LOS CABOS, MEXICO Dr. Mitchel P. Goldman doesn't accept insurance and says he believes that his cash-only acne patients get more for their money with one to three photodynamic therapy sessions than they do with years of prescriptions for medications, he said at the annual meeting of the Noah Worcester Dermatological Society.
Although he says he knows it sounds heretical"and maybe you'll strip me of my derm boards"he has been using the photosensitizing agent 5-aminolevulinic acid (ALA) followed by exposure to a blue-light laser for nearly 4 years and he thinks that there is nothing better for acne. "As soon as insurance companies wake up and realize it's a hell of a lot cheaper to do this than prescribe Accutanethey'll cover it," said Dr. Goldman, a dermatologist in private practice in La Jolla, Calif.
In the meantime, his patients pay $500-$600 for a treatment session that consists of a salicylic acid prep, microdermabrasion of the affected area, a scrub with acetone, 1-hour exposure to ALA (Levulan Kerastik, DUSA Pharmaceuticals), and 1015 minutes' exposure to a blue light that is approved for the treatment of acne (BLU-U Photodynamic Therapy Illuminator, DUSA Pharmaceuticals Inc.), as well as long-pulse dye laser to individual acne lesions.
He said that he sees at least a 30% improvement in inflammatory acne after each treatment, spaced about 4 weeks apart. He has never done more than three treatments on a patient and he has never seen a patient's acne rebound, even years after a final treatment.
"Have I done controlled studies? No," he admitted. "It definitely lasts a long time."
Dr. Goldman explained that he is reassured by animal data, which show that exposure to photodynamic therapy (PDT) actually reduced, and did not increase, the risk of skin cancer ("Photodynamic Therapy" [London: Elsevier, 2005], pp. 5364).
He says he has biopsied patients and seen a 90% decrease in the size of sebaceous glands after PDT.
He's read the studies that show that ALA-PDT kills bacteria and appears to normalize follicular shedding, and has participated in a study comparing blue light therapy with topical 1% clindamycin solution for inflammatory acne, in which lesions were reduced 34% after blue light therapy, compared with 14% with clindamycin (J. Drugs Dermatol. 2005;4:6470).
"This is something the pharmaceutical companies do not want us to investigate, because they're going to lose a few billion dollars in acne treatment," he said.
Dr. Goldman disclosed that he has served as a consultant to DUSA Pharmaceuticals, the manufacturer of Levulan Kerastik (ALA) and the BLU-U light source.