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My Experience with Levulan/PDT (started 9/24/08)

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The moderator deleted my previous posts, so here is the summary of the week's worth of posts that I had......


I am almost 22 years old and I have been battling acne for about 10 years. It is mild-moderate. In the last 2 years or so, it has been cystic and all along my jawline and into my cheeks. I tried many things and had acne facials done regularly (every 6-8 weeks) for the last 2 years. Recently I discovered Thermaclear while I was researching zeno. This is a device that zaps your pimples and uses heat to kill the bacteria. It is AMAZING at clearing up stubborn and deep pimples, but does nothing from preventing them in the first place. So I was still looking for something for that part of the problem. That is what led me to the levulan and PDT (photodynamic therapy)


My first treatment was on 9/24/2008. It started with a cleansing of my face, followed by a microdermabrasion to help the levulan penetrate deeper. Next, she put three layers of levulan on my whole face and I sat (well fell asleep actually) for 1 hour. This felt a little tingly at first, but I got over that quickly and it just felt tight. Next, she washed that off and I sat under the blue light for 15 minutes. This was definitely uncomfortable, but bearable. It was very warm and felt like I had been sitting in the sun for a very long time.

Day one...

Face was red and just felt like a sunburn. Pretty tight, but not very painful. My dermatologist told me to soak my face in 1 teaspoon white vinegar and 1 cup cold water. That was very soothing, but awkward because I had wet paper towels stuck all over my face..

Acne was exactly the same as the day before.

Day four...

No more redness or tightness. The acne I had before going in was almost completely gone. But I did have a few new ones that came up along my jawline. My face is still peeling a little. Mostly around my eyes. In places where I did not have acne, my skin felt smoother and looked less oily.

Week 1...

Yesterday marked one week after my first treatment and I have to say, I am not impressed at this point. All the acne I had going in cleared up quickly, but new ones took their place. I have about 8-10 new cystic acne spots that have come up. I wouldn't call this my "worst breakout ever" (as others have noted), but it is annoying. The brown spots I had seem to be lighter, but have not gone away.

Since everything is cystic, it is hard to see in pictures and it seems to me that the acne moved from the left side of my face to the right, but is getting better in appearance. But if you were to feel my face, it is still bumpy and not at all better. So keep that in mind when you look at the pictures that I have posted below.


I will keep you updated on my progress over the coming weeks and after my other treatments. I am getting 2 more (one every 4 weeks). The next is scheduled for a 3 weeks from tomorrow.

I hope reading through my experience helps someone make a more informed decision with this costly, but hopefully effective, treatment. Keeping my fingers crossed. :)

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2 weeks after first treatment...

My face is actually looking better. In the past week, I have only had 2 pimples come up and one was on my cheek. The downside is that all the ones I had from the first week have left red marks...You can't really see them with make-up on, but they are annoying because I know how long they take to go away. Hopefully the microderm I get before my next treatment will decrease them a bit.

I have not noticed a decrease in oil production on my face and my pores do not look any smaller (which are the other benefits of levulan/PDT).

I moved my appointment, so I will be going in on October 18th instead of the 24th. I will keep those of you following along updated for the next 10 days and I will post new pictures before going in for the second treatment.

If anyone has miracle cream for red marks, I would love to hear about it.

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So it has been 3 weeks and 1 day since my first treatment and my face feels like crap. My cheeks and jawline have quite a bit of painful, cystic acne. Even my forehead had a couple pimples... I am really looking forward to Saturday when I get the second treatment, because it is pretty miserable right now...

I will post before pictures in a couple days and then the after pictures about a week later. I will also post how the second treatment goes.

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I don;t have acne, but have a few under the skin pimples (Iguess thats what they are) and my derm rec. levulan treatment.

But I don't think i need it. I was going to do it for my oilyniess and larger pores. Which, honestly , i dont even really notice lol.

I jsut cant really afford to be stuck at hoem for days to heal. Even though I dont have sensitive skin and hav a olive/tan complexion I'm afraid.

