Daylight PDT (Photodynamic Therapy) for Actinic Keratosis

What to expect one week before, on the day of your treatment and one week after treatment:

One week before:

Dr. Poelman will give you a prescription for Tazorac 0.05% cream to apply a thin layer evenly at night over the areas that will be treated with PDT. This will make your skin red and a bit scaly (irritated).

Day of treatment:

1. Patient washes their skin well with recommended gentle cleanser at clinic

2. A  sunscreen will be applied to all areas that will be sun-exposed.

3. A gentle curettage (scraping) will be performed on your treatment area which gently removes the dead skin and thin top layer of the skin to allow even and consistent penetration of the Metvix cream.

4. The Metvix cream will be cold as it is kept refrigerated prior to treatment to ensure the integrity of the product. The Metvix cream will be applied using a spatula/tongue depressor using gloved hands and then rubbed in for penetration.

5. Once the Metvix cream had been applied to your treatment area you will be asked to go outside within 30 minutes of the application and remain outside for 2-3 hours. You may sit outside in the sun, or under an umbrella or porch as long as the covered area is not more than 7m in diameter and as long as there is ample daylight around you (i.e. you are not in a tightly enclosed area). The weather may be sunny or partly cloudy but on rainy days we won’t likely be able to do daylight PDT. You may sit next to a window only if you are exposed to direct sunlight.

6. After 2-3 hours, you will return to the clinic where the treatment area will then be exposed to a specific calibrated light for your treatment for a period of 9-36 minutes, depending on your condition. During this activation time you will experience a sensation of tingling and slight burning (much like a mild sunburn).
This reaction of your skin is normal and will subside in a few short minutes. There will be cool compresses or a hand-held fan on hand if you require a cooling of the treatment area during treatment.

7. Once the light activation of Metvix is complete you will wash your face thoroughly with a recommended cleanser and apply moisturizer if suggested. You will then be provided with a follow-up date with Dr. Poelman. Once you leave the clinic, remain inside for the rest of the day. You should avoid sunlight or prolonged indoor light exposure to the treated area for 48 hours after your treatment.

8. You will be provided with post-treatment instructions and recommended products for use during your period of recovery. Typically your skin will appear red (sunburned) for a period of 5-7 days with a possibility of crusting at the lesion site and flaking of the dead skin. These reactions are entirely expected and normal as your skin renews itself with new healthy skin cells and the old skin sloughs off naturally.

9. Depending on your treatment area and skin condition treated, you may require a second treatment within 2-4 weeks. These details will be discussed and provided to you upon your follow-up appointment booking.

10. If you have third party coverage to a receipt of the Metvix drug will be provided to you upon completion to supply to your third party coverage group for re-imbursement of the cost of the Metvix cream only. In Alberta, the Alberta Health Services Plan covers the cost of the procedure.

Post Treatment Instruction:

Home care instructions following Photodynamic Therapy with Metvix:

Day of Treatment:

  • *Your physician may recommend you take a Benadryl prior to treatment
  • Remain indoors and avoid direct daylight for 48 hours
  • Begin applying cold cloths; adding an ice pack over top (frozen peas or corn work well as a re-usable ice pack – this will help keep the area cool and alleviate any discomfort due to mild swelling) – this can be repeated as often as you wish for periods of 5-10 minutes allowing skin to recover from ice pack in-between sessions.
  • Before bed you can soak the treated areas with a solution of 1 teaspoon white vinegar in 1 cup of water. Keep in fridge. Pour solution over clean face cloth. Apply to treatment area for 10-15 minutes. Ice may be applied directly over the vinegar soaks.
  • Prior to bed; pat area dry and apply 1% hydrocortisone ointment
  • Swelling will be most evident around the eyes and is usually more prominent in the morning
  • Elevate your head on two pillows when sleeping to reduce swelling
  • Take analgesics such as Tylenol or Advil if necessary

Day 2:

  • *Your physician may recommend taking Benadryl as needed
  • Avoid sunlight and fluorescent lights all day (stay home if you can).
  • Continue to apply ice packs as needed. Apply vinegar soak every 4-6 hours to alleviate discomfort and swelling as directed above.
  • You may take a shower. You may take analgesics (Tylenol or Advil).
  • Any discomfort usually subsides by day 3
  • Photosensitivity is usually gone 24 hours after treatment, but may last as long as 40 hours

Day 3-7:

  • Skin will feel tight and dry- use the daily cleanser to keep skin clean and aid in the sloughing of the dead skin process. Once you have cleaned the treated area, pat the skin dry and moisturize with Glaxal base or Cerave cream. Repeat above mentioned ice packs and vinegar solution as required, however it is not likely any discomfort will be present at this time. The directed area may be red for 7-10 days after the Metvix treatment.
  • Your treated area will be sun sensitive (and more likely to burn) for the next two weeks. Be sure to wear a sunscreen with SPF 50, and a hat, sunglasses, or protective clothing depending on area
  • If you are experiencing more pain and irritation than is expected, please contact out office at (403)-457-0063 for further support.
  • **If you have fever above 39 degrees Celsius, redness or swelling outside of the treatment area, greenish discharge or foul odor go immediately to your local emergency room.