The ASDS Technology Report is a new member service designed to inform dermasurgeons of new technologies or procedures.. The series represents a distillation of available published scientific data and anecdotal information on a specific technology or procedure and should not be misconstrued as an endorsement by the ASDS. The Society encourages its members to use their independent judgment in applying any new technology or procedure in the care and treatment of their patients.
Low level light therapy (LLLT) consists of low light energies that do not cause gross thermal heating of tissue and instead rely on causing subtle changes in tissue at the molecular level for clinical effects. Light emitting diode (LED) light sources are the first LLLT systems used for dermatologic indications.
Low level laser/light therapy (LLLT) has a long and checkered history with dramatic claims being made, but not backed up with controlled studies. LLLT has been used primarily for improving healing of chronic ulcers, pain relief and healing of bone fractures. In the past couple of years, the science has incrementally improved while the claims have become more realistic.
Yellow (590 nm) LED irradiation has been shown, in vitro, to down-regulate metalloprotease-1 (MMP-1 or collagenase) and stimulate fibroblasts to increase procollagen production. This effect is only seen if the light is pulsed in a specific sequence (approximately 0.1 sec on and off pulses). Another approach has been 633 nm continuous red light LED that, in vitro, stimulates mast cell degranulation and increased fibroblast growth factor production. Other wavelengths are under study, but no conclusions can, as yet, be reached.
Pulsed yellow LED, Gentlewaves (LightBioscience, Virginia Beach, VA) twice per week for 4 weeks has been shown in two prospective blinded studies, that included a total of 183 patients, to achieve mild reduction of signs of photoaging including improvement in skin texture, dyspigmentation, erythema and fine lines in the periorbital region in a majority of patients assessed by blinded observers, patient self-reporting, digital microscopy and ultrasound. Improvement continued for 4-6 months with gradual loss of benefit thereafter. LED photorejuvenation may have a role to play as an adjunct to other rejuvenation procedures such as intense pulsed light treatments and other non-ablative photorejuvenation techniques that rely on photothermal light effects. There are numerous other LED systems including Dermillume, (Care Elctronics, Boulder, CO), Lumiphase (Opusmed, Montreal, Canada), Omnilux (Photo Therapeutics, Manchester, UK) and Soli-Tone (Custom Esthetics, Woburn, MA) with wavelengths throughout the visible to near infrared (420-1000 nm) spectrum being marketed for photorejuvenation (red light) and acne (blue light). Their efficacy remains to be established, as there have been no controlled studies published to date in peer-reviewed journals to support their efficacy. The addition of short contact topical aminolevulinic acid (ALA) photodynamic therapy to enhance efficacy is under investigation.
Recommended treatment course consists of twice-a-week irradiations lasting less than 1 minute for 4 weeks followed by a booster treatment every month. Prior to treatment, all make-up is removed and exfoliation with enzymatic peel or microdermabrasion is recommended. There is no discomfort during treatment and no downtime after treatment. Treatment parameters for other LED devices for photorejuvenation have not been reproducibly established.
None.
LED photorejuvenation may become another way to achieve incremental improvement of photodamaged skin. However, at this point, it is not known what percentage of patients achieve clinically significant improvement. The degree of improvement achieved may not be significant or predictable enough for LED photorejuvenation to be used by itself. In patients who do show improvement, it seems to approximate that achieved with topical retinoids, which do not require frequent visits to the doctor’s office. It is unclear if combining LED photorejuvenation with other modalities makes no difference, is additive or is synergistic.
- Weiss RA, Weiss MA, Geronemus RG, McDaniel DH. A novel non-thermal non- ablative full panel LED photomodulation device for reversal of photoaging: digital microscopic and clinical results in various skin types. J Drugs Dermatol 2004;3(6):605-610.
- Weiss RA, McDaniel DH, Geronemus RG, Weiss MA. Clinical trial of a novel non thermal LED array for reversal of photoaging: clinical, histologic and surface profilometric results. Lasers Surg Med 2005; 36(2):85-91.
George Hruza, MD, Chair
Kenneth Arndt, MD
Paul Friedman, MD
Gary Lask, MD
David Narins, MD
Victor Neel, MD
Margo Weishar, MD
Lisa Doty
American Society for Dermatologic Surgery (ASDS)
847-956-9133
ldoty@asds.net