Anew photodynamic cosmetic treatment procedure recently launched in the US has expanded the field of non-invasive rejuvenation procedures and achieved a high level of patientreported satisfaction. According to a recent survey of patients three months after receiving Allumera (Photocure), 93 percent said their skin felt softer, and almost as many (91 percent) said skin felt more hydrated, moisturized and smoother. Eighty-nine percent said their skin texture was improved. The data were reported by Photocure. Ahead, Jeanine B. Downie, MD, an investigator in the trials of Allumera, describes the new procedure and its role in practice.

How do you describe Allumera to patients?

Allumera is a photodynamic cosmetic therapy that involves three basic steps. Allumera cream—the photosensitizing agent—is applied to the face and left in place for an hour. The cream is then washed off and the treated skin is exposed to a red light source from 400-700nm. Dr. Downie uses the OmniLux (PhotoMedex, Inc.) red light source that is 635nm.

According to Dr. Downie, Allumera is an ideal intervention for individuals who want a rejuvenation procedure that provides a more dramatic improvement than a superficial chemical peel but who are not ready for a more invasive procedure. She says the photodynamic therapy successfully addresses pore size, pigmentation irregularities, texture, tone, and to some degree fine lines and wrinkles.

Allumera's ability to reduce pore size sets it apart from chemical peels. Additionally, the procedure is safe and effective in all skin types; stronger chemical peels may not be. Dr. Downie considers Allumera to fall somewhere between superficial chemical peels and an ablative procedure like Fraxel re:store.

“To help patients understand the procedure, I call it ‘light-activated therapy,'” Dr. Downie says. Pre-procedure, Dr. Downie explains how it works, the time commitment (they'll be in the office over an hour) and the need to avoid sun exposure after the procedure, as described below. Optimal results require three treatments spaced four weeks apart. For maintenance, Allumera has recommended retreatment every six months

What is the process like for patients?

The most important consideration for patient selection, Dr. Downie says, is the patient's ability to comply with sun avoidance. “If you can't stay out of the sun then you can't do the procedure,” she says. Immediately after treatment, patients apply sunscreen and are to avoid UV exposure for at least 48 hours, preferably longer. Walking to and from the car is permitted (exposure is minimized with use of sunscreen and physical protection, like hats and scarves) but patients should stay indoors as much as possible the first few days after treatment. General UV avoidance weeks and months after treatment will improve and preserve long-term outcomes, Dr. Downie says.

Because of the one-hour Allumera incubation period, a comfortable waiting area for patients is essential. Dr. Downie uses rooms originally designated as “numbing rooms” for cosmetic laser procedures. She offers WiFi and encourages her patients to bring wireless devices with them to pass the time. She says she has an open attitude about cell phones and is flexible with patients. If someone is mid-conversation when she enters the room, she'll move on to another patient and give the individual time to wrap up their call.

The cost of the procedure may vary from provider to provider, but is expected to be around $400-500 on average. Dr. Downie believes cost will make the procedure attractive to patients who would not pay much less for a superficial chemical peel and would pay three- to four-times as much for fractionated resurfacing.

What are the demands on the physician and staff?

The lone investment a practice must make to provide Allumera is to purchase an appropriate light source, either blue or red, from 400-700nm. To treat all skin types, Dr. Downie feels the OmniLux is the best light source. There may be minimal additional costs in creating a space for patients to wait (if one is not already available) and providing WiFi, television access, etc.

Staff can apply the photosensitizing cream after physician evaluation, and they should be involved in educating patients about sun avoidance and long-term post-procedure skincare. For most patients, Dr. Downie recommends use of topical retinoids and a suitable antioxidant cosmeceutical (such as TNS Recovery, SkinMedica) for preservation of benefit and possible further improvement. Dr. Downie tells all patients to avoid smoking and encourages exercise and a generally healthy lifestyle.

What are strengths and limitations? Who is the ideal candidate?

The ideal treatment candidate is the individual seeking an overall refreshed and rejuvenated appearance. Dr. Downie says many patients report non-specific benefits, such as a “healthy glow” to the skin. “Patients are pretty happy with Allumera so far,” she adds.

Patients with specific concerns, such as pore size, pigmentation, rough texture, or some mild wrinkling, are good candidates, Dr. Downie says. The individual may not wish to undergo a superficial chemical peel, may not be a candidate due to darker skin tone, or may be ready for a more dramatic intervention than a peel but not ready for lasers. A benefit of the procedure is its ability to treat virtually any skin type, Dr. Downie notes. The procedure is not recommended for patients who are truly candidates for laser therapies.

The patient must be willing and able to adhere to sun avoidance requirements, follow a long-term skincare regimen, and avoid unhealthy behaviors that contribute to skin aging. Further study may indicate when to provide regular maintenance treatments and which other procedures Allumera may complement, Dr. Downie observes.