Levulan

The commentaries expressed on this page are an opinion.

The FDA approved Levulan for treatment of actinic keratosis (and for the face only). However apparently some patients are getting approval from physicians to treat DSAP on arms and legs. My opinion and personal assessment of this drug (as used for DSAP), based on feedback from 2 people and one researcher, is to completely avoid this drug.  I have had two people email me with negative reports regarding their use of Levulan to treat DSAP. One patient  experienced promising improvement at first, but then about a year later reality sets in as the DSAP patient's skin returns to it's original state. The other experienced a worsening of DSAP. This "treatment" can be a painful procedure too! 

Someone has emailed me with a very promising report of another patient having great cosmetic success using Levulan to treat DSAP on her arms, after having tried all kinds of other medications and such to no avail. This had me excited. But no sooner did another patient contact me with some disappointing results. He lapsed back to his previous condition after what appeared to be initial optimism...

"...I have tried just about everything but have had no success. My last treatment was "Blue Light", which did make my spots less red and smooth. In fact, both my doctors were very optimistic as I was the same. However, my first time being exposed to the Summers sunlight, even though I used sunscreen, red spots reappeared as they were before and even spread to areas that were not affected before." - 06/28/02

Still another patient says that Levulan made their condition worse and biopsy revealed that it spread.

"I had treatment on my arms and legs and I have recently gotten a biopsy report that confirmed that the treatment actually spread the DSAP and now look awful to the point I can't wear short sleeves or shorts." - 7/18/07

It is a 2-step process where first they apply the Levulan, which acts as a "photosensitizer", or light sensitive drug for the damaged cells. Only the damaged cells, which grow faster than normal cells, "soak up" the Levulan. You return the next day for light therapy using a non-laser fluorescent blue light source. This light therapy is supposed to take 15 minutes and is somewhat painful (a burning feeling). But at least for one DSAP patient it was well worth it. 

In the Levulan Actinic Keratosis clinical trial summary “Over 90% of AK lesions cleared with Levulan® PDT. The treatment was well tolerated, gave excellent cosmetic results and would be chosen by most patients if they needed AKs treated in the future. 

However (as mentioned in a January 14, 2003 post) phototoxic reaction of Levulan treatment can also alter the skin's DNA! In this regard there are potentially serious unanswered questions. So one should definitely first read up on the "cons" on this treatment before blindly jumping in to this treatment. One post in the guestbook addresses these concerns. Try only a test spot before you jump in all the way with this treatment! And PLEASE report back with your results!

The person I got information from said that one doctor told her, “We have had some very nice results treating DSAP -- most impressive.” Keep in mind that the last this doctor sees of his patients are follow up visits. This doctor probably never sees his patients a year or more later!

If anyone out there learns of more doctors treating DSAP with Levulan then please report back! What kind of success have they had?

Finally I have to wonder why freezing and/or lasers wouldn't essentially achieve the same thing that Levulan does (and without the possible phototoxic risks that may or may occur). My opinion is that freezing would be the more desirable choice, because you're not possibly tampering with your DNA!

Again I am not a doctor and my opinion is based on emails, but my resounding conclusion is to steer clear of Levulan! Don't use it for DSAP.