I got microderm done today and was just red for about 20 minutes. Pretty much back to normal now. Any advice on if i shoudl get it or not? Any other pores treatments you guys knwo of?

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6 hours after my 2nd treatment...

I got my second treatment of the levulan and PDT today (3 weeks and 3 days after my first). It was a little worse than the first time...

Same process. First a cleansing, then a microdermabrasion. She did a few extractions and then cleaned my face with acetone. The acetone stung a lot more than the first time...I am not sure why, but she gave me a fan and that helped a lot. Next was the 2 layers of levulan. That also stung a lot more than the first time. The fan was a big help again. Once it dried though, it didn't hurt at all. Only a little tight. I had this on for an hour and then went under the blu-u light (PDT) for 20 minutes (5 minutes more than last time). She decided to put me under the light longer this time because my down time the first time around was fairly minimal. This also burned quite a bit more than the last time. It was VERY uncomfortable almost from the second the light went on. But I figured I can stand 20 minutes of pain if it means my acne clears up...

Right now my face is pretty red and burns quite a bit. It is definitely more painful than the first time. I am constantly aware of it, whereas last time, it died down pretty quickly. I just put white vinegar and water on my face and that helped, but it was only temporarily.

So I guess I am in for another boring weekend of staying indoors. I put a link to my before the second treatment pictures, and then 2 hours after the treatment. But honestly, not much has changed since I started this whole process...


And to Wvulovey-

You do not seem that bothered by your acne..So I wouldn't recommend a treatment that is expensive and takes months for the full effects, unless money is of no object. I mean it is kind of a catch 22, you could have less downtime if you are conservative on the treatments, but then you would have to get more of them. If you don't care what people think of your face's appearance, you could always get a treatment done on a Friday afternoon and hide out during the weekend, then go about your normal life on Monday with flaking and peeling skin.

As of right now, I haven't noticed a decrease in oil production or smaller pores - stay tuned for my upcoming treatments.

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30 hours after 2nd treatment...

All day yesterday and this morning my face was very red and painful. Right now, it is still pretty tender, very tight and very dry (mostly on my cheeks, chin, and jawline). The redness has almost completely gone away. No new pimples have come up; the old ones feel like they are drying up and a little scabby. Moisturizer only does so much because it is soo dry that it just sucks it away...

Nothing too different than last time except the initial pain level increasing. Acne is not better or worse.

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3 days after 2nd treatment...

My face is flaking quite a bit, which is unfortunate because I have work.. It is focused on my chin and cheeks. It is very dry, tight, and a little itchy. This is much more of a reaction than the first time around and I find that kind of amazing that only 5 additional minutes of the blue light causes this much more flaking and peeling.

For those of you thinking of getting this treatment, I would recommend staying away from people if you embarrass easily and you may want to think about taking more than 2 days off. Last time I took 4 days, and I only needed two...And this time it seems the other way around. I am trying very hard to not peel off the layers, but it is tempting. Oh, and I have been using Purpose moisturizing lotion. That takes away the tightness, but doesn't do anything for the peeling.

No new acne. And what I had going in is almost completely gone. Still lots of brown/red (hard to tell) spots on my cheeks...

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5 days after second treatment...

Well all of the peeling and flaking has stopped. My face still feels a little dry, but nothing too noticeable. Apparently my face is purging again...I got about 5-6 new pimples yesterday and today on my cheeks and jawline. And I haven't seen any change in my pore size.

I don't know. I am feeling discouraged right now, but hopefully it turns around.

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It has been one week and one day since the second treatment and my face is exactly the same from the very beginning. The pimples are just in different places. It seems like my face is looking great, or looking bad. There does not seem to be much middle ground and it changes from day to day. I don't know what else to say at this point...

Below is a link to the before and one week after the second treatment pictures.


Not much difference in my opinion...

