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Levulan

aminolevulinic acid
Used for Actinic Keratosis
Used for Actinic Keratosis

Levulan Kerastick is made up of aminolevulinic acid 20% topical solution. It's a photosensitizing agent that's used to treat actinic keratoses (sun spots) on adults. Levulan Kerastick (aminolevulinic acid) is applied directly to the spots on the skin by a healthcare provider at their office or clinic. Afterwards, your provider will use blue light photodynamic therapy (PDT) to activate the medication. If needed, you can repeat the treatment again after 2 months. Some of the more common side effects of Levulan Kerastick (aminolevulinic acid) include swelling, stinging, or scaling around the treated skin areas.

Reviewed by:
reviewer
Connie Zheng, PharmD
reviewer
Kristianne Hannemann, PharmD
Last reviewed on December 13, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsContraindicationsAlternativesReferencesPricesMedicare
basics-icon

What is Levulan Kerastick (aminolevulinic acid)?

What is Levulan Kerastick (aminolevulinic acid) used for?

  • Minimally to moderately thick actinic keratoses of the face, scalp, or arms and hands (in combination with photodynamic therapy)

How Levulan Kerastick (aminolevulinic acid) works

Levulan Kerastick (aminolevulinic acid) is a photosensitizing agent. It's activated ("turned on") by light and kills skin cells that cause actinic keratoses.

Are you looking for information on Ameluz (aminolevulinic acid) instead?

Drug Facts

Common BrandsLevulan Kerastick
Drug ClassTopical skin product
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
basics-icon

What are the side effects of Levulan Kerastick (aminolevulinic acid)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Redness (up to 100%)
  • Stinging or burning (up to 96%)
  • Dryness, peeling, or crusting on the skin (64-87%)
  • Skin color changes (22-73%)
  • Swelling (up to 56%)
  • Fluid-filled blisters (up to 41%)
  • Itchy skin (14-25%)

Other Side Effects

  • Damaged skin
  • Welts
  • Bleeding
  • Scabbing
  • Tingling sensation

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Bleeding

hives

persistent non-healing sore

pink growth

reddish patch or irritated area

scabbing

shiny bump

spots on your skin resembling a blister or pimple

stinging, burning, pain, redness, swelling, scaling, crusting, lightening or darkening of the skin, itching, cracking, crusting, or dryness of the skin at the application site

tenderness

white, yellow or waxy scar-like area

Less common

Bleeding during lesion preparation

blistering or irritation of the skin

flaking, pain, peeling, itching rash, breaking down of the skin

Incidence not known

Difficulty seeing at night

double vision

increased sensitivity of the eyes to sunlight

loss of memory

problems with memory

red, sore eyes

seeing double

swelling of the eyelids

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Burning, crawling, itching, numbness, prickling, “pins and needles,” stinging, or tingling feelings

darkening or lightening of the treated skin

skin sore

small, red, raised, itchy bumps

swelling of the skin

Less common

Cough

fever

headache

oozing

open sore on the skin

pain

pain or tenderness around the eyes and cheekbones

pus filled blister or pimple

raw skin

stuffy or runny nose

tenderness

tightness of the chest

troubled breathing

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Levulan Kerastick (aminolevulinic acid)

thumbs-up

Pros

Only need one or two treatments

Many people had clear skin 3 months after the first treatment

Skin can stay clear for as long as a year after treatment for some people

thumbs-down

Cons

Up to 18 hour (for face and scalp) waiting period before PDT

Can cause irritation and discomfort on treated areas

Must avoid sunlight or bright indoor light for at least 40 hours after treatment

pharmacist-tips

Pharmacist tips for Levulan Kerastick (aminolevulinic acid)

pharmacist

  • Make sure to bring a wide-brimmed hat, gloves, and/or a long-sleeved shirt to your appointment so you can protect the treated areas from the sun or bright indoor light when you leave. You'll need to avoid light for at least 2 days to minimize burning and stinging in these areas. Keep in mind that sunscreen won't protect you from visible light.

    • If you aren't able to return to your provider's office for light therapy after Levulan Kerastick (aminolevulinic acid) has been applied, call the office for further instructions.

      • Some medications, such as certain antibiotics or acne medication, can make your skin even more sensitive to sunlight during treatment with Levulan Kerastick (aminolevulinic acid). Tell your provider all of the medications you're taking so they can check if they're safe to use with Levulan Kerastick (aminolevulinic acid).

