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LEDs in dermatology 235 Figure 13 UV photography of skin taken 30 days after (SS) UV irra- diation on areas pretreated for 7 days or 30 days with LED and control. The 7-day LED treatment before UV insult appears to be the best regimen to prevent PIH. trol). In our hands, from 1 to 8 treatments delivered during a 1- to 2-week period prior to trauma will provide significantly less pigmentary response at the site of the trauma, especially if the area has been irradiated by UV posttrauma (by a sun simulator; Fig. 13). This could have tremendous implications since more than half of the planet (Asians and dark-complex- ioned people) is prone to such a postinflammatory pigmen- tary response. Scar Prevention Hypertrophic scars and keloids can form after surgery, trauma, or acne and are characterized by fibroblastic prolif- eration and excess collagen deposition.39 An imbalance be- tween rates of collagen biosynthesis and degradation super- Figure 14 Patient after facelift preauricular scar revision (upper) and 12-month follow-up (lower). Left: LED-treated side X30 days post- surgery; Right: control (no LED). Figure 15 Nineteen year-old male patient before and 4-weeks after PDT for control right hemiface (upper panel) and LED-pretreated left hemiface with no residual inflammatory lesion on his cheek pretreated (lower panel). imposed on the individual’s genetic predisposition have been implicated in the pathologenesis of these scar types. It has recently been proposed that interleukin (IL)-6 signaling pathways play a central role in this process and thus, that IL-6 pathway inhibition could be a promising therapeutic target for scar prevention.40,41 As LED therapy has been shown to decrease IL-6 mRNA levels,42 it may potentially be prevent- ing aberrant healing. A recent study conducted by our re- search group revealed significant improvements on the treated versus the control side in appearance and outline of scars (Fig. 14).43 Photopreparation Photopreparation is another new concept that we have been working on that characterizes a way to enhance the delivery, through a substantially uniform penetration, of a given com- pound in the skin resulting in more active conversion of such topical agents (ie, ALA to PpIX) in targeted tissues. Radiant IR photopreparation increases skin temperature, which may lead to an increase in pore size (diameter) for enhanced pen- etration of a given topical in the pilosebaceous unit. The efficacy of aminolevulinic acid photodynamic therapy (ALA-PDT), for instance, is dependent on ALA absorption and remains one of the main challenges of PDT. We have recently showed that increasing the skin temperature for 15 minutes with radiant IR (CW LEDs emitting @ 970 nm, irradiance 50 mW/cm2, total fluence 45 J/cm2) before ALA- PDT in the treatment of a cystic acne patient significantlyPDF Image | (LEDs) in Dermatology
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