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236 D. Barolet Figure 16 A 24-year-old patient with KPR after 2 months of daily treatments with 660/805 nm home use LED device. decreased the number of cystic lesions in comparison with the non IR-heated side (Fig. 15).44 Photoregulation Photoregulation involves an exciting new 2-level (impor- tance of dermal–epidermal communication via cytokines) approach that we have evaluated with success to enhance the biological effects of a given topical. The main goal of this application would be to synergistically optimize any bioac- tive compound trajectory/route to ultimately up-regulate specific gene expression with simultaneous down-regulation of undesired ones via cell signaling pathways. In the esthetics industry, we believe such a method— even though still in its infancy—will become applicable in such applications as home-use skin rejuvenation and the treatment of inflamma- tory acne, hyperpigmentation disorders, oily skin, hyperhi- drosis, eczema, etc. UV-Free Phototherapy UV radiation phototherapy has been used for decades in the management of common skin diseases.45 However, there are side effects associated with UV deleterious effects as well as several contra-indications, including the long-term manage- ment of children and young adults and patients receiving topical or systemic immunosuppressive drugs. The primary effectors of UV phototherapy in the treatment of various skin Table 3 Fluorescent and High end LED Systems for PDT conditions bear similarities with some of those associated with blue LEDs and IR phototherapy with LEDs, including singlet oxygen production and modulation of interleu- kins.46,47 This provides a unique opportunity to explore the use of LED in skin conditions where UV therapy is used without the downside of inherent side effects. This approach has been termed UV-free therapy. For instance, the mode of action of UVA phototherapy for atopic dermatitis was found to involve the induction of apo- ptosis in skin-infiltrating T-helper cells through a mechanism that requires the generation of singlet oxygen.48 A recent study demonstrated that visible light (400-500 nm) can be successfully used for the treatment of patients with atopic eczema.49 In our hands, even resistant KPR (keratosis pilaris rubra) may respond to LED therapy in the visible-NIR spec- trum (Fig. 16). These promising results introduce a wide range of new potential application for LED. Photodynamic Therapy (PDT) PDT can best be defined as the use of light to activate a photosensitive medication that is applied to the skin prior to treatment. The PDT light source has a direct influence on treatment efficacy. Nowadays, the importance of treatment parameters of this light source is unfortunately greatly under- estimated. High-end LED devices meet this challenge and can be used as the light source of choice for PDT (Table 3). Thus, PDT can serve as a treatment that complements other skin rejuvenation therapies or topical agents used to enhance col- lagen production. The use of a dual wavelength (red and blue) LED light source enhances PDT results for acne and other sebaceous disorders.50 Red wavelength (630 nm) can reach the sebaceous glands and blue (405 nm) light photo- bleaches any residual protoporphyrin IX (PpIX) in the epi- dermis, thereby reducing posttreatment photosensitivity (Fig. 17). The way light photons are delivered seems to hold part of the answer for more effective PDT. Hence, dose rate is becoming one of the important criteria as opposed to total dose (fluence). Also, it is now suggested to avoid peak power effects on the photosensitizer—so-called thermal effects —that are usually encountered with light sources (thermal technologies) such as IPLs and lasers (ie, PDL). PDT frequent indications, both cosmetic and medical, are described in Ta- ble 4. LED technology clearly brings several advantages to Device Parameters Wavelength (nm) Power density (mW/cm2) Working distance gauge Treatment time (sec) PDT light source Blu-U Fluorescent tubes 417 10 No 1000 Yes Model LumiPhase-R/B LED 405/630 (R/B) 150/60 (R/B) Optical Positioning System on both R & R/B Models 160-1000 Yes Omnilux Revive LED 633 105 No 1200-1800 YesPDF Image | (LEDs) in Dermatology
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