LED treatments

Dr Paul Charlson looks at the benefits of light-emitting diodes in aesthetic medicine

Light-emitting diode treatments are an established therapy in many aesthetic clinics. Most machines are designed for facial treatment and work by nonthermal photobiomodulation stimulating fibroblast proliferation, collagen synthesis and growth factors. They mainly utilise blue, red, and near-infrared light and are efficacious in treating acne, psoriasis, photo-rejuvenation, and wound healing. The treatment has relatively few side effects and short downtime. LED therapy is often used in combination with other treatment modalities, such as radiofrequency (RF) skin tightening and laser, but it can be used as a stand-alone treatment. Treatment protocols vary but usually require several treatments over a few weeks, with effects taking three to six months to become evident.

Originally, all treatments were carried out using larger, clinic-based lamps, but more recently, LED masks have become popular.

LED treatments usually consist of blue light around 415nm, red light around 630nm and near-infrared around 830nm. These are often combined to maximise the effects. LED therapy is a low-energy light delivery system.

ACNE

Acne is common and causes significant physical and psychological disability for patients. Treatment can be topical retinoids and benzyl peroxide, oral antibiotics and isotretinoin. These treatments are usually effective; however, they all have side effects.

Blue or red light is used in the treatment of acne, either alone or in combination. Blue light is considered to have antibacterial properties and is effective against P Acnes.1 A combination of red-blue light can produce even better results.2 Goldberg and Russell used microdermabrasion followed by red-blue LED twice weekly over four weeks and demonstrated a significant improvement in acne after 12 weeks.3 Other studies have confirmed these results. Melnick, using blue light and the photosensitiser 5-ALA, showed a significant improvement in cystic acne.4

It appears that LED is potentially a useful addition to traditional acne treatments, particularly where other treatments might be contraindicated, such as during pregnancy.

PSORIASIS

Psoriasis is a relatively common condition. Treatment is usually focussed on topical applications followed by light treatments and, for more severe cases, systemic treatments. It is increasingly difficult to obtain phototherapy via the NHS. As a result, some patients may turn to aesthetic clinics for assistance. Two studies demonstrated the effectiveness of red and near-infrared LED treatments in plaque and guttate psoriasis.5,6

PHOTOREJUVENATION

LED light works by non-thermal photobiomodulation, leading to fibroblast proliferation, collagen synthesis, growth factors, and extracellular matrix production, by activating cellular mitochondrial respiratory pathways. This results in the lifting and tightening of lax skin and the reduction of rhytids. In aged, photodamaged skin, collagen synthesis is reduced with elevation of matrix metalloproteinase (MMP) expression.

Bhat J et al used 633nm light with three treatments per week for three weeks and showed an improvement in fine lines and wrinkles and a softer smoother skin.7

In a study of 31 patients, Russell BA, Kellett N and Reilly LR concluded a combination of red and near-infrared LED therapy represents an effective and acceptable method of photo-rejuvenation.8

Lee et al compared fake LED with real LED treatment (red and infrared) and found that red and infrared light combined improved wrinkles significantly more than control and was better than red LED alone.9 However, red LED alone reduced melanin in the skin more, and tissue assay confirmed increased collagen throughout the dermis. When used for photo rejuvenation, optimal results tend to occur between three to six months after treatment.

WOUND HEALING

Red light significantly increases cell growth in a diversity of cell lines, accelerating healing and increasing amounts of epithelialisation in skin grafts as demonstrated by Conlan, Rapley and Cobb.10 Using red and infrared LED, Trelles, Allones and Mayo showed 50% better wound healing post-ablative laser treatment at three months than the control group but little difference in wrinkles after six months, although the LED-treated side appeared younger looking. Weiss et al found infrared LED useful in hastening the recovery of bruising.11 This is something utilised by many aesthetic clinics.

SUNBURN AND PHOTO PROPHYLAXIS

This is potentially a new use for LED treatment. Shorter healing times have been reported in small studies using LED treatment post-exposure.12 There is also indication from in vitro studies that LED treatments could be used to stimulate skin resistance to UV damage without the drawbacks of traditional sunscreens.

LED AND COSMECEUTICAL DRUGS

LED treatments can be used as a stand-alone or with skincare such as cosmeceuticals. LED can also be used to activate drugs in the skin as a photodynamic therapy and there is growing interest in the field.

An interesting study conducted over 12 weeks examined flushing, skin glow, sebum and pigmentation using a mixed LED mask, compared to LED alone.13 Both groups showed improvement with no statistical difference between the two groups. The largest improvement was found in those patients who previously had neglected to treat their skin.

LED LAMPS VS LED MASKS

I could find no studies comparing the efficacy of LED masks with LED clinic lamps. The advantage of LED masks is that they are easier and more accessible to patients and can be used at any time. LED lamps are considered more effective than LED masks because they deliver a higher intensity of light over a larger area, allowing for deeper penetration, with canopy-style masks providing a more uniform distribution of light.

THE FUTURE

Face-fit microLED masks may become popular, as they will fit the face and have the potential to be mass-produced and bespoke. Kim M.S et al found significant improvement in facial sagging, wrinkles and elasticity in the face compared with current LED masks.14 Zhanghu, M. et al, in an addendum to their original research, suggested microLED masks would be even more effective eye masks.15

MicroLED masks have tiny multiple LED lights which are densely packed, allowing amore precise and even light distribution than traditional LED masks. The other area of interest is photodynamic drugs, which are activated using LED masks. These could provide very convenient treatments without the need for multiple clinic appointments.

CONCLUSION

LED therapy appears to be safe, easy and inexpensive to administer, with no reported side effects or downtime. There have been concerns regarding normal LED lighting, particularly if blue spectrum LED caused retinal damage, but I could find none related to controlled clinical treatments.16 Evidence for LED therapy effectiveness is often from small studies, but these have shown clear benefits, particularly in photo-rejuvenation, acne and wound healing. Many aesthetic clinics report significant patient satisfaction using LED treatments post-procedure to reduce erythema and aid healing or to brighten photo-damaged skin. The cost of a single treatment is around £40, making even a course of 10 treatments within reach of many patients. Clinics report that patients tend to return for further courses, which is a sure sign of benefit.

DR PAUL CHARLSON

Dr Paul Charlson is the director of Skinqure (Yorkshire) and Intoskin (London) Clinics and the medical director of Continental Skin Clinic (London). He is the past president of BCAM and a JCCP board member. Dr Charlson has worked in aesthetics for 24 years and uses a range of autologous products, including T-Lab.

Harvey Barrett is head of business development for Hawksley and Sons which distributes T-Lab autologous products in the UK.