Photodynamic therapy has its limitations. Photodynamic therapy with a topical porphyrin precursor drug is promising but not quite a reality. One day it is hoped that this treatment will provide prolonged or permanent results similar to oral retinoid (Accutane) therapy, but with minimal side effects.
Photodynamic therapy with topical porphyrin precursor drugs can be a good therapeutic alternative in countries where oral isotretinoin (Accutane) is prohibited such as Japan, in patients with acne refractory to conventional therapies, those with multiple bacterial antibiotic resistance, or those unable or unwilling to use oral Accutane; further in women who intend to get pregnant, or in any patient who cannot tolerated Accutane. It is important to note that photodynamic therapy with topical porphyrin precursor drug has not been studied for use in pregnant women (currently pregnancy category C). PDT for acne is an “off label” indication in the USA for treatment of acne.
PDT is currently only approved for actinic keratosis.