An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology
Issue link: https://jcadonline.epubxp.com/i/934167
26 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY February 2018 • Volume 11 • Number 2 R E V I E W history of photosensitivity and were not taking photosensitizing medications. For the dose ranging study, 5%, 10%, and 20% ALA or placebo cream were applied to the forearm and an occlusive dressing applied. After 30 to 120 minutes, the dressing and excess cream were removed, and the test areas were exposed to 633nm at 126 J/cm 2 light for 20 minutes. The treated areas were examined for evidence of edema, erythema, and changes in pigmentation immediately post-exposure and one, two, three, and seven days post-exposure. Subjects were queried about potential adverse events during each assessment. Minimum erythema with no significant change in pigmentation was achieved with 5% ALA and a 30-minute occlusion time. The 10% ALA with a 30-minute occlusion resulted in more consistent erythema and mild pigmentation. The 10% ALA with a 60-minute occlusion time increased pigmentation in several sites with adverse textural changes to the skin. The 20% ALA caused severe erythema, some ulceration and pigmentation, and adverse textural skin changes at all occlusion times. For this reason, the combination of 5% 5-ALA incubated for 30 minutes was chosen as the treatment parameter that gave the desired amount of erythema with no side effects. For the second part of the study, 5% ALA was applied to the skin immediately around the periorbital region and an occlusive dressing was applied for 30 minutes. After that time, the dressing and excess cream were removed and the area was exposed to 633nm light for 20 minutes. Digital photography was used to record baseline appearance of the lateral canthal areas and changes after one, two, three, and seven days. Subjects were queried about potential adverse events during each assessment. The use of 5% ALA and a 30-minute occlusion time resulted in mild, self-limiting erythema at Day 1 and mild skin peeling at Day 3, which resolved by Day 7. Clinical assessment of the periorbital region showed a significant treatment response in four subjects (67%) with a reduction in fine lines. Skin softness was improved in all subjects at the test area. The treatment was well tolerated with no reported adverse events. DISCUSSION LED phototherapy is a valuable tool in the dermatologist's armamentarium. It can be used alone or in combination with other therapies to treat a wide variety of dermatological conditions, many of which have been described in this paper. Moreover, the technology has numerous aesthetic applications, both as a stand-alone treatment and as an adjunctive to other aesthetic procedures, including such commonly performed procedures as injections, laser resurfacing, peels, intense pulsed light, and microneedling. There is no other technology available to the practicing dermatologist that has such broad utility in such a wide variety of medical and aesthetic applications. The effectiveness of other devices used for phototherapy, primarily PDL, has also been clinically demonstrated. 42–45 Devices with published efficacy data are shown in Table 5. One of the most important aspects of LED phototherapy devices is their safety. LEDs are nonablative and nonthermal, and when used alone (i.e., without topical photosensitizers in PDT applications) do not cause damage to the epidermis or dermal tissue. There are no adverse events associated with the use of these devices and little to no downtime for the patient. When LED phototherapy is used alone, patients do not experience redness, peeling, blistering, swelling, or pain. In fact, patients can have a treatment during their lunch hour and return to work immediately afterwards. While home use devices have been available for several years, there are many differences between those devices and those specifically designed for use by physicians. The home use devices necessarily deliver significantly less power and typically do not have light panel arrays large enough to treat the entire face at once, for example. As they often are hand-held, it might be cumbersome, time-consuming, and impractical to treat the entire face in a single session. In contrast with the medical LED units and their protocols, home use devices have not been validated by controlled clinical studies published in peer- reviewed journals. In some cases, home units may be used adjunctively with dermatologist-provided treatment to address specific areas of concern, but they are dissimilar enough from the medical- grade units to not be considered an alternative to these tested technologies. CONCLUSION Phototherapy using LEDs is beneficial for a broad range of medical and aesthetic conditions encountered in the dermatology practice. The treatment modality displays an excellent safety profile and can be effectively used for the treatment of acne vulgaris, wound healing applications following surgical aesthetic and resurfacing procedures, actinic keratosis, squamous cell carcinoma in situ, and basal cell carcinoma. LED phototherapy is also an effective means for rejuvenating aged skin when used alone or together with a photosensitizer, such as 5-ALA, as well as post-procedural erythema. Having implemented this technology in my practice since 2009, I have also had success treating TABLE 5. Other commercially available phototherapy devices DEVICE MANUFACTURER DESCRIPTION INDICATIONS PUBLICATIONS Blue-U® DUSA® Pharmaceuticals, Inc., Wilmington, Massachusetts Blue light PDT illuminator, used with 5-ALA moderate inflammatory acne vulgaris Melnick, 2005 42 BF-RhodoLED® Biofrontera AG, Leverkusen, Germany Red light PDT illuminator, used with 5-ALA actinic keratosis and superficial and/or nodular basal cell carcinoma Reinhold et al, 2016 43 Aktilite® Galderma Laboratories, LP, Fort Worth, Texas Red light PDT illuminator, used with methyl-aminolaevulinic acid actinic keratosis Sung and Kim, 2017 44 Healite II® Lutronic North America, Burlington, Massachusetts Low-level light therapy temporary relief of minor muscle and joint pain, arthritis and muscle spasm; relieving stiffness; promoting the relaxation of muscle tissue; temporarily increase local blood circulation Min and Goo, 2013 45 5-ALA: 5-aminolevulinic acid; PDT: photodynamic therapy