PEER-REVIEW | FACIAL AESTHETICS | USING LED PHOTOBIOMODULATION TO TREAT PREMATURE AGEING
Leonardo Marini, Giuliana Crisman, Vera Trashlieva, Aleksandar Krunic, Panagis Polizois and Andrea De Faveri present the findings from a clinical study on the sequential use of continous emission and pulsed emission light therapy
ABSTRACT Background and objective Facial skin shows signs of ageing earlier than other anatomical areas. Predominantly non-thermal infrared A (IR-A) light-emitting diode (LED) photobiomodulation has proven effective in triggering intracellular photobiochemical reactions leading to new collagen synthesis and reduction of matrix metalloproteinase-1 (MMP-1). The objective of this study was to assess the effectiveness, safety, and tolerability of a sequentially combined, continuous (CW) 835±5 nm and pulsed emission (PW) 875±5 nm LED facial mask array in the treatment of facial premature ageing.
Materials and methods Ten female subjects (47 –77 years; mean 55 years) affected by photoageing were
LEONARDO MARINI, MD, is Medical Director at The Skin Doctors’ Center, Italy; GIULIANA CRISMAN, MD, is a Consultant Dermatopathologist at The Skin Doctors’ Center; VERA TRASHLIEVA, MD, is a Senior Consultant at The Skin Doctors’ Center; ALEKSANDAR KRUNIC MD, is Associate Professor of Dermatology at University of Illinois, Chicago, and a Consultant at The Skin Doctors’ Center; PANAGIS POLIZOIS MD; Consultant Dermatologist at The Skin Doctors’ Center; ANDREA DE FAVERI Statistician at The Skin Doctors’ Center
email:
leonardo.marini@
skindoctors.it
24 ❚
KEYWORDS collagen remodelling, LED photobiomodulation, photorejuvenation
factors are intimately associated in determining typical morphological changes, including wrinkles, telangiectasia, dryness, rough texture, yellowish colour plaque-like thickening, and pigment irregularities. Collagen synthesis is progressively
P March 2013 |
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reduced, while interstitial matrix metalloproteinases (MMP; MMP-1 in particular) are up-regulated in aged skin 1,2,3
. It
has been demonstrated that a variety of narrow band, incoherent light-emitting diodes (LEDs) can stimulate natural intracellular photobiochemical reactions, producing clinical improvements of aged skin as well as accelerating wound repair through predominantly non-thermal photobiological processes 4–9
. Karu and
Kolyakov identified four ‘active’ regions in the wavelength range considered important for phototherapy (600–860 nm), after analysing action spectra of red infrared (IR) (580– 860 nm) monochromatic light; two were located in the red range (613–623 nm and 667–683 nm) and two in the IR range (750– 772 nm and 812–846 nm) 10
. Claimed
enrolled in this pilot prospective single cohort study. Facial skin was exposed to a sequentially combined 840 nm and 880 nm LED for 15 minutes twice per week for 4 weeks. Elastometry, skin colourimetry, and standardised computerised facial complexion analysis were performed to assess clinical improvements. Standardised digital photographs were taken immediately pre- and 45 days post-treatment to evaluate the internal consistency between two independent blinded observers who were asked to sort out and identify pre- and post-treatment images.
Results Skin texture, wrinkle count, and elasticity were remarkably improved 15 days and 45 days after eight LED facial treatments. Surface erythema showed a moderate increase after the same intervals of time.
REMATURE SKIN AGEING IS more pronounced on sun-exposed body areas, particularly on facial regions, where
intrinsic, environmental, and lifestyle
Minimal surface micro-dyspigmentation was detected by computerised digital skin complexion analysis 15 days and 45 days after eight LED treatments. Skin texture, tone, and wrinkles were considered improved by the majority of subjects. Moderate burning and warmth sensation were reported by 70% of subjects during LED exposures. Identification of pre-treatment digital images of treated subjects by two independent, blind dermatologists showed a 90% concordance.
Conclusions A series of combined, sequential CW 840 nm and PW 880 nm narrowband LED irradiations, delivered through an innovative anatomically designed facial mask, has proven effective in temporarily improving premature ageing-related structural and functional skin alterations.
photobiological effects have included fibroblasts
activation, neovascularisation,
improved enhanced
neocollagenesis, and macrophage biostimulation, mostly induced after light absorption by cellular photoacceptors 11,12 Continuous emission (CW) has been
.
considered as the gold standard for the majority of low level light therapy (LLLT); however, some studies indicate that pulsed light emission (PW) may be superior to CW keeping constant all other parameters 13
.
Different pulse frequencies have been used, but there is no universal consensus on the identification of the most effective 14–21
. All
previously listed biological effects are quite different from those produced by molecular ‘broadband IR response’ seen after prolonged exposure to IR radiation (760 nm – 1 cm). The IR spectral region is arbitrarily divided according to wavelength into three sub-regions: IR-A (760–1400 nm); IR-B (1400– 3000 nm); IR-C (3000 nm–1 mm). IR constitutes 54.3% of total solar irradiance, while IR-A accounts for approximately one third of solar energy load of human skin. The depth of penetration into skin and subcutaneous tissue decreases with increasing wavelength in the IR spectrum. Broadband IR radiation typically induces molecular vibrations and rotations,
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