Enhancing Photodynamic Therapy With Red Light Applications, Patient Comfort, and Seasonal Trends

In a recent Dermatology Times Expert Perspectives custom video series, “Optimizing Photodynamic Therapy in Dermatology: Benefits of Red Light Therapy,” Aaron Farberg, MD; Brad Glick, DO, MPH; Anthony Rossi, MD; Ted Lain, MD, MBA; and Monica Boen, MD, discussed the intricacies of photodynamic therapy for actinic keratosis (AK), emphasizing patient-centered approaches, seasonal considerations, and more.

The 5 experts examined tailored photodynamic therapy strategies, highlighted patient education on treatment tolerability, and discussed advancements in combination therapies that aim to improve outcomes for patients with AK and other dermatologic conditions.

Variety of Uses

Farberg, a board-certified dermatologist and chief medical officer at Bare Dermatology in Dallas, Texas, discussed the uses of red light therapy. Primarily, red light therapy, when combined with 5-aminolevulinic acid (5-ALA), is approved for treating patients with AK. During photodynamic therapy, 5-ALA is metabolized into protoporphyrin IX, which becomes cytotoxic upon activation by red light at 635 nm, effectively targeting and destroying abnormal cells. Beyond AK, Farberg noted red light therapy’s off-label uses.

“For the most part in the dermatology space, what we see red light therapy used for off-label is skin rejuvenation. It is the antiaging light,” Farberg said. It’s also a natural treatment alternative for acne and may help with scarring and wound healing, although scientific support varies, he said. He emphasized the importance of avoiding insurance billing for aesthetic uses, as these applications lack FDA approval. In-office and at-home devices are available, with patients typically undergoing sessions several times a week.

Treating Damaged Skin

Glick, a board-certified dermatologist, residency program director at the Larkin Community Hospital Palm Springs Campus in Hialeah, Florida, and clinical assistant professor of dermatology at the Florida International University Herbert Wertheim College of Medicine in Miami, discussed the clinical applications of red light therapy, particularly in photodynamic therapy (PDT). Glick said that he primarily uses PDT for patients with AK or superficial nonmelanoma skin cancers, noting high clearance rates. “We get complete clearance rates of 70% to 80% lasting for about a year,” Glick said.

Beyond oncology, Glick uses PDT for photodamaged skin, achieving improvements in hyperpigmentation and collagen remodeling, which benefit patients seeking skin rejuvenation. PDT also provides a less-invasive alternative for treating superficial basal and squamous cell carcinomas, making it suitable for patients contraindicated for surgical excision or seeking less-intensive therapies.

Barriers of PDT

Rossi, a board-certified dermatologist at Memorial Sloan Kettering Cancer Center in New York, New York, addressed the challenges of PDT for patients with extensive sun damage or field cancerization. Treating large areas covered in AKs or early-stage squamous cell carcinoma can be painful for patients, particularly when treating areas such as the scalp or face, creating a barrier to PDT adherence.

“Finding ways to mitigate pain during photodynamic therapy is really important, not just for the patient, but just to make sure that they can complete the treatment and also come back for further treatments as needed,” Rossi said.

To increase patient comfort, Rossi shared pain mitigation strategies, including shortened incubation times for aminolevulinic acid; frequent, shorter sessions; and breaks during light exposure. Rossi also emphasized patient education, ensuring they understand the procedure’s potential discomfort and the “sunburn” sensation that may follow. Additional pain management options include cold air, water sprays, acetaminophen, and nerve blocks.

Combination Treatments

Lain, a board-certified dermatologist and chief medical officer of Sanova Dermatology in Austin, Texas, discussed effective combination strategies for PDT aimed at managing hyperkeratotic AK. Noting that PDT is best suited for grade 1 and 2 AKs, Lain highlighted liquid nitrogen as a pretreatment for more resilient, grade 3 lesions, as these are generally resistant to PDT alone. He also advocated for using tirbanibulin (Klisyri; Almirall) for field therapy 6 months post PDT, benefiting from its now-expanded 100 cm² area FDA approval.

“I freeze the hyperkeratotic AKs, wait 6 weeks, then perform PDT. Six months later, I will have my patients use Klisyri large-field field therapy for their full face or full scalp,” Lain explained, emphasizing the sequential approach. He also cited European trials’ results suggesting that adapalene 0.1% (Differin; Galderma) applied before PDT enhances AK clearance. Additionally, warming packs used post application can improve efficacy and provide a balanced strategy to optimize AK treatment outcomes, he said.

Seasonality of PDT

Boen, a board-certified dermatologist at Cosmetic Laser Dermatology in San Diego, California, noted a seasonal trend in PDT usage, with more procedures performed in winter than summer due to posttreatment photosensitivity. “There was an increase in PDT procedural claims during the winter months, September through February,” Boen explained, citing recent study results showing as much as a 278% increase in winter PDT use in some regions.

Although the shorter days of winter help patients limit sun exposure, summer treatments require greater caution, as the therapy increases photosensitivity for 48 hours. Patients may delay PDT in summer to avoid potential UV exposure and accommodate vacation plans. Despite this trend, Boen continues PDT yearround for patients with severe AK or acne, offering strict sun protection guidance to ensure safe outcomes and meet patient needs.