Metvix
Photosensitiser Cream for Photodynamic Therapy of Skin Lesions
Quick Facts About Metvix
Key Takeaways
- Metvix is a topical cream used exclusively in combination with light exposure (photodynamic therapy) to treat precancerous and cancerous skin lesions.
- Treatment can use red light (conventional PDT), natural daylight, or artificial daylight, depending on the condition being treated and your doctor's assessment.
- The cream contains peanut oil – it must not be used by anyone with a peanut or soya allergy.
- Pain and burning during light exposure are the most common side effects; daylight PDT causes significantly less pain than conventional red-light PDT.
- Actinic keratoses require one treatment session, while basal cell carcinoma and Bowen's disease require two sessions one week apart, with a follow-up assessment at 3 months.
What Is Metvix and What Is It Used For?
Metvix is a prescription photosensitising cream that forms part of a two-step treatment called photodynamic therapy (PDT). In the first step, the cream is applied to the affected skin area. The active ingredient, methyl aminolevulinate, is preferentially absorbed by damaged and abnormal cells. In the second step, the treated area is exposed to light of an appropriate wavelength and intensity. This light activates the compound within the damaged cells, generating reactive oxygen species that cause selective destruction of the abnormal tissue while leaving surrounding healthy skin largely unaffected.
Actinic Keratoses
Actinic keratoses (also known as solar keratoses) are rough, scaly patches of skin caused by years of cumulative sun exposure. They appear most commonly on sun-exposed areas such as the face, scalp, ears, and backs of the hands. While actinic keratoses are not themselves cancerous, they are considered precancerous lesions – if left untreated, a small percentage may progress to squamous cell carcinoma. Metvix PDT is particularly effective for treating multiple actinic keratoses across a broad area, offering excellent cosmetic outcomes compared to surgical or cryotherapy approaches.
Clinical studies have demonstrated clearance rates of 69–91% for actinic keratoses treated with Metvix PDT, with consistently superior cosmetic outcomes compared to cryotherapy. The treatment is especially valuable for patients with field cancerisation, where multiple lesions are present across a wider area of sun-damaged skin.
Basal Cell Carcinoma (BCC)
Basal cell carcinoma is the most common form of skin cancer worldwide. Metvix PDT is indicated for two subtypes: superficial BCC, which presents as flat, reddened, scaly patches, and nodular BCC, which appears as small, pearly or translucent bumps that may bleed easily and fail to heal. Metvix PDT is used for basal cell carcinoma when other treatments (such as surgery) are not considered suitable. The treatment offers the advantage of excellent cosmetic results and preservation of surrounding tissue, making it particularly useful for lesions in cosmetically sensitive areas such as the face.
Research published in the British Journal of Dermatology has shown complete response rates of 92–97% for superficial BCC and 73–82% for nodular BCC treated with Metvix PDT. These results, combined with superior cosmetic outcomes, make PDT a valuable treatment option especially for lesions in areas where surgical scarring would be undesirable.
Bowen's Disease
Bowen's disease (squamous cell carcinoma in situ) presents as slowly growing, reddish-pink patches on the skin. It is a form of early-stage squamous cell carcinoma confined to the outermost layer of the skin (epidermis). Metvix PDT is indicated for Bowen's disease when surgery is not considered appropriate. Clinical trials have shown clearance rates comparable to those achieved with cryotherapy and 5-fluorouracil, with significantly better cosmetic results.
How Photodynamic Therapy Works
The mechanism of Metvix PDT relies on the haem biosynthetic pathway. Once applied topically, methyl aminolevulinate penetrates the skin and is taken up preferentially by rapidly dividing abnormal cells. Inside these cells, it is metabolised to protoporphyrin IX (PpIX), a potent photosensitising agent. When PpIX is subsequently exposed to light of the correct wavelength (red light at approximately 630 nm, or the visible spectrum in daylight), it generates singlet oxygen and other reactive oxygen species. These reactive molecules damage intracellular structures, particularly mitochondria, leading to apoptosis (programmed cell death) of the treated abnormal cells. Because healthy skin cells accumulate substantially less PpIX, they remain largely undamaged by the light exposure.
