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FIGURE 1. Prisma Records identified through Ovid MEDLINE searching (((phototherapy) AND (((LED light) OR light emitting diode) AND therapy))) AND skin)) AND human) (n=155) Records after duplicates removed (n=171) Additional records identified through other sources (n=16) Records screened (n=171) Records excluded (n=38) Full-text articles assessed for eligibility (n=133) Full-text articles excluded due to wavelengths or treatments not addressed, ex vivo studies, fewer than 5 patients (n=36) Studies included in qualitative synthesis (n=97) Studies included in quantitative synthesis (meta-analysis) (n=60) differently than continuous light.1 Commercially available LED units include wavelengths in the red, yellow, blue, and near infrared portions of the spectrum. MECHANISM Research on LED mechanisms has yielded multiple pathways by which clinical benefit is achieved. LEDs appear to affect cellular metabolism by triggering intra- cellular photobiochemical re- actions. Observed effects include increased ATP, modulation of reactive oxygen species, the induction of transcription factors, alteration of collagen synthesis, stimulation of angiogenesis, and increased blood flow.2 Red LEDs specifically have been shown to activate fibroblast growth factor, increase type 1 pro- collagen, increase matrix metallo- proteinase-9 (MMP-9), and decrease MMP-1. An increase in fibroblast number and a mild inflammatory infiltrate following exposure has been demonstrated histologically.3,4 Photomodulated yellow light alters ATP production, gene expression, and fibroblast activity.5–7 Increased ATP pro- duction is thought to be mediated via the absorption of photons by mitochondrial protoporphyrin IX. Interestingly, only photomodulated yellow LED has been shown to produce a tissue response implying that the light’s ability to affect cells is dependent on the number and pattern of photon delivery.8 Blue light appears to exert its effect on acne via its influence on Propionibacterium acnes and its anti- inflammatory properties. P. acnes contains naturally occurring porphyrins, mainly coproporphyrin and protoporphyrin IX. Absorption of blue light by these molecules is believed to induce a natural photodynamic therapy (PDT) effect with destruction of the bacteria via the formation of oxygen free radicals. Blue light’s anti- inflammatory effect appears to be the result of a shift in cytokine production.9 Near infrared light, also known as monochromatic infrared energy (MIRE), is believed to stimulate circulation by inducing the release of guanylate cyclase and nitrous oxide, which, in turn, promotes vasodilation and growth factor production as well as angiogenesis, leading to subsequent wound healing.10 Figure 1. PRISMA flow diagram showing how the articles were selected FDA APPROVED DEVICES AND INDICATIONS There are numerous manufacturers of LED lights and some produce systems of different wavelengths. Photo Therapeutics, Inc. of Carlsbad, California, markets several LED systems under the brand name Omnilux©. Omnilux PDTTM (633nm) is indicated for PDT of nonmelanoma skin cancer (NMSC). Omnilux ReviveTM (633nm) is a red light device marketed for skin rejuvenation. It produces about 30 percent more output energy than the PDT device. Omnilux BlueTM (415nm) is approved for the treatment of acne and actinic keratoses (AKs). Omnilux PlusTM (830nm) is an infrared device indicated for skin rejuvenation and wound healing.11 More recently, Ambicare Health of Scotland has created a portable adhesive PDT device called Ambulight PDTTM. Ibbotson and Ferguson12 showed it to be as effective and less painful in the treatment of nonmelanoma skin cancers as conventional PDT due to its lower irradiance. It may be [June 2015 • Volume 8 • Number 6] 37 Included Eligibility Screening IdentificationPDF Image | Light-emitting Diodes A Brief Review and Clinical Experience
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