Healing After Photodynamic Therapy (PDT)

As I sit down to write about why you shouldn’t pick at your skin or peel it after photodynamic therapy, or PDT, I realize that I am picking at my skin. Specifically, I’m picking at a rough, slightly raised area in the middle of my forehead that did not go away after PDT.

I pick up my phone and put the camera in selfie mode, not so I can take a photo but instead to use it as a mirror. I seem to have the energy to pick but not to get up out of my chair. Yup, the spot is now roughed up. But it did not come off. I get up and look in the real mirror and, knowing better but doing it anyway, see if I can scratch it off.

Then I come to my senses, apply a dab of Aquaphor, and make a mental note to write the doctor and ask what she thinks. I already treated it with Efudex, but it was stubborn. I try to take a spot selfie, but it doesn’t show up well in the photo. They are going to have to take my word for it when I write or call.

Healing after PDT

Just as healing after Mohs surgery can be a pain, so, too, healing after PDT can present challenges. Pain is a common denominator. But the PDT pain is not that of having an incision followed by stitches. It is similar to having a bad sunburn. After my recent PDT, I had sunburn-like pain and a headache. I was out of sorts. A situation with my boyfriend came up that I could have dealt with better if my face and my head didn’t hurt.

My “goodie bag” after PDT included small tubes of Aquaphor, sunscreen with 70 SPF, and a gentle facial cleanser. The instructions called for applying Aquaphor until healed. The same basics apply to both: Don’t pick or peel. An article on the Skin Cancer Foundation’s website, on how to treat a sunburn, explains, “When skin begins to peel, it is a sign the body is trying to rid itself of damaged cells.” Natalie Curcio, a Nashville dermatologist, says in the article, “It may be tempting to try to exfoliate a peeling sunburn in an attempt to remove the dead skin.” But, she continues, “Do not pull off your peeling skin, and avoid active exfoliation…Instead, allow it to slough off your body on its own.”¹

As for soothing the skin, it’s different for PDT and sunburn. While my doctors had me apply Aquaphor, that’s not the preferred option for sunburn. For sunburn, Curcio recommends moisturizing the area with an aloe vera or soy-based product. She says to avoid petroleum-based or other oil-based creams, which could trap heat and make the sunburn worse.¹

Staying disciplined

I already confessed to my bad job regarding picking. So how did I do with peeling? I give myself a B minus. I was disciplined almost to the end of the healing process. First misstep: I noticed a discolored area on my right cheek. What was this? I thought maybe she had overdone it and damaged the skin.

I explored with my fingernail. A little bit of the discolored area came off. I poked around a little more and realized that the dark area was simply a piece of skin that was slower to slough off. Since I had already started, I finished peeling it off. I noticed a similar, smaller patch above my eyebrow and helped it off. Does that bring me down to a C plus? You can decide. I hope you give me the benefit of the doubt. I had been patient for more than a week, after all.

When all of the skin had finally peeled, either (mostly) on its own or with a little help from me, I noticed a new problem. I pointed it out to someone at tennis. (Informal skin check by friends!) It was a painful red tiny bump on the side of my nose. “I think I’m getting a PIMPLE,” I said. She agreed. I think maybe the greasy Aquaphor caused it. Because otherwise, who gets a pimple at my age?

Well, I’m not going to complain, because it soothed the “sunburn” caused by the PDT. I’m going to be careful about washing it well. Also, I’m going to resolve not to pick at it or try to pop it like the good old high school days when we did that without thinking. At least, unlike during my teen years, it’s not on the tip of my nose.