What Should You Know Before Using Metvix?
Contraindications
- You are allergic to methyl aminolevulinate or any other ingredient in the cream (see Ingredients section below)
- You have a peanut or soya allergy – Metvix contains refined peanut oil
- You have morphoeaform (sclerosing) basal cell carcinoma – a subtype characterised by yellowish-white, scar-like plaques
- You have porphyria – a rare group of metabolic disorders affecting the haem biosynthetic pathway
Warnings and Precautions
Before using Metvix, inform your doctor if any of the following apply to you:
- Your skin lesions are pigmented, deeply invasive, or located on the genitals
- You have thick (hyperkeratotic) actinic keratoses
- You have large areas of Bowen's disease
- You are taking immunosuppressive medications such as systemic corticosteroids or ciclosporin
- Your Bowen's disease is a result of arsenic exposure
- You have, or have had, high blood pressure (pain during treatment may elevate blood pressure)
Avoid direct eye contact with Metvix cream. The cream should not be applied to the eyelids or mucous membranes. If you develop swelling of the face, tongue or throat, rash, or difficulty breathing, stop using Metvix immediately and seek medical attention – these may be signs of a severe allergic reaction (angioedema).
If red light is used and the application time or light dose is increased beyond the recommended parameters, more severe skin reactions may occur. In very rare cases, photodynamic therapy with a red light source has been associated with temporary memory loss, including confusion or disorientation. Contact your doctor immediately if you experience such symptoms.
Sunlight and UV Exposure
As a general precaution, avoid direct sunlight on the treated and surrounding skin areas for a few days following treatment. If you are currently receiving ultraviolet (UV) light therapy, this should be discontinued before beginning Metvix treatment. This precaution helps prevent excessive photosensitivity reactions in the treated area.
Pregnancy and Breastfeeding
The use of Metvix during pregnancy is not recommended. There is insufficient data on the safety of methyl aminolevulinate in pregnant women. If you are pregnant, think you may be pregnant, or are planning to have a baby, consult your doctor before using this medicine. Similarly, discuss with your doctor if you are breastfeeding, as it is not known whether methyl aminolevulinate or its metabolites pass into breast milk.
Driving and Using Machines
No adverse effects on the ability to drive or operate machinery have been reported with Metvix. However, if you experience side effects such as dizziness or visual disturbances following treatment, you should refrain from driving until these symptoms resolve.
Important Information About Excipients
Metvix contains several excipients that may cause reactions in sensitive individuals:
- Peanut oil: Do not use this product if you are allergic to peanuts or soya
- Cetostearyl alcohol: May cause local skin reactions such as contact dermatitis
- Methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216): May cause allergic reactions, possibly delayed
How Does Metvix Interact with Other Drugs?
Metvix is a topical preparation with negligible systemic absorption when applied to intact or mildly damaged skin. As a result, pharmacokinetic drug interactions (where one drug affects the blood levels of another) are not expected to be clinically relevant. However, certain co-administered treatments can affect the pharmacodynamic response – that is, the therapeutic or adverse effects of photodynamic therapy.
It is important that your treating physician is aware of all medications you are taking, including prescription drugs, over-the-counter medicines, herbal supplements, and any topical preparations applied to the treatment area.
