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Avci et al. Page 5 increased collagen could be through the induction of TIMPs (Figure 4). When these observations are put together, it is possible that increased production of IL-1β and TNF-α might have induced MMPs in the early response to LED therapy. This may clear the photodamaged collagen fragments to enable biosynthesis of new collagen fibers. Later on, an increase in the amount of TIMPs might protect the newly synthesized collagen from proteolytic degradation by MMPs.33 Furthermore, increased expression of Cx43 may possibly enhance cell-to-cell communication between dermal components, especially the fibroblasts, and enhance the cellular responses to the photobiostimulation effects from LED treatment, in order to produce new collagen in a larger area which even includes the non- irradiated regions.33 In a clinical study performed by Weiss et al., 300 patients received LED therapy (590 nm, 0.10 J/cm2) alone, and 600 patients received LED therapy in combination with a thermal-based photorejuvenation procedure. Among patients who received LED photorejuvenation alone, 90% reported that they observed a softening of skin texture and a reduction in roughness and fine lines ranging from a significant reduction to sometimes subtle changes.36 Moreover, patients receiving a thermal photorejuvenation laser with or without additional LED photomodulation (n = 152) reported a prominent reduction in post-treatment erythema and an overall impression of increased efficacy with the additional LED treatment.36,45 This reduction in post-treatment erythema could be attributed to anti-inflammatory effects of LLLT.40 Using different pulse sequence parameters, a multicenter clinical trial was conducted, with 90 patients receiving 8 LED treatments over 4 weeks.37,46–48 The outcome of this study showed very favorable results, with over 90% of patients improving by at least one Fitzpatrick photoaging category and 65% of patients demonstrating global improvement in facial texture, fine lines, background erythema, and pigmentation. The results peaked at 4 to 6 months following completion of 8 treatments. Markedly increased collagen in the papillary dermis and reduced MMP-1 were common findings. Barolet et al.’s study is also consistent with the previously mentioned studies. They used a 3-D model of tissue-engineered human reconstructed skin to investigate the potential of 660 nm, 50 mW/cm, 4 J/cm2 LED in modulating collagen and MMP-1 and results showed upregulation of collagen and down-regulation MMP-1 in vitro.40 A split-face, single-blinded clinical study was then carried out to assess the results of this light treatment on skin texture and appearance of individuals with aged/photoaged skin.40 Following 12 LED treatments, profilometry quantification demonstrated that while more than 90% of individuals had a reduction in rhytid depth and surface roughness, 87% of the individuals reported that they have experienced a reduction in the Fitzpatrick wrinkling severity score.40 LLLT for Acne Pathogenesis of acne vulgaris has not yet been clarified, however current consensus is that it involves four main events: follicular hyperconification, increased sebum secretion effected by the androgenic hormone secretions, colonization of Propionibacterium acnes and inflammation.49 P. acnes plays a key role by acting on triglycerides and releasing its cytokines which in turn trigger inflammatory reactions and alter infundibular keratinization.49 Current treatments for acne vulgaris include topical and oral medications such as topical antibiotics, topical retinoids, benzoyl peroxide, alpha hydroxy acids, salicylic acid, or azaleic acid. In severe cases, systemic antibiotics such as tetracycline and Semin Cutan Med Surg. Author manuscript; available in PMC 2014 August 08. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptPDF Image | Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring
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