Journal of Clinical and Aesthetic Dermatology

FEB 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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22 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 R E V I E W received two 20-minute treatments weekly for 4 to 8 weeks, and clinical assessments were made at baseline and two, four, and eight weeks post- treatment. Therapeutic response was measured using a global improvement scoring system: 0 (no improvement), 1 (0–25% improvement), 2 (25–50% improvement), 3 (51–75% improvement), and 4 (76–100% improvement). Among the evaluable subjects (n=43), the mean improvement score was 3.14 at four weeks and 2.90 at eight weeks. Nine patients experienced complete clearing at eight weeks, and 50 percent of subjects were highly satisfied with the treatment. There were no adverse events. Since it had been demonstrated that phototherapy with combined blue and red light could achieve even greater efficacy in the treatment of acne, 6 an open-label study was designed to assess the efficacy of combining 415nm blue light and 633nm red light for treating subjects with mild-to-moderate facial acne. 7 Enrolled subjects (N=24) with Fitzpatrick Skin Types II to V had not received treatment with oral or topical acne agents during the six weeks preceding the trial or oral retinoid use in the previous nine months. Subjects with a history of photosensitivity disorder were excluded. Each subject received two treatments per week, three days apart, alternating between 415nm blue light (20 minutes/session, 48J/cm 2 ) and 633nm red light (20 minutes/session, 96J/cm 2 ) for four weeks using an LED-based therapy system. Patients received a mild microdermabrasion prior to each treatment session. The purpose of microdermabrasion is to provide a nonchemical superficial removal of the stratum corneum. This allows products or other procedures to pass more readily through the protective barrier of the epidermis. While recent studies have reported some histologic changes in the dermis on collagen density with microdermabrasion, published data demonstrate improvement of acne when microdermabrasion is used in combination therapy. 8 Acne severity was assessed at baseline and at Weeks 2, 4, 8, and 12. Among the evaluable subjects (n=22), a mean reduction in lesion count was observed at each follow-up evaluation. At the four-week follow-up, the mean lesion count was reduced by 46 percent (p=0.001) and by 81 percent at the 12-week follow-up (p=0.001). Severe acne showed a marginally better response than mild acne, although comedones did not respond as well as inflammatory lesions. This is a common finding in light therapy studies because noninflammatory acne lesions have fewer chromophores (coproporphyrin III and protoporphyrin IX). 9 Adverse events were mild and transient. A similar study assessed the same treatment in subjects with Fitzpatrick Skin Type IV and mild-to- moderately severe facial acne (N=24). 10 Subjects had not used topical acne treatment or systemic antibiotics within the two weeks of the trial or systemic retinoids within three months. Subjects with a history of photosensitivity or recent use of photosensitizing drugs were excluded. Treatment was performed twice weekly for four weeks with alternating quasi-monochromatic blue (415nm) and red (633nm) light. Clinical assessments were conducted at baseline and following Treatments 2, 4, and 6, as well as two, four, and eight weeks after the final treatment. Evaluations included lesion counts and an acne grading scale. The final mean percentage improvements in noninflammatory and inflammatory lesions were 34.2 percent and 77.9 percent, respectively. Changes in acne lesion type are summarized in Table 1. Phototherapy and wound healing. Pre- clinical in-vitro studies and early clinical studies demonstrated LEDs developed by the National Aeronautics and Space Administration (NASA) had beneficial effects on wound healing. 11,12 Based on these reports, the following controlled pilot study was performed to determine whether LED phototherapy might enhance wound healing following surgical aesthetic and resurfacing procedures. 13 Male (n=2) and female (n=8) subjects with a mean age of 52.3 years (range 44– 59 years) underwent combined blepharoplasty and Er:YAG/CO 2 laser ablative resurfacing. Subsequently, one-half of each subject's face was randomly selected and treated with a 633nm (96J/ cm 2 ) red LED for 20 minutes immediately after surgery, 48 hours post-surgery, and twice more the following week. Subjects were assessed 24 and 48 hours after surgery, at seven and 10 days, and at two, three, and six weeks. Resolution of erythema, edema, bruising, and days to healing was assessed using digital photography and was reviewed by a blinded and independent plastic surgeon. The LED-treated side healed after a mean (SD) of 13.5 (0.34) days versus 26.8 (0.49) days for the untreated side (p<0.0001; Table 2). These same investigators conducted a larger study to further assess the beneficial effects of LED phototherapy on wound healing. 14 The study involved a prospective treatment arm and a retrospective analysis of a matched cohort. The prospective study population included female patients (N=28) who underwent ablative Er:YAG/ CO 2 laser resurfacing (4 full-face, 8 periocular, 16 perioral). This was immediately followed by exposure to LEDs emitting infrared 830nm light (55 J/cm 2 ) for 20 minutes and red 633nm light (98 J/cm 2 ) for 20 minutes, which was repeated after 72 hours. Two additional treatments were performed three days apart during the following week and a final session during the third week. Digital images were obtained after 24 hours, three days, one, TABLE 1. Mean change in acne lesions at baseline and eight weeks post-treatment LESION TYPE BASELINE, MEAN (SD) POST-TREATMENT WEEK 8, MEAN (SD) SIGNIFICANCE A Closed comedones 38.5 (26.1) 21.4 (15.9) 0.0007 Open comedones 9.5 (11.0) 6.4 (10.3) 0.752 Papules 28.9 (14.7) 7.2 (4.8) <0.0001 Pustules 6.5 (4.0) 0.5 (0.8) <0.0001 Nodules or cysts 1.0 (1.6) 0.1 (0.5) 0.00129 a Paired t-test from Lee et al 2007 10 SD: standard deviation FIGURE 1. Light-emitting diode phototherapy device (Omnilux™, GlobalMed Technologies, Glen Ellen, California

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