| Interacting Agent | Type | Effect | Clinical Advice |
|---|---|---|---|
| Photosensitising drugs (e.g. tetracyclines, fluoroquinolones, thiazides, NSAIDs, St John's Wort) | Major | Increased photosensitivity; risk of enhanced skin reactions | Inform your doctor; may require additional sun protection or treatment timing adjustment |
| Immunosuppressants (ciclosporin, systemic corticosteroids, azathioprine) | Moderate | May reduce the immune-mediated component of PDT response; potentially reduced efficacy | Inform your doctor; closer monitoring and additional treatment sessions may be needed |
| UV phototherapy (PUVA, UVB) | Major | Additive photosensitivity; risk of severe skin reactions | Discontinue UV therapy before starting Metvix treatment |
| Physical sunscreens (titanium dioxide, zinc oxide) | Moderate | Block visible light absorption; may reduce efficacy of daylight PDT | Use only chemical sunscreen filters (not physical) for daylight PDT |
| Other topical treatments on the same area | Minor | May interfere with cream absorption or light penetration | Do not apply other topical products to the treatment area on the day of PDT |
Major Interactions
The most clinically relevant interactions involve other photosensitising agents. Medications such as tetracycline antibiotics (doxycycline, minocycline), fluoroquinolone antibiotics (ciprofloxacin, levofloxacin), thiazide diuretics, certain NSAIDs, and the herbal remedy St John's Wort can increase the skin's sensitivity to light. When taken concurrently with Metvix PDT, these agents may potentiate the photodynamic reaction, leading to more severe pain, redness, and skin damage in the treated area. If you are taking any of these medications, your doctor will advise on appropriate precautions.
Concurrent UV phototherapy (such as PUVA or narrowband UVB) poses a significant risk of additive photosensitivity. UV therapy should be discontinued before commencing Metvix PDT to prevent excessive skin damage.
Minor Interactions
When using daylight PDT, sunscreen must be applied to protect surrounding skin. However, sunscreens containing physical (mineral) filters such as titanium dioxide or zinc oxide block visible light and should not be used, as they may impair the effectiveness of the treatment. Only sunscreens containing chemical (organic) filters should be applied, as recommended by your doctor. Other topical preparations should not be applied to the treatment area on the day of the procedure, as they may interfere with cream absorption or light penetration.
What Is the Correct Dosage of Metvix?
Metvix PDT is a healthcare professional-administered treatment. It requires specific expertise in photodynamic therapy and is performed in a clinical setting (or with professional supervision for daylight PDT). The dosing protocol depends on both the condition being treated and the light source used.
Treatment with Red Light (Conventional PDT)
This approach is used for all three indications – actinic keratoses, basal cell carcinoma, and Bowen's disease. Red-light PDT requires specialised photodynamic therapy equipment and trained personnel.
Red-Light PDT Protocol
- Lesion preparation: Scales and crusts are removed, and the surface is gently roughened (debrided) to facilitate cream and light penetration. For certain BCC types, the overlying skin layer may be removed as directed by the doctor.
- Cream application: A layer of Metvix approximately 1 mm thick is applied with a spatula to the lesion and a small margin of surrounding skin. Avoid contact with the eyes.
- Occlusion: The treated area is covered with an occlusive dressing for 3 hours.
- Removal: After 3 hours, the dressing is removed and the cream is washed off with saline solution.
- Illumination: The treated area is immediately exposed to red light (approximately 630 nm wavelength) using a certified PDT lamp. Protective goggles are provided during light exposure.
Treatment with Natural Daylight
Daylight PDT is suitable for treating actinic keratoses only. It is not used for basal cell carcinoma or Bowen's disease. This method is clinically equivalent to red-light PDT for actinic keratoses and causes significantly less pain.
Daylight PDT Protocol
- Sunscreen application: A chemical-filter-only sunscreen is applied to all sun-exposed areas, including the treatment zone, before lesion preparation. Do not use sunscreens containing titanium dioxide or zinc oxide.
- Lesion preparation: Scales and crusts are removed, and the surface is gently roughened.
- Cream application: A thin layer of Metvix is applied to the lesion with a spatula or gloved hand. Avoid contact with the eyes.
- Outdoor exposure: Within 30 minutes of application, go outdoors and remain in full daylight (or a shaded area if needed) for 2 continuous hours. Do not go indoors during this period. Ensure the treatment area is not covered by clothing.
- Removal: After 2 hours, the cream is washed off.
Weather considerations: Daylight PDT can be performed on sunny or cloudy days, but should not be started if it is raining or likely to rain. The outdoor temperature must be comfortable enough for the patient to remain outside for 2 hours.
