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grade 2, and grade 3 reactions were 0, 33, 67, and 0 percent, respectively; the non-treated groups were 7, 27, 60, and 7 percent, respectively. The authors concluded that it did not reduce any incidence of radiation-induced skin reactions.38 BLUE LIGHT-EMITTING DIODES Blue LED light (400–470nm) has a maximal penetration of up to 1mm.2 It is best suited for the treatment of more superficial conditions, such as AKs, or to target P. acnes in acne vulgaris. Morton et al39 treated 30 patients with mild- to-moderate acne with 8-, 10-, or 20-minute blue LED (415nm) treatments over a period of four weeks. Mean inflammatory lesion counts decreased at Weeks 5, 8, and 12 by 25, 53, and 60 percent, respectively, with minimal effect on noninflammatory lesions.39 Tremblay et al40 gave patients with mild-to-moderate inflammatory acne two 20-minute treatments of blue LED (415nm) per week for 4 to 8 weeks. Ninety percent of patients were satisfied with the result.40 Objectively, patients had a 50-percent reduction in lesion counts and nine patients were completely clear. Two similar clinical studies showed reductions in lesion size, number, and erythema in patients as evaluated by physician and patients after treatment with blue LED.41,42 Although blue light has been tried in conjunction with ALA in the treatment of acne of 20 patients, patients experienced greater side effects and the results were not clinically significant when compared with blue LED alone.43 Recently, blue LED has also shown promise in the treatment of thicker lesions such as psoriasis. A 2011 prospective, randomized study of 37 patients showed statistically significant improvement of irradiated plaques after four weeks of treatment with an at-home LED-based on the Local Psoriasis Severity Index (LPSI).44 INFRARED IR LED treatment can penetrate the skin between 5 and 10mm and has been used to treat wounds, ulcers, recalcitrant lesions, cutaneous scleroderma, and has even been shown to treat cellulite.45–47 They are frequently used in combination therapy with other light devices. Data on monotherapy with IR LEDs is limited. In 2007, Hunter et al48 reviewed the use of an infrared LED device on several patients: a diabetic with non-healing wounds, a bed- bound patient with methicillin-resistant Staphylococcus aureus furuncles, and a patient with painful full-thickness pressure wounds. Patients received 30-minute IR treatments 2 to 5 times a week coupled with a topical treatment of the clinician’s choice. In each case, there was noted to be increased wound contraction and granulation and decreased pain, edema, and infection.48 In 2013, Lev- Tov et al49 concluded that certain low-level IR fluences resulted in a statistically significant reduction in fibroblast proliferation than in controls without a reduction in cellular viability. With more study, this could prove to be beneficial for scar treatment and wound healing. Combination therapy using IR A plus visible light treatment has been shown to be effective in the treatment of patients with cutaneous scleroderma. Durometry measurements in 7 out of 10 patients showed a persistent marked improvement in hardness of the skin after therapy.46 This could prove to be beneficial in the future treatment of dysmorphism, contractures, and restricted movement. COMBINATION TREATMENT A number of studies have indicated that exposing patients to a combination of LED wavelengths is more effective than monotherapy.50–56 This synergistic effect has been investigated on a variety of skin disorders, most notably photoaging and acne. A prospective, placebo-controlled, double-blind, split- face trial by Lee et al50 randomized patients with facial rhytides to receive red LED (640nm), IR (830nm), both, or sham treatments. Patients demonstrated a statistically significant reduction in wrinkle severity across all treatment groups; 26, 33, and 36 percent, respectively. Skin elasticity also improved. Tissue assays were notable for an increase in collagen and elastic fibers adjacent to highly active fibroblasts. The pro-inflammatory cytokines interleukin 1β (IL-1β) and tumor necrosis factor-α (TNF-α) were increased while interleukin 6 (IL-6) was decreased. In a separate study, Goldberg et al51 investigated the combination of red (633nm) and IR (830nm) LED treatment on photodamaged skin and reported softening of periorbital wrinkles in 80 percent of subjects. There was subjective improvement of softness, smoothness, and firmness. Histologic examination demonstrated increased number and thickness of collagen fibrils.51 A similar study in 2012 showed increases type I collagen expression and the number of viable fibroblasts when treated with different combinations of 630nm, 830nm, and varying wavelengths of red and IR light.57 Three additional studies investigating the effects of combination red and IR LED on photodamaged skin were also reviewed and showed similar results. In all three of the studies, patients reported subjective improvement and a slight-to-moderate objective improvement was observed.52–54 Combination LED for the treatment of acne is also promising. Lee et al55 treated patients with moderate acne with a combination of blue (415nm) and red (640nm) LED devices. A 34-percent improvement in comedone count and a 78-percent improvement in the number of inflammatory lesions were observed. Reduced melanin levels were measured with a MexameterTM (Courage+Khazaka electronic GmbH, Cologne, Germany), corresponding to an overall perception of improved complexion. A similar study by Sadick et al58 using combination blue and near infrared (830nm) LED therapy showed improvement in 11 individuals’ lesions an average of 48.8 percent. Goldberg et al56 treated patients with mild-to-severe acne with dermabrasion followed by alternating red (633nm) and blue (415nm) LEDs. There was a 46 percent and 81 percent decrease in lesion count at four and 12 weeks, respectively. More recently, Kwon et al59 demonstrated a decrease of both inflammatory and noninflammatory acne lesions by 77 percent and 54 percent, respectively, following home-use combined blue and red LED. 40 [June 2015 • Volume 8 • Number 6]PDF Image | Light-emitting Diodes A Brief Review and Clinical Experience
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