FDA Green-Lights Light Therapy for Dangerous Skin Condition
Oct. 3, 2000 -- The FDA has approved a new therapy for treating actinic keratoses, a skin disease resulting from repeated sun exposure. The treatment is called photodynamic therapy -- or PDT -- and although patients prefer the new approach over current treatments, doctors say prevention is still the best medicine.
Actinic keratoses consists of scaly discolored patches often found on the face and scalp of fair-skinned adults over the age of 40. If left untreated, the patches can lead to skin cancer. In fact, 40% of one type of skin cancer starts as actinic keratoses. That's why the American Cancer Society, the Skin Cancer Foundation, and the American Academy of Dermatology recommend prompt treatment, especially if the patches are bleeding or getting larger.
PDT uses blue light to activate the drug Levulan. After a physician applies Levulan to the skin with a special applicator, patients return the next day for a light treatment. Compared to two other treatment options, PDT has fewer side effects, yet it costs about the same.
One of these options is cryotherapy, or freezing the lesions with liquid nitrogen. This is effective, but time-consuming if there's lots of patches. It's also not covered by Medicare without a previous history of skin cancer, which causes many dermatologists to prescribe the other option, Efudex liquid or cream, for up to a month. Unfortunately, this therapy often causes severe redness and burning of the skin.
"After using [Efudex], I've seen faces that look like hamburger in no time," says Richard Taylor, MD, chief of dermatology at the Miami VA Medical Center. "It's often unpleasant, so many patients just stop using it," Taylor, who is also professor of dermatology at the University of Miami School of Medicine, tells WebMD.
But as one of the doctors who tested the new light therapy, Taylor tells WebMD that it has very few side effects. Following treatment in studies, more than 80% of the patients said they'd use it again, and over 90% rated their response as excellent or good. With just one or two applications, nearly 90% had most of their lesions cleared, and only 3% discontinued treatment due to stinging or burning.
After winning FDA approval last week, the therapy will soon be available to patients. In the meantime, its developer and distributor are teaching doctors how to bill insurance plans for the procedure so patients won't have to pay out of pocket, according to dermatologist Geoffrey Shulman, MD, the president and CEO of DUSA Pharmaceuticals in Wilmington, Mass.
Others want to make sure that patients know how to prevent actinic keratoses. "If you reduce sun exposure, you not only lower the risk of [actinic keratoses], but also squamous cell carcinoma, basal cell carcinoma, and malignant melanoma," says Mark Naylor, MD, an associate professor of dermatology at the University of Oklahoma School of Medicine. As a three-step prevention approach, here's what Naylor and the American Academy of Dermatology recommend:
- Avoid the sun from 10 a.m. to 4 p.m., when it's directly overhead.
- Wear protective clothing like long sleeves and a hat.
- Apply a sunscreen with an SPF of 30 daily, using enough to fill a shot glass.
Suspicious-looking skin patches on the face or body should be seen by a doctor for evaluation.