Treatment with Artificial Daylight
Artificial daylight PDT uses a certified lamp that emits a spectrum mimicking natural daylight. It is used for actinic keratoses and follows a similar protocol to natural daylight PDT: cream application followed by immediate illumination (within 30 minutes) for 2 hours. This approach allows PDT to be performed regardless of weather conditions and in a controlled clinical environment.
Number of Treatment Sessions
| Condition | Number of Sessions | Light Source | Follow-up |
|---|---|---|---|
| Actinic keratoses | 1 session | Red light, natural daylight, or artificial daylight | Assessment at 3 months; repeat if necessary |
| Basal cell carcinoma (superficial or nodular) | 2 sessions, 1 week apart | Red light only | Assessment at 3 months; biopsy may be taken |
| Bowen's disease | 2 sessions, 1 week apart | Red light only | Assessment at 3 months; repeat if necessary |
Children and Adolescents
Metvix is not recommended for use in children and adolescents under 18 years of age. There is insufficient clinical experience in this age group to establish safety and efficacy.
Missed or Incomplete Treatment
If the light exposure phase is interrupted or not completed – whether the red-light session was cut short or daylight exposure lasted less than 2 hours – the effectiveness of the treatment may be reduced. Contact your treating clinic to discuss whether the session needs to be rescheduled or repeated.
Overdose
Because Metvix is applied topically by healthcare professionals in a controlled clinical setting, overdose through excessive application is unlikely. If an excessive amount of cream were applied or left on for a prolonged period, more intense skin reactions (pain, redness, blistering) could occur during light exposure. There is no specific antidote; treatment would be supportive and symptomatic. Systemic toxicity from topical application is not expected given the minimal systemic absorption of methyl aminolevulinate.
What Are the Side Effects of Metvix?
Like all medicines, Metvix can cause side effects, although not everyone experiences them. The side effects described below have been reported with Metvix used with red light. In clinical trials comparing daylight PDT with conventional red-light PDT, similar types of side effects were observed with daylight treatment, but with a significant reduction in pain during the light exposure phase.
Pain and a burning sensation in the treatment area during and after light exposure are the most frequently reported side effects, occurring in more than half of treated patients. These reactions are typically mild to moderate in intensity and rarely require discontinuation of the light treatment. They usually begin during or shortly after light exposure and resolve within several hours, typically on the same day. Redness and swelling may persist for 1–2 weeks, and in some cases longer. Repeated treatment does not generally worsen these reactions.
Very Common
- Skin pain at the application site (with red light)
- Burning sensation in the skin
- Skin crusting (scab formation)
- Erythema (skin redness)
Common
- Numbness, tingling, and crawling sensation (paraesthesia)
- Bleeding at the treatment site (may follow lesion preparation)
- Warm skin at the application site
- Infection at the treatment site
- Skin ulceration (open sores)
- Oedema (swelling) at the application site
- Blistering (vesicles)
- Itching (pruritus)
- Skin peeling (desquamation)
- Weeping or exudation from the treatment area
- Headache
- Sensation of warmth
Uncommon
- Skin irritation
- Urticaria (hives) at the treatment site
- Rash at the treatment site
- Hypo- or hyperpigmentation (lighter or darker skin) after healing
- Photosensitivity reaction
- Discomfort at the application site
- Eyelid swelling
- Eye pain
- Nausea
- Heat rash
- Fatigue
Rare / Not Known Frequency
- Allergic reaction leading to angioedema (swelling of face, tongue, or throat; difficulty breathing)
- Eyelid swelling, pustules, and eczema at the application site
- Signs of contact allergy (allergic contact dermatitis)
- Elevated blood pressure (may be caused by pain during red-light treatment)
- Temporary memory loss, including confusion or disorientation
You develop swelling of the face, tongue, or throat, widespread rash, or difficulty breathing. These may be signs of a severe allergic reaction (angioedema) and require emergency treatment. Also contact your doctor immediately if you experience confusion, disorientation, or memory loss following treatment.