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Well, you've only been doing this for a month, skin usually takes about 3 months to respond to a treatment. Hopefully you'll see improvement from here on.

Having said that, levulan seems to have poor improvement rates, most other treatments are up in the 75% of people seem to get improvement from it. levulan is more like 30% improvement, the rest see worsening or no change. And there's no published papers on levulan in the dermatological journals- that's pretty scary.

What other treatments have you tried before levulan popsicle?

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Oh wait, I found a study back in 2006:


They found that BLU-U (which is just the blue light) actually gave better clearance than BLU-U + Levulan (80% clearance versus 60% clearance).

That would seem to suggest that the levulan irritates the skin and makes acne worse.

And other research says that blue light + red light gives better clearance than just blue light. Red light is anti-inflammatory.

That might explain the relatively bad response that people seem to get to levulan.

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Dusa Pharmaceuticals abandons Levulan PDT

Oct 27, 2008

Dermatology Times

Wilmington, Mass. — Dusa Pharmaceuticals has stopped developing Levulan photo dynamic therapy for acne, after mid-stage trials failed to show statistically significant results, Reuters reports.

The treatment combination, called Levulan PDT, is approved for the treatment of actinic keratoses of the face and scalp. It is also used off-label to treat photodamage.

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What other treatments have you tried before levulan popsicle?

Well, this is the first major treatment I have done. But I have been on a large variety of product over the last 10 or so years. Some that I have used the most of are Retin-A, benzamycin, differin, Jan Marini products, dermalogica, and other random ones. Over the last 2 years, I have had pretty regular acne facials (every 6-8 weeks) and these often included some kind of peel. Most everything I have tried has done a decent job at making sure the acne didn’t get any worse, but nothing was preventing it from coming up. About 2 months ago I discovered Thermaclear and I love it. It helps my cystic acne go away in a few days (in most cases). But again, it doesn’t keep them from coming up in the first place.

But I do all the normal stuff, like sunscreen daily, changing washcloths and pillowcases constantly (which are washed in baby soap). And when I travel, I always bring my own towels and pillowcases.

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12 days after my second treatment, and 36 days after my first...

Well my face is looking much better than my last post. I have a couple deep cystic ones on my right cheek right now, but they are going down little by little. My jawline is almost completely clear (2 tiny ones - one on each side). I have noticed zero difference in my oil production. Some of the red marks have gone away, but I think that is from the microderm. I have not had a new pimple come up in about 4 days. This is a new record for me. But knock on wood!

I will post some more pictures this weekend at the 2 week mark.

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It doesn't look that different from the 1 week after the second treatment because my cheeks are about the same. But it is hard to tell in the pictures, but the cystic acne on my jawline is almost gone. Just two very shallow ones. Also, I have a fair amount of red marks and as most of you know those won't go away in a week.

Here is the link to the pictures 2 weeks after second treatment.


And so you don't have to go looking for the other links... This is the before and 1 week after the second treatment.


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Popsicle, what do you think about the phase II results of Levulan?

Well I am really pleased with the results along my jawline. I used to get a lot of deep and painful cystic acne and now it hasn't been like that for about a week and a half. But on the other hand, I have gotten more cystic acne on my cheeks...But I know that purging is to be expected.

Right now, I have about 4-5 cystic pimples total on my face. The problem is I still have a lot of red marks, so it doesn't LOOK a whole lot better, but FEELS a lot better.

So overall, I am happy with the results as of right now. I think the second treatment was much more effective than the first.

I wish I could capture that better in the pictures, but it is just hard to see the cystic acne come and go and the red marks make it look worse...

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No I meant the phase II clinical study that seems to show that levulan didn't do any better than just blue light on its own; (actually the blue light seemed to clear more people.)

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Oh, sorry. I hadn't honestly taken the time to read it yet, but now that I have, here are my thoughts...

