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treat Bowen’s disease of the digit. The treatment was delivered at 240J/cm2 in two 50-minute sessions. Complete clinical clearance occurred in 3 out of 4 patients, all of which healed without scarring. Histologic clearance was confirmed in one of these patients.20 Lopez et al21 demonstrated effective treatment of extensive Bowen’s disease using red LED PDT preceded by application of MAL cream. Eighteen patients were treated and 90 percent of their lesions showed a complete clinical response after 12 weeks with good or excellent cosmetic outcomes in 94 percent of patients at a 12-month follow-up.21 Indeed, a 2011 review article of three databases found that MAL combined with LED had the highest response rates of 95 percent compared with 82 percent with ALA-PDT.22 In the United Kingdom, Baas et al23 have shown promising results in basal cell carcinoma (BCC) treatment after use of a second-generation intravenous photosensitizer, meta- tetrahydroxyphenylchlorin (mTHPC), in conjunction with a red LED (652 nm).23 Additional studies have evaluated the effectiveness of red LED PDT in the treatment of AKs. Wiegell et al24 have shown red LED to be more effective than continuous, ultra- low-intensity artificial daylight in AK therapy.24 In two other studies, patients underwent two MAL-PDT treatments one week apart. The first study found a complete response rate of 59.2 percent in the treatment group versus 14.9 percent in the placebo group.25 The second study found 68.4 percent a complete response rate for the treatment group versus 6.9 percent in the placebo group.26 A recent study of 50 patients, however, showed no difference between the effectiveness of MAL-PDT and pulsed dye laser (PDL) on AKs, although PDL appears to be easier to use and less painful.27 A retrospective analysis of off-label PDT with MAL in Italy suggested a therapeutic role for treatment of granulomatous dermal disorders and follicular inflammatory diseases, such as acne vulgaris, granuloma annulare, and necrobiosis lipoidica.28 Despite these suggestions, a 2011 multicenter study by Berking et al29 did not recommend MAL-PDT as first-line therapy of necrobiois lipoidica due to its response rate of 39 percent. Red LED (660nm) has been shown to prevent ultraviolet (UV)-induced erythema. In a study by Barolet et al,30 subjects experienced an increase in minimal erythema dose (MED) corresponding to approximately a sun protection factor (SPF) of 15 after a series of 5 to 10 red LED treatments.30 Whether LED exposure provides a true reduction in UV damage or just a reduction in erythema was not assessed. Lastly, Whelen et al31 found a beneficial effect of daily red LED (670nm) treatments on the incidence and severity of oral mucositis (OM) in pediatric patients undergoing myeloablative therapy.31 Similarly, Corti et al32 reported that red LED treatment is safe and capable of reducing the duration of chemotherapy-induced OM in adults. YELLOW LIGHT-EMITTING DIODES Much of yellow LED application has been focused on photoaging and as an adjuvant therapy to laser treatment. Recently, it has also been shown to decrease the intensity and duration of erythema after fractional laser skin resurfacing.33 In a large study, Weiss et al6 reported their clinical experience with photomodulated yellow LED (590nm) in a total of 900 patients with photoaged skin. Patients received LED treatment alone or in combination with intense pulsed light (IPL), PDL, potassium-titanyl-phosphate (KTP) laser, or infrared lasers. Patients who received LED alone self- reported a softening of skin and a reduction in fine lines. Post-thermal/nonablative-treated patients self-reported a reduction in post-treatment erythema of the primary treatment. In two studies by Weiss et al, a yellow LED (590nm) was used on 93 and 90 patients, respectively, with mild-to-moderate photoaging. In the first study, an independent observer determined that photoaging was decreased by one Fitzpatrick wrinkle class in 90 percent of subjects.8 In the second study, optical profilometry showed a 10-percent improvement by surface topographical measurements, and histology showed increased collagen in 100 percent of post-treatment subjects.34 Despite these promising results, a study by Boulos et al35 suggests that these results are complicated by placebo effect or observer bias. They conducted a study designed to replicate the results of Weiss. They found similar patient perceptions, but were unable to replicate the objective data using a panel of 30 blinded experts, including ophthalmologists and oculoplastic surgeons.35 The authors’ experience, which will be discussed later, is consistent with Boulos’ results. Khoury and Goldman36 performed a split-face study in which subjects received two photomodulated yellow LED treatments after IPL. A blinded observer determined an approximate 10-percent reduction in erythema on the treated side. Four patients also reported decreased pain.36 Similarly, photomodulated yellow LED has also been shown to speed healing and reduce erythema after fractionated laser therapy.33 DeLand et al37 investigated the value of yellow LED photomodulation therapy (590nm) in regards to preventing or improving the skin’s tolerance to radiation dermatitis. Patients were treated with yellow LED after a series of intensity-modulated radiation treatments. The majority of patients experienced a minimal skin reaction to radiation (grade 0 or 1 radiation dermatitis) and only 5.3 percent of patients had to interrupt radiation therapy due to a skin reaction as compared to 68 percent of controls. This suggests that LED treatments reduced the incidence and degree of radiation-induced skin reactions as well as the incidence of treatment interruption because of skin reaction. However, in a similarly sized study that evaluated yellow LED photomodulation in patients with radiation dermatitis, the authors found statistically insignificant differences between the treatment groups’ and the control groups’ graded reactions post-radiation therapy. The percentage of LED-treated patients with grade 0, grade 1, Yellow LEDs penetrate the skin between 0.5 and 2mm. [June 2015 • Volume 8 • Number 6] 39PDF Image | Light-emitting Diodes A Brief Review and Clinical Experience
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