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Preliminary research on nine patients using combination 830nm and 633nm light for the treatment of recalcitrant psoriasis is promising. Clearance rates by the end of the follow-up period ranged from 60 to 100 percent with universally high satisfaction rates.60 THE AUTHORS’ EXPERIENCE At the authors’ institution, they have used the GentleWaves® LED Photomodulation® yellow LED device, which is FDA approved for the treatment of photoaging, and delivers 250ms pulses of 0.1J/cm2 of energy in a patented 35-second treatment. However, FDA approval for these devices did not necessitate demonstration of efficacy. The authors undertook an open-label, Institutional Review Board (IRB)-approved trial, with the goal of examining the effectiveness of photomodulated yellow LED in the treatment of several common skin conditions. Signed informed consent was obtained. They enrolled patients with acne (N=3), rosacea (N=6), photoaging (N=10), alopecia areata, and androgenetic alopecia (N=2). Study patients received weekly treatments for eight weeks. A blinded observer evaluated pre- and post-treatment photographic images for clinical efficacy and participants were asked to subjectively rate changes in their skin. Overall treatments were well-tolerated and most patients completed the eight- week protocol. Those who discontinued early cited minimal perceived benefit and the inconvenience of office visits. Ten patients were enrolled for photoaging. A modest improvement in the appearance of fine periocular rhytides was observed in 8 out of 10 patients, which is similar to results published elsewhere.6,8 Most patients reported an overall perceived benefit, although photographic evidence is subtle (Figure 2). Unlike other studies, none of the authors’ patients improved their Glogau photoaging score. One patient, however, perceived such satisfactory improvement in her photoaging that after the study she has continued twice-monthly treatments. Two of four rosacea patients noted a reduction of erythema that was confirmed with photography (Figure 3). There was no change in the papulopustular component of their disease. The effect of yellow LEDs on vasculature has been demonstrated previously,33,35–38 so it is not surprising that the erythematotelangiectatic component of rosacea was more responsive to treatment than the inflammatory component. In a patient with a nine-month history of erosive pustular dermatosis of the scalp, the authors saw a dramatic improvement after one treatment. However, the condition recurred about three months later and has not yet been retreated pending a scheduled visit. Another patient was given a yellow LED treatment immediately following a 30- percent glycolic acid peel. She reported less post-procedure erythema than she had experienced after previous glycolic peels. No clinical benefit was seen in a patient with alopecia totalis. One woman with androgenetic alopecia was treated; she reported a slight re-growth over the anterior hairline, but this was not collaborated with clinical photos. Several Figure 2. Evaluation of photoaging in a 70-year-old patient with rhytides for 30 years who received eight total treatments on the forehead and around the eyes patients were treated for acne and had no clinical improvement. One patient quit the study after three treatments because she noticed a flare of her acne. SIDE EFFECTS Generally, minimal to no side effects were experienced. One patient reported post-treatment erythema that lasted 24 hours. The authors were unable to examine this patient while symptoms were present and she received additional treatments without complication. In the other literature reviewed, side effects were either mild or not reported. It remains prudent to screen individuals with photosensitive dermatoses, or those taking photosensitizing medications, as these are contraindications to treatment.13–15,20,36–40,45 DISCUSSION While much of the data on LED use in dermatologic therapy is promising, it is important to highlight the value of randomized, controlled trials and randomized, blinded trials for their increased objectivity. From the authors’ review, it appears as though combination blue-red PDT, ALA/MAL- [June 2015 • Volume 8 • Number 6] 41PDF Image | Light-emitting Diodes A Brief Review and Clinical Experience
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