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Avci et al. Page 9 Even though mechanism of action is still not clear, an indirect effect of LLLT on cellular and humoral components of the immune system involved in antiviral responses rather than a direct virus-inactivating effect was proposed.76 Inoue et al. investigated tuberculin reactions at the bilateral sites of the backs of sensitized guinea pigs. They applied a single low-power laser irradiation dose at a fluence of 3.6 J per cm2on one side and compared it to contralateral non-irradiated sites.77 Interestingly, following irradiation, tuberculin reaction was suppressed not only at the irradiated site but also at the contralateral nonirradiated site. It is worth to note that this phenomenon was observed when mononuclear cells were dominant in the perivascular cellular infiltration. Based on their results, they have suggested a possible systemic inhibitory effect of LLLT on delayed hypersensitivity reactions.77 Activation and proliferation of lymphocytes78–81 and macrophages82 as well as the synthesis and expression of cytokines83,84 following low intensities of red and NIR light have been reported by several investigators. The question of whether these effects of LLLT have any influence on HSV infection remains to be determined. LLLT for Vitiligo Vitiligo is an acquired pigmentary disorder characterized by depigmentation of the skin and hair. The underlying mechanism of how the functional melanocytes disappear from the involved skin is still under investigation. However, findings suggest that regardless of the pathogenetic mechanism involved, keratinocytes, fibroblasts, melanoblasts and melanocytes may all be involved in both the depigmentation and also the repigmentation processes of vitiligo.66,85–89 Therefore, stimulation of these epidermal and dermal cells may be a possible treatment option. Due to the obscure pathogenesis of the disease, treatment of vitiligo has generally been unsatisfactory. Current existing therapies that induce varying degrees of repigmentation in patients with vitiligo are topical corticosteroids, phototherapy, and photochemotherapy (PUVA).89 In 1982, a group of investigators found that low energy laser irradiation had effects on defective biosynthesis of catecholamine in certain dermatological conditions including scleroderma and vitiligo.90,91 Later on, one of the investigators from the same group reported that after 6–8 months of treating 18 vitiglio patients with low- energy HeNe laser (632 nm, 25 mW/cm2 ) therapy, marked repigmentation was observed in 64% of the patients and some follicular repigmentation was observed in the remaining 34%.91 Since then, LLLT has been suggested as an alternative effective treatment option for patients with vitiligo.66,88,89 Segmental-type vitiligo is associated with a dysfunction of the sympathetic nerves in the affected skin and it is relatively resistant to conventional therapies.66 Based on the previous reports stating that HeNe laser irradiation leads to improvement in nerve injury92–94 and LLLT induces repigmentation responses,95,96 it was proposed that the HeNe laser might be a potential treatment modality for treatment of segmental type vitiligo. 66 When the HeNe laser light was administered locally (3 J/cm2, 1.0 mW, 632.8 nm), marked perilesional and perifollicular repigmentation (> 50%) was observed in 60% of patients with successive treatments. Both NGF and bFGF stimulate melanocyte migration and deficiencies of these mediators may participate in the development of vitiligo.86,97,98 In the same study, when cultured keratinocytes and fibroblasts were irradiated with 0.5–1.5 J per cm2 HeNe laser, significant increase in bFGF release both from keratinocytes and fibroblasts as well as a 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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