The patient was a 13-year-old female, who came in complaining of red, itchy lesions scattered in her face and left arm for the past 4 months. She has a history of seasonal allergies and had previously been seen by a dermatologist who told her she had allergic dermatitis. She claimed she was previously diagnosed with “impetigo” by her family physician. She was previously treated with oral antibiotics (Ciprofloxacin 500 mg BID) and topical Hydrocortisone cream 1% although it was unclear who prescribed the medications and for what purpose. She claimed that medication provided relief for one week, but symptoms returned after treatment was discontinued. Past medical history was otherwise unremarkable.
On physical examination, she was found to have scattered hyperemic, maculopapular rashes scattered on her face and left upper arm. Working diagnosis was moderate acne rule out atopic dermatitis. Image 1 shows rashes in her cheek area.
Photobiomodulation therapy was initially applied to this patient using the BIOFLEX +240 arrays and the red and infrared laser probes the following parameters:
|Treatment Head Wavelength||Frequency (Hz 5 μs resolution)||Duty Cycle (10% steps)||Duration (sec)||Average Power Output (mW)||Power Density (mW/cm2)||Energy (J)||Energy Density (J/cm2)|
|DUO 240 Arrays|
|660 nm (100% power)||CW||7**||75||750||0.525||5.25|
|825 nm (41% power)||CW||7**||75||738||0.516||5.16|
*CW – Continuous Wave
** 7 seconds per spot treatment. Spot treatment distributed for 7 minutes
The arrays were applied horizontally on the forehead and diagonally on both cheek and chin area. Laser probes were applied as spot treatment for 5-10 seconds per spot (average 7 seconds) on individual rashes and spread throughout the treatment area. Eye protection using opaque laser safety goggles were provided during treatment. The patient had a total of 5 treatments provided in the areas described. Image 2 shows cheek area after 5 treatments.
The skin is the most accessible organ in the body for photobiomodulation therapy (PBMT). You don’t need any fancy equipment to demonstrate depth of penetration in all the skin layers, just shine a flashlight on the tip of your index finger and see it glow. So naturally, dermatological applications have a found a lot of utility for PBMT. As with any organ, the potential physiological effects of PBMT also apply to the skin. More than just the frequently referenced improvement in ATP production, probably a more important effect of PBMT as it applies to the integument are the secondary effects caused by the release of Nitric Oxide (NO) and Reactive Oxygen Species (ROS), which activates nuclear factor-kappa B (NF-kB), a cytoplasmic molecule that signals a cascade which includes wound contraction, inflammation, fibroblast differentiation and collagen deposition. PBMT also influences pain and inflammatory mediators such as histamine, serotonin, bradykinin, and prostaglandins and promotes epithelial migration and proliferation, endothelial migration and organization for angiogenesis, inflammatory infiltration, macrophage phagocytoses, immune surveillance, fibroblast matrix synthesis, and wound contraction. One thing PBMT does NOT do is kill bacteria. The purpose of treatment is to treat the entire skin and not to point the laser “gun” at individual critters and see them vapourize (as satisfying as that may sound to lovers of the second amendment of the American Constitution). That is especially pertinent in this case, in which atopic dermatitis cannot be totally ruled out although individual lesions seem to be acneiform and may probably be coexistent. PBMT replaces the role cortisone creams were probably prescribed for, to calm down inflammation, without stimulating the growth of Propionibacterium acnes which may have been stimulated by steroid application.
It is also worth noting that with the growth of the PBMT industry, comes various devices that address skin issues, particularly as it pertains to the face. This case was an old case encountered at the dawn of Light Emitting Diodes (LED) at the start of the century. Various masks for “skin rejuvenation” use also using LEDs of various wavelengths that would put the pride parade to shame can be bought in Amazon. This case is proof that a technology pioneered and developed by Meditech and still in use today is just as efficacious and versatile as it was decades ago and has found its extended off-label application in conditions as varied as acne to Alzheimer’s.