Photodynamic therapy (PDT) uses a photosensitizer, light, and molecular oxygen to selectively kill cells. When localized in the target tissue, the photosensitizer is activated by light to produce oxygen intermediates that destroy target tissue cells. The easy access of skin to light-based therapy has led dermatologists to apply PDT to cutaneous disorders. In dermatology, PDT has been most successful in treating actinic keratoses, basal cell carcinoma, and Bowen's disease. The introduction of aminolevulinic acid, which does not make patients susceptible to phototoxicity for extended periods, has reduced morbidity associated with PDT. This has led to new interest in PDT not only for nonmelanoma skin cancer and premalignant lesions but also in the treatment of acne and as an adjuvant to photorejuvenation procedures. This review examines the historical roots of PDT and the research evaluating different light and laser sources as well as reports on new horizons for PDT in dermatology.