        • After treatment with Levulan Kerastick (aminolevulinic acid), it's normal to experience irritation, crusting, oozing, itching, and dryness at the sites where you had it applied. These side effects are temporary and should get better over the next 1 to 2 months. If anything concerns you, call your provider to discuss.

          • If your sun spots don't start to fade within 2 months, contact your provider. You might need another treatment with Levulan Kerastick (aminolevulinic acid).

            • It isn't known if Levulan Kerastick (aminolevulinic acid) causes harm to unborn babies or breastfed babies. If you're pregnant or breastfeeding, discuss the risks and benefits for you and your baby with your provider.

              faqs

              Frequently asked questions about Levulan Kerastick (aminolevulinic acid)

              Is Levulan Kerastick (aminolevulinic acid) chemotherapy?
              No, Levulan Kerastick (aminolevulinic acid) isn't chemotherapy. Chemotherapies are medications that target and kill all fast-growing cells in the body, such as cancer cells. While Levulan Kerastick (aminolevulinic acid) isn't chemotherapy nor approved to treat cancer, it does treat actinic keratoses, a skin condition that can sometimes turn into skin cancer.
              How well does Levulan Kerastick (aminolevulinic acid) work?
              Studies show that at the 3-month check up, 72% of the people who used Levulan Kerastick (aminolevulinic acid) to treat actinic keratoses (AK) of the face and scalp had clear skin after 1 to 2 treatments, compared to 11% of the people who received placebo. In addition, 31% of people who received Levulan Kerastick (aminolevulinic acid) for AK on the arms or hands had clear skin 3 months after their first treatment, compared to only 13% of people who received placebo. Talk with your provider if you have questions about how well Levulan Kerastick (aminolevulinic acid) works.
              How long does photosensitivity last after Levulan Kerastick (aminolevulinic acid)?
              After your provider has applied Levulan Kerastick (aminolevulinic acid), the treated skin area will be sensitive to light for at least 40 hours (almost 2 days). You should avoid getting exposed to sunlight or bright indoor lights, including tanning beds, examination lamps, or lights that are close to your body. If you need to go outside, make sure to cover the treated area by wearing a wide-brimmed hat, long-sleeve shirt, and gloves. Keep in mind that wearing sunscreen won't help protect you since sunscreen blocks ultraviolet (UV) light, not visible light. If your skin becomes exposed to light, you'll feel stinging and burning, and notice swelling or redness in the treated area.
              How does photodynamic therapy (PDT) work with Levulan Kerastick (aminolevulinic acid)?
              After applying Levulan Kerastick (aminolevulinic acid) and allowing the medication to fully absorb into the skin, your provider will treat the area with the BLU-U Blue Light Photodynamic Therapy (PDT) Illuminator. This takes about 16 minutes. The PDT helps activate (or "turn on") Levulan Kerastick (aminolevulinic acid) so that it can kill the cells that cause actinic keratoses.
              What if I can't return for my light treatment after getting Levulan Kerastick (aminolevulinic acid) applied to my skin?
              If for some reason you can't get your light treatment after Levulan Kerastick (aminolevulinic acid) has already been applied to your skin, contact your provider to let them know and get further instructions. You'll need to avoid exposure to sunlight or any intense indoor light for at about 2 days to limit side effects like stinging and burning. If you need to go outside, cover the treated areas of your skin with protection, like a wide-brimmed hat or other head coverings, long-sleeve shirt, and clothing that can block light.
              What's the difference between Ameluz and Levulan Kerastick?
              Ameluz and Levulan Kerastick are different brand names of aminolevulinic acid. While they're both used to treat actinic keratoses, there are some differences. Ameluz (aminolevulinic acid 10% gel) is used with red light therapy, and can only treat areas on the face and scalp. Levulan Kerastick (aminolevulinic acid 20% liquid solution) is used with blue light therapy, and treat AK spots on the arms and hands, in addition to those on the face and scalp. Talk with your provider if you have more questions about the differences between Ameluz and Levulan Kerastick.
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              What are the risks and warnings for Levulan Kerastick (aminolevulinic acid)?