Reporting Side Effects
Reporting suspected side effects after a medicine has been authorised is important. It allows ongoing monitoring of the benefit-risk balance of the medicine. Healthcare professionals and patients are encouraged to report any suspected adverse reactions to their national pharmacovigilance authority (e.g. the MHRA Yellow Card Scheme in the UK, EMA in Europe, or the FDA MedWatch programme in the USA).
How Should You Store Metvix?
Proper storage of Metvix is essential to maintain its effectiveness and safety. Because Metvix is typically handled by healthcare professionals in clinical settings, the storage requirements are primarily relevant to pharmacies and treatment centres. However, patients should be aware of the following guidelines:
- Temperature: Store in a refrigerator at 2°C to 8°C (36°F to 46°F). Do not freeze.
- After opening: The cream should be used within 3 months of first opening the tube.
- Expiry date: Do not use after the expiry date printed on the carton and tube. The expiry date refers to the last day of the stated month.
- Visual inspection: Do not use if there are visible signs of deterioration – if the cream has darkened from its normal pale yellow colour to brown, it should be discarded.
- Keep out of reach of children.
- Disposal: Do not dispose of unused medicine via wastewater or household waste. Return unused or expired medication to a pharmacy for proper disposal to protect the environment.
What Does Metvix Contain?
Active substance: Methyl aminolevulinate 160 mg/g (as hydrochloride).
Other ingredients (excipients): Self-emulsifying glyceryl monostearate, cetostearyl alcohol, polyoxyl 40 stearate, methyl parahydroxybenzoate (E218), propyl parahydroxybenzoate (E216), disodium edetate, glycerol, white soft paraffin, cholesterol, isopropyl myristate, peanut oil (refined), refined almond oil, oleyl alcohol, and purified water.
Metvix contains peanut oil (refined) and almond oil (refined). Patients with known allergies to peanuts or soya must not use this product. The parabens (methyl parahydroxybenzoate and propyl parahydroxybenzoate) may cause allergic reactions, which may be delayed. Cetostearyl alcohol may cause local skin reactions such as contact dermatitis.
Appearance and Pack Sizes
Metvix is a cream-coloured to slightly yellow cream supplied in aluminium tubes containing 1 g or 2 g. Not all pack sizes may be marketed in every country.
Marketing Authorisation
Metvix is manufactured by Laboratoires Galderma (Alby-sur-Chéran, France) and is authorised across the European Economic Area under the name Metvix. The marketing authorisation is held by Galderma Nordic AB. Metvix has been approved by the European Medicines Agency (EMA) and is available through prescription in numerous countries worldwide.
Frequently Asked Questions About Metvix
Photodynamic therapy (PDT) is a two-step treatment that combines a light-sensitive cream (Metvix) with light exposure to destroy abnormal skin cells. First, Metvix cream is applied to the affected skin area. The active ingredient, methyl aminolevulinate, is absorbed by damaged cells and converted into a photosensitising substance called protoporphyrin IX (PpIX). When the treated area is then exposed to light (red light or daylight), PpIX generates reactive oxygen species that selectively destroy the abnormal cells while leaving surrounding healthy tissue intact.
Pain and burning at the treatment site are the most common side effects, particularly with conventional red-light PDT, affecting more than half of patients. The pain is usually mild to moderate and peaks during the light exposure phase, then resolves within hours. Daylight PDT offers a significant advantage in this regard: clinical trials have consistently shown that pain is substantially reduced compared to red-light PDT, while maintaining comparable clinical efficacy for actinic keratoses. Your doctor may recommend pain management strategies such as cool air fans or local anaesthesia if needed.
No. Metvix PDT must be administered by or under the supervision of a healthcare professional trained in photodynamic therapy. The lesion preparation (debridement), cream application, and light exposure phases all require clinical expertise and specialised equipment (for red-light PDT). Even daylight PDT, which uses natural sunlight, involves professional lesion preparation and clinical oversight.
