Harnessing The Healing Power of Light for Your Skin
Photobiomodulation
The power of photobiomodulation (PBM) can be observed throughout the natural world. It is the process by which chlorophyll absorbs energy from the sun which allows the plant to grow and produce nutrients. In this case chlorophyll is termed a chromophore as it absorbs specific wavelengths of light which in turn produces a series of chemical reactions in the plant.
Photobiomodulation also plays a significant role in our cells as well. Two well known examples are chromophores in the retina and skin which facilitate colour vision and vitamin D production, respectively. There are other chromophores present in literally every cell in the body which absorb very specific wavelengths and intensities of light. This results in:
Repair of cells if they are damaged
Improvements in the specific function of the cell that is stimulated.
Increase in the number of cells if more are required for optimal functioning
Impressive results can be achieved with photobiomodulation provided that the correct wavelengths and energy levels are employed. The active wavelengths are well known but the most common issue is failure to use the optimal energy levels. Too little or too much energy will lead to sub-optimal results. This is a widespread problem within the beauty and physical therapy industries where there is often insufficient appreciation of the power output of the devices used and the energy required for various applications. This has led to mixed results and the perception that photobiomodulation therapy can be “hit or miss”. However, thousands of well designed basic science and clinical studies provide strong evidence that this is a tremendously effective and yet safe method of treating various dermatology and other medical complaints. Photobiomodulation has shown beneficial effects for a variety of medical conditions such as chronic neck and other joint pain, wound healing, nerve regeneration, stroke recovery, and the prevention and treatment of mucositis especially in cancer patients.
Photobiomodulation therapy employs light energy within the safe, visible light part of the electromagnetic spectrum. There is no risk of damaging radiation as seen with gamma rays, x-rays or ultraviolet radiation.
Photobiomodulation offers many advantages over other treatment modalities:
It is a completely non-invasive therapy with no “downtime”
Treatments are quick - 15-20 minutes on average. However multiple sessions may be required to achieve a meaningful result depending on the indication.
Provided that the eyes are adequately shielded, there are usually no side-effects, pain, redness or other signs of irritation
It is safe and beneficial for all skin types from very fair skin to dark skin.
Because PBM targets every type of cell it offers benefit in a multitude of skin and other medical complaints
More significant results are seen in damaged, reactive and sensitive skin
The benefits are long term - not just a “quick fix”
The hands-free, non-contact treatments may be preferred in view of the current pandemic.
Photodynamic Therapy
Photodynamic therapy (PDT) is also a light based therapy but in this case the therapeutic effect is obtained by combining a chemical photosensitizer with light energy. It is very effective for targeting pre-cancer and cancer cells and infectious agents. PDT offers many advantages over antibiotics:
PDT has a broad spectrum of activity targeting not only bacteria, but also viruses, fungal infections and parasites
The infectious organisms do not develop resistance to PDT. This is critically important as bacterial resistance is a major and rapidly increasing problem
PDT is very safe and well tolerated.
Acne
Photobiomodulation and photodynamic therapy are very useful means of clearing acne and maintaining response.
Blue Wavelength (405-415nm): This very active wavelength attacks the acne bacteria in the skin by taking advantage of the fact that acne bacteria actually produce photosensitizers called porphyrins. These “on-board “ photosensitizers can be excited by blue light energy to kill the bacteria. Although highly active, light of this wavelength does not penetrate very deeply into the skin. Seeing that acne bacteria are generally located deep within the skin pores, this can limit the efficacy. This challenge can be addressed by exfoliating the skin prior to administering the light treatment to increase absorption of the light energy and/or employing a novel means of targeting the skin from “inside” via the sublingual circulation. In this way the acne bacteria can be targeted with an external light source, internally via the blood circulation or a combination of both measures at the same time for optimal results.
Additionally an external photosensitizer which is selectively absorbed by the skin pores can be applied to the skin and stimulated by the correct power and wavelength of light to stimulate the applied photosensitizer and kill the acne bacteria. This is not usually required unless the acne is severe.
Red and Infra-Red Wavelengths: Along with blue light, red and infra-red wavelengths not only significantly reduce acne inflammation, they also reduce blockage of the pores and excessively oily skin. Pulsed infra-red therapy has also been shown to reduce post-inflammatory hyperpigmentation - often the most troubling and prominent acne symptom observed in darker skin.
Skin Rejuvenation
Skin aging results from an interplay of normal intrinsic biological factors and environmental factors, the most important being damage from ultraviolet radiation. UV radiation degrades every component of the skin. The epidermis, the most superficial layer of the skin, becomes progressively thinner with an increasingly rough texture. Wrinkles and sagging skin results from changes to the dermis, the second layer of the skin. This is due to depletion collagen and elastin fibers along with reduced lubrication in the vitally important substance surrounding the cells in the dermis.
Fortunately all of these factors can be addressed by photobiomodulation using various wavelengths to target different structures and depths within the skin. PBM can be used as a standalone measure to give real improvements in wrinkles and sagging skin. However this gentle, safe process can take up to 3 months for notable effects to become apparent. Results can be significantly accelerated by combining these treatments with light exfoliation and use of specific