              Levulan Kerastick (aminolevulinic acid) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Temporary memory problems

              Though rare, some people reported temporary memory problems after using Levulan Kerastick (aminolevulinic acid) with photodynamic therapy (PDT). If you feel confused or have trouble remembering things after your treatment, contact your provider.

              risk-warning

              Higher sensitivity to light

              • Risk factors: Taking medications that make your skin more sensitive to light

                Levulan Kerastick (aminolevulinic acid) makes your skin more sensitive to light. Your risk for skin damage from light exposure is higher if you're taking other medications that make your skin more sensitive to light. After getting treatment with Levulan Kerastick (aminolevulinic acid), avoid sunlight, tanning beds, and bright indoor light for 2 days, even if you aren't exposed to light therapy.

                You can protect the treated areas of your skin by wearing a wide-brimmed hat, long-sleeved shirts, or gloves. Doing so can help prevent stinging, burning, irritation, and swelling at the treatment sites on your skin. Keep in mind that wearing sunscreen won't protect your skin from visible light.

                risk-warning

                Skin irritation

                • Risk factors: Covering the treated area for longer than 3 hours

                  Levulan Kerastick (aminolevulinic acid) contains alcohol, which can cause skin irritations. Your provider will be very careful to avoid putting this medication too close to the eyes or mouth. If you experience bothersome skin irritation, let your provider know.

                  risk-warning

                  Risk of bleeding

                  • Risk factors: Taking blood thinners | Bleeding problems

                    It isn't known if Levulan Kerastick (aminolevulinic acid) is safe to use in people with bleeding problems. Let your provider know if you're taking blood-thinning medications (e.g., warfarin (Coumadin)) or if you have a history of bleeding problems. Your provider will look out for any signs of bleeding while applying Levulan Kerastick (aminolevulinic acid), and can talk with you about the benefits and risks of using this medication.

                    dosage

                    Levulan Kerastick (aminolevulinic acid) dosage forms

                    Typical dosing for Levulan Kerastick (aminolevulinic acid)

                    Levulan Kerastick is made up of aminolevulinic acid 20% topical solution.

                    • Adults: Levulan Kerastick (aminolevulinic acid) is applied to the sun spots (on the scalp, face, or arms and hands only) by a healthcare provider at their clinic. Your provider will let the medication sit on the skin for a certain amount of time (14-18 hours for face and scalp; 3 hours for arms and hands). Afterwards, you'll receive photodynamic therapy (PDT) with the BLU-U Illuminator for about 16 minutes.

                    If needed, your provider can prescribe this treatment again after 2 months.

                    interactions

                    Interactions between Levulan Kerastick (aminolevulinic acid) and other drugs

                    Levulan Kerastick (aminolevulinic acid) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Levulan Kerastick (aminolevulinic acid). Please note that only the generic name of each medication is listed below.

                    Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

                    contraindications-icon

                    Levulan Kerastick (aminolevulinic acid) contraindications

                    Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Levulan Kerastick (aminolevulinic acid) will not be safe for you to take.

                    • Skin that's sensitive to visible light (wavelengths of 400 nm to 450 nm)

                    • Porphyria (a genetic condition where your body has problems making a protein called heme)

                    • Allergies to porphyrins

                    alternatives

                    What are alternatives to Levulan Kerastick (aminolevulinic acid)?

                    There are a number of medications that your doctor can prescribe in place of Levulan Kerastick (aminolevulinic acid). Compare a few possible alternatives below.
                    Levulan Kerastick (aminolevulinic acid)
                    Used for:

                    • Minimally to moderately thick actinic keratoses of the face, scalp, or arms and hands (in combination with photodynamic therapy)

                    View Prices
                    Ameluz (aminolevulinic acid)
                    Used for:

                    • Mild-to-moderate actinic keratoses on the face and scalp (in combination with photodynamic therapy)

                    View Prices
                    Diclofenac sodium (Solaraze) 3% gel
                    Used for:
                    $40.00 Lowest GoodRx priceView Prices

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                    References

                    Best studies we found

                    American Academy of Dermatology Association. (n.d.). Actinic keratosis: Overview.

                    American Cancer Society. (2021). Getting photodynamic therapy.

                    DUSA Pharmaceuticals, Inc. (2021). Levulan Kerastick- aminolevulinic acid hydrochloride kit [package insert]. DailyMed.

                    View All References (2)

                    Malcolm, E. (2020). What are porphyrins and how are they connected to porphyria? Porphyria News.

                    MedlinePlus. (2009). Porphyria.

                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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