The present work is focussed on the principles of photodynamic therapy (PDT), emphasizing the photochemical mechanisms of reactive oxygen species formation and the consequent biochemical processes generated by the action of reactive oxygen species on various biological macromolecules and organelles. This paper also presents some of the most used photosensitizers, including Photofrin, and the new prototypes of photosensitizers, analysing their physicochemical and spectroscopic properties. At this point, the review discusses the therapeutic window of absorption of specific wavelengths involving first- and second-generation photosensitizers, as well as the principal light sources used in PDT. Additionally, the aggregation process, which consists in a phenomenon common to several photosensitizers, is studied. J-aggregates and H-aggregates are discussed, along with their spectroscopic effects. Most photosensitizers have a significant hydrophobic character; thus, the study of the types of aggregation in aqueous solvent is very relevant. Important aspects of the coordination chemistry of metalloporphyrins and metallophthalocyanines used as photosensitizers are also discussed. The state-of-the-art in PDT is evaluated, discussing recent articles in this area. Furthermore, macrocyclic photosensitizers, such as porphyrins and phthalocyanines, are specifically described. The present review is an important contribution, because PDT is one of the most auspicious advances in the therapy against cancer and other non-malignant diseases.