After treatment, the treated area will typically be red, swollen, and possibly crusted or blistered. Pain and burning usually subside within hours. Redness and swelling may last 1–2 weeks. During the healing period, you should protect the treated area from direct sunlight and follow your doctor's aftercare instructions. The skin will gradually heal, and the cosmetic outcome is usually excellent. Your doctor will schedule a follow-up appointment at approximately 3 months to assess the treatment response.
Refined peanut oil is used as an excipient in the Metvix cream formulation to aid in the delivery and penetration of the active ingredient into the skin. While refined peanut oil has a very low allergenic potential compared to crude peanut oil, it cannot be guaranteed to be completely free of peanut protein. Therefore, Metvix is contraindicated in patients with known peanut or soya allergies as a precautionary measure.
Clinical trials have demonstrated clearance rates of 69–91% for actinic keratoses, 92–97% for superficial basal cell carcinoma, and 73–82% for nodular basal cell carcinoma. A key advantage of Metvix PDT over surgical excision and cryotherapy is significantly superior cosmetic outcomes. Studies published in the British Journal of Dermatology and Journal of the European Academy of Dermatology and Venereology have confirmed that PDT produces better or equal cosmetic results with comparable long-term recurrence rates for appropriately selected lesions.
References
- European Medicines Agency (EMA). Metvix – Summary of Product Characteristics. EMA/EPAR. Available at: www.ema.europa.eu
- Morton CA, Szeimies RM, Basset-Seguin N, et al. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 1: Treatment delivery and established indications. J Eur Acad Dermatol Venereol. 2019;33(12):2225-2238.
- Morton CA, Szeimies RM, Basset-Seguin N, et al. European Dermatology Forum guidelines on topical photodynamic therapy 2019 Part 2: Emerging indications. J Eur Acad Dermatol Venereol. 2020;34(1):17-29.
- Wiegell SR, Haedersdal M, Philipsen PA, et al. Continuous activation of PpIX by daylight is as effective as and less painful than conventional photodynamic therapy. Br J Dermatol. 2008;158(4):740-746.
- Basset-Seguin N, Ibbotson SH, Emtestam L, et al. Topical methyl aminolaevulinate photodynamic therapy versus cryotherapy for superficial basal cell carcinoma: a 5 year randomized trial. Eur J Dermatol. 2008;18(5):547-553.
- National Institute for Health and Care Excellence (NICE). Photodynamic therapy for non-melanoma skin tumours. Interventional procedures guidance [IPG155]. 2006.
- British Association of Dermatologists (BAD). Guidelines for topical photodynamic therapy: update. Br J Dermatol. 2019;180(4):730-739.
- World Health Organization (WHO). WHO Model List of Essential Medicines. 23rd List, 2023.
- Szeimies RM, Ibbotson S, Murrell DF, et al. A clinical study comparing methyl aminolevulinate photodynamic therapy and surgery in small superficial basal cell carcinoma. Br J Dermatol. 2008;159(6):1341-1348.
- Lacour JP, Ulrich C, Gilaberte Y, et al. Daylight photodynamic therapy with methyl aminolevulinate cream is effective and nearly painless in treating actinic keratoses: a randomised, investigator-blinded, controlled, phase III study throughout Europe. J Eur Acad Dermatol Venereol. 2015;29(12):2342-2348.
About the Medical Editorial Team
This article has been written and medically reviewed by the iMedic Medical Editorial Team, which includes board-certified specialists in dermatology, clinical pharmacology, and oncology. Our team follows the GRADE evidence framework and adheres to guidelines from the European Medicines Agency (EMA), British Association of Dermatologists (BAD), National Institute for Health and Care Excellence (NICE), and the World Health Organization (WHO).
Licensed physicians with expertise in dermatology and photodynamic therapy
Independent review by the iMedic Medical Review Board according to EMA, BAD, and NICE guidelines
Level 1A – Based on systematic reviews and randomised controlled trials
None. iMedic receives no pharmaceutical funding or commercial sponsorship