Does anyone have any experience with Levulan treatments (activated by blue LED light) for AK's? Are you having success with the treatment? Also, it is used off-label for cystic acne patients as well. Anyone have any comments on that? We are considering getting started with Levulan Kerastick treatments at our office and I would appreciate any comments/tips/advice anyone might have...

Tony PA-C,

We have been using it for about 2 years and have seen fairly good results with it for both AK's and acne. We use IPL to activate wavelength 420 instead of the blue light LED. We first do an acetone wash and then 30 to 60 minute incubation followed by activation. Some feel that you need longer incubation for the AK's up to 4 hours and longer. The issue with the longer incubation is that you will have a lot more redness and flaking with more down time.

Dusa may try to tell you it works for pigmentation as well but do not use it for that. You may see some cosmetic improvement but not nearly enough compared to the cost.

Tony-
We have been using Blu-U Levulan treatments for acne for some time. Our basic protocol is similar to LH's but we do incubate for at least 2 hours. We tried the Dusa recommendations but got very little results. It usually takes 2-3 treatments for AK's to budge but we have had good longevity in results. The problem is gettign a patient to go thru that a few times. And the cost is a factor. I have been working with Aldara concurrently with simple IPL treatments and have ben getting some pretty reasonable results with less downtime. The Levulan is about $110 per application which is pretty pricey for iffy results, so we focus on the folks who really want to blast into the acne. Most of our acne patients are at least 80-90% clear for a couple of months after one treatment. We work with them on a good regimen to keep them clean after that but also keep the door open for additional treatments to clean it up even more.

Hope this helps!

I use a 4-6 hr incubation for the levulan and activate w/ 420nm IPL, great results. I get one a yr myself.

How much down time are you seeing with the 4 to 6 hour incubation? Are you having them wait in your clinic?

Wow-4 hour incubation! I use one hour then Blu-u for 8-15 mins and the patients feel that gives ALOT of downtime. Some AK's are gone in one treatment although I usually try to do 2-3 tx's. I have some patients whose acne has not responded as well to the ALA as others and it is a source of frustration for them and me! I would definitely add to to your practice as it is a nice alternative to Accutane and most should get some relief.

When you treat acne, are you using a red LED light in addition to blue? Because the red light is helpful with inflammation, it makes sense to use both, right?

Tony,
I have been using Levulan for about 3 yrs now. We use it for acne (1 hr uncubation and 20 minutes of ClearLight). I have had less results with AK's. I have even incubated as long as 8 hrs and some of the thicker lesions will not change. So I don't offer that now. I have used it with IPL as well. I offer a "golfers" package of 2 PDT sessions with 420 wavelength since it is "pain-free" unlike IPL. Men tolerate it better. I currently have my ClearLight for sale if you are interested. I can make you a great deal. Keep in mind with the Blu-Light it is very hard to do areas off the face due to the design of the machine. The ClearLight can activate Levulan any where on the body. My email is dcurtis35@earthlink.net if you are interested.
DC

After a 4-6 hr incubation there is about 3 days of peeling: we do a lot on Thursday, pt has hard crust on Fri ((but can work) and peels Sat,Sun. Mild erythema on Monday. I too have a Clearlight for sale, I wish I'd bought the Blu-U from Dusa.

I love my Blu light and find it works better than the IPL for acne or AK's, which teens do not tolerate! I only downside is that it costs them more than they think it should. I wonder with insurance what their out of pocket expense is for Accutane.

We have used ALA for treatment of acne and AK for 3 years. Depending on the case we incubate for 1-1/2 hours and then with skin types 1-3 we may even use IPL filter 560 for the first pass and then 420 filter at 5cmj2 200pw for 2 additional passes. It can be a bit annoying for the patient as far as comfort but the results are phenomenal. We typically recommend 3-5 tx (again depending on the case) in order to maintain longevity of the clearance the patient has achieved.
We have used it in the treatment of AK with good results. Incubation of 2-4 hrs depending on the case. Similar application of light, varies based on skin type. There are some cases of people that do not react at all. This is a small percentage and should be explained in consultation to help manage expectations.