Well I didn't take that it to mean that acne gets worse with both levulan and blu-u than from blu-u alone. It seems to just not make much difference....From what I understand from the article, it seems that blu-u alone is better for those with moderate acne and the combination of both is better for those with more severe acne. Which I could see as true, just because of the results of the Thermaclear (blue light) that I used as spot treatment before starting this process. It did an awesome job and didn't make it worse.

But the study doesn't seem to have gone beyond the 8 week mark and from everything else I have heard, you don't see full results for 3-4 months.

I think their results are interesting, but I also believe that there needs to be a much more intensive study done including more varying levels of acne and more people, for the evidence to be credible. The study doesn't talk about other factors either. I mean, for example, I would assume the at home regimens of all the participants is the same, but it isn't specified. Neither is age, lifestyle, previous treatments, etc.

On the other hand, I totally agree that the mid-way results are far from impressive. Which, most people admit it takes much more time than that.

But I do hope to see further research and studies done on Levulan and Blu-U because they do seem to have something here, it just hasn't been perfected at this point. And whether it is true or not, I do not think that Dusa Pharmaceuticals should abandon this treatment because of midway results, but because of failure to work in the long run (a couple of months out). Also, failure to show statistically significant results means they didn't find that it helped or made it worse. Just that they couldn't really say one way or the other. Which is how I felt at half-way point, as well.

For me personally, I have seen big differences from the first and second treatment and hopefully after my third treatment (Friday, Nov. 14th), I will see even more. It boils down to the fact that everyone has different skin types, acne levels, regimens, and the list goes on and on. I think that is what makes curing acne sooo difficult. We all know people who have tried something that worked for them, gotten hopeful, and tried it ourselves with no results. That is why I just decided to bite the bullet and try something different because, frankly, the success rate of everything else I have tried is far less than 60% clearance.

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I don't know. Some people here got more or less permanent pigmentation changes and there's nothing in the literature that would make me want to risk that. It also seems quite random, people had brilliant results, and then suddenly had a really, really bad experience, others just had fantastic results. I'm also unconvinced by the severe group- they probably didn't have enough people to draw firm conclusions.

BLU-U for example would probably be cheaper and a lot less risky, and it looks like it would work just as well. Blue/red should work if anything better still, and be very low risk.

Anyway, let us know what you decide.

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Im 27 years old (female) and I have been battling acne for 15 years. It only got really bad in the last 4 years. I have cystic acne along the jawline. I did Levulan/PDT treatments and saw no results! I believe it will work if the underlying problem is not hormonal. I know all acne is hormonal to some point, but for women with hormone problems, seeking out other cures is the way to go.

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3rd and Final treatment...

It has been about 20 hours since my third treatment. It went just like the other two. Cleanse, microderm, acetone, 1 hour of levulan, and 22 minutes under the light.

The process felt a lot like the first time and was not nearly as bad as the second time. I think this was because I don't really have any breakouts right now and before the second time, my face was not doing great. This time around, the levulan stung and was itchy going on but subsided after about 5 minutes. She concentrated most of the levulan on my cheeks (4 layers there as opposed to 3 everywhere else). The blu-u was very hot and uncomfortable. Last night, my face was hardly red and I was a little concerned that something might have gone wrong. But this morning it was nice and sunburnt-looking and I have goggle marks. It is not nearly as tight and dry as the second time.

As far as the acne goes, it is loads better. I only have a couple of cystic ones that are getting smaller each day (rather slowly though). Nothing new has come up for a little while now.

The downside...I have a lot more red marks than before. I don't think they have every been this bad on my cheeks. I am hoping they are superficial and will go away soon, but time will tell. I have heard glycolic helps with that, so I will look into that once my face is back to normal.

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3 days after 3rd treatment

My face is really dry and starting to flake. Not near as bad as the second time. And you can't really tell unless you are starring at me and you are really close.

I have had one rather large pimple come up on my cheekbone, but nothing else. Red marks look a little better from the microderm but nothing significant.

Soooo, nothing too exciting except dryness. Not that dryness is cool or anything, Just something to report. :)

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