and it doesn’t go away then, we really need your help to bring those lesions to our attention. Because in this continuum the closer you get to becoming a squamous cell cancer, the less likely the treatments that we’ve prescribed for pre-cancers are going to work.

So anything a dermatologist ever treats, but doesn’t go away in the prescribed period of time which is usually about four weeks, we really need to know and we need you to call us to make that appointment. Thank you as always for helping us to allow you become comfortable in your skin.

Patient: The blue light, you come in and for about, they’ve had it timed to 14 point point something minutes or 17 point something minutes, and you, they put this, you get in this horseshoe-shaped apparatus with these blue light shining on you, and they put cream, this cream or a solution on your face which reacts with the keratosis when they turn that blue light, on it gets hot.

They do have a fan that you can use to keep yourself cool, but it’s, it’s very warm and then for the next, three or four days that’s rather unpleasant, because you have to keep it moisturized, you have to stay out, err, indoors as much as possible. You have to put on a sunscreen that has metals in it to keep you, keep any light away from the procedure. Because you’re so, so skin sensitive at that point. That tends to go away. You still got to keep your skin very moist for a couple of weeks, and then after that, there’s, there’s nothing, there’s no aftermath.

Hopefully the results will keep me from having as many surgeries in the future. That it got rid of err, those keratosis before they become harmless or harmful.

About the author

Dr. Anderson with Doctors Quarterly Magazine - Cropped
Dr. Reagan Anderson

Dr. Anderson is a Board Certified Dermatologist and Mohs Micrographic Surgeon. He serves as a Clinical Professor of Dermatology and is actively involved in patient and healthcare provider education on dermatology conditions and treatment.

Colorado Dermatology Institute
8580 Scarborough Drive / 1220 Lake Plaza Drive
Colorado Springs, Colorado