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Avci et al. Page 8 resistance prior to upcoming UV damage was investigated in a group of subjects with normal fair skin and patients presenting polymorphous light eruption (PLE). Results suggested that LED based therapy prior to UV exposure provided significant dose-related protection against UVB induced erythema. A significant reduction in UVB induced erythema reaction was observed in at least one occasion in 85% of subjects as well as in the patients suffering from PLE. Furthermore, a sun protection factor SPF-15-like effect and a reduction in post-inflammatory hyperpigmentation were observed. An in vitro study by Yu et al. revealed that HeNe laser irradiation stimulated an increase in nerve growth factor (NGF) release from cultured keratinocytes and its gene expression.66 NGF is a major paracrine maintenance factor for melanocyte survival in skin.67 It was shown that NGF can protect melanocytes from UV-induced apoptosis by upregulating BCL-2 levels in the cells.68 Therefore, an increase in NGF production induced by HeNe laser treatment may provide another explanation for the photoprotective effects of LLLT. LLLT for Herpes Virus Lesions One of the most common virus infections is caused by herpes simplex virus (HSV). HSV is chronic and lasts one’s entire life. The exposure of the host to several kinds of physical or emotional stresses such as fever, exposure to UV light, and immune suppression causes virus reactivation and migration through sensory nerves to skin and mucosa, localizing particularly on the basal epithelium of the lips and the perioral area.69 Up to 60% of sufferers will experience a prodromic stage, after which the lesions develop through stages of erythema, papule, vesicle, ulcer and crust, until healing is achieved. It is accompanied by pain, burning, itching, or tingling at the site where the blisters form. Immune responses to HSV infection involve: macrophages, Langerhans cells, natural killer cells, lymphocyte- mediated delayed-type hypersensitivity, and cytotoxicity.70 While several anti-viral drugs such as acyclovir and valacyclovir are used to control recurrent herpes outbreaks, only limited reduction in the lesions’ healing time has been observed.69 Furthermore, development of drug-resistant HSV strains is of increasing significance especially in immunocompromised patients.70 Therefore, new therapy modalities that can shorten the recurrent episodes and cause prominent reduction of related pain and inflammation are necessary. LLLT has been suggested as an alternative to current medications for accelerated healing, reducing symptoms and influencing the length of the recurrence period.69,71,72 Among 50 patients with recurrent perioral herpes simplex infection (at least once per month for more than 6 months), when LLLT (690 nm, 80 mW/cm2, 48 J/cm2) was applied daily for 2 weeks during recurrence-free periods it was shown to decrease the frequency of herpes labialis episodes.73 In another study with similar irradiation parameters (647 nm, 50 mW/cm2, 4.5 J/cm2), investigators achieved a significant prolongation of remission intervals from 30 to 73 days in patients with recurrent herpes simplex infection.74 Interestingly, patients with labial herpes infection showed better results than those with genital infection. However, irradiation did not effect established HSV latency in a murine model.75 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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