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Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach

Mosca, Rodrigo Crespo PhD, DDS, MSc; Ong, Adrian A. MD; Albasha, Omar; Bass, Kathryn MD, MBA; Arany, Praveen PhD, BDS, MDS, MMSc Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach, Advances in Skin & Wound Care: April 2019 - Volume 32 - Issue 4 - p 157-167

doi: 10.1097/01.ASW.0000553600.97572.d2 DOWNLOAD HERE https://journals.lww.com/aswcjournal/Fulltext/2019/04000/Photobiomodulation_Therapy_for_Wound_Care__A.3.aspx


The use of light therapy dates back to ancient civilizations, going as far back as the ancient Egyptians and Indians, who used sunlight (heliotherapy) for healing and promoting health.1 The therapeutic use of light energy was more fully appreciated in the late 19th century when a Danish physician-scientist, Niels Ryberg Finsen, demonstrated the benefits of red and blue light in the treatment of lupus vulgaris and was recognized with the 1903 Nobel Prize in Medicine and Physiology.2 In 1960, the L.A.S.E.R. (Light Amplification by Stimulated Emission of Radiation) by Theodore Maiman was invented, based on theoretical work by Albert Einstein in 1917. This brought renewed attention to the therapeutic light energy field.3,4 The monochromatic, coherent, and collimated nature of lasers led to immediate interest in their biologic effects. In 1967, Endre Mester,5,6 a Hungarian physician-scientist, reported that low-dose laser treatments were capable of promoting wound healing and hair regrowth in mice. He termed this phenomenon photostimulation and went on to demonstrate the efficacy of this treatment in human patients with skin ulcers.7

This brief literature review indicates the benefits of PBM therapy for various types of wounds. There are several studies on the therapeutic efficacy of PBM therapy for oral mucositis, ultraviolet skin damage, and radiation dermatitis that were outside the scope of this review.42,57–59

A major limitation noted in this review was the wide range of PBM clinical protocols among studies with respect to wavelength, dose, and delivery that prevent a rigorous consensus. Understanding the photobiologic mechanisms of PBM using correct wavelengths is critical for optimal clinical light treatment parameters for desired therapeutic medical and biological outcomes. Nonetheless, within the limits of the presented studies, the clinical benefits noted could serve as templates for development of more rigorously designed clinical studies to evaluate PBM therapy in wound healing.

Attention to treatment costs such as purchase and maintenance of PBM equipment should be balanced with potential improved clinical efficacy and the benefits of lowered care costs. Further, the access to wound care afforded by this nonpharmacologic intervention could also be specifically evaluated. Among various avenues for further development of PBM technologies, a photoceutical approach to validating pharmacodynamics, pharmacokinetics, and clinical safety and efficacy seems most attractive. Targeting robust, objective outcomes, especially molecular biomarkers, will enable PBM therapy to become a potent modality for wound management in the future.

PRACTICE PEARLS

  • Promotion of wound healing was among the first observed benefits of low-dose light treatments (photobiomodulation therapy). There is now growing evidence from well-designed controlled human studies for this specific application.

  • Discrete wavelengths and light dose can be used to promote specific phases of wound healing.

  • There are now well-understood molecular mechanisms mediating the use of low-dose light therapies.

  • Light treatment parameters can be tailored to specifically account for both anatomical and pathophysiologic responses, including device settings and treatment delivery approaches.

  • As with most current therapies, the biologic target and disease etiology must be addressed for maximal reproducible therapeutic benefit from these treatments.




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