Its record in treating warts is erratic, he said, although he has had luck sometimes by paring the wart down, applying several coats of ALA, and then occluding the wart overnight prior to exposure to a light source.
Dr. Hanke has conducted clinical trials for DUSA Pharmaceuticals. Dr. Goldman has been a consultant for DUSA and for the Luminis LightSheer diode laser system, which can be used for phototherapy. Dr. Sadick has conducted research and/or consulted with Syneron, Thermage Inc., and Omnilux Inc., companies that manufacture lasers and light sources that can be used in phototherapy.
Getting the Most from PDT
The following steps can maximize the effects of ALA-PDT:
1Discontinue topical retinoids several weeks before treatment with 5-aminolevulinic acid photodynamic therapy (ALA-PDT).
2Prepare the skin using gentle microdermabrasion or acetone (to maximize the PDT reaction), or isopropyl alcohol (to minimize the PDT reaction).
3 Use a fresh ampule of Levulan Kerastick (ALA). The drug becomes inactive 4 hours after being opened.
4Apply two coats of ALA with a cotton swab. Take extra care to avoid getting the solution in the patient's eyes.
5Adjust exposure to ALA and to the light or laser source according to the patient's condition and severity. For example, the photosensitizer should remain on the skin 60 minutes prior to PDT for treatment of photoaging. Exposure time will vary: 2225 minutes for an intense pulsed light source or 16 minutes and 40 seconds for a blue light source.
6Use cool airflow, rest periods, and, possibly, topical anesthesia or diazepam (510 mg) for pain management.
7Observe the patient post phototherapy, and wash the area thoroughly with soap and water to ensure that all of the photosensitizer has been removed. Apply sunscreen in the office.
8Be adamant in instructing the patient to avoid sun exposure altogether for 24 hours and to wear heavy sunscreen for 34 days. Patients can have extreme reactions to sun exposure in the days following phototherapy.
Source: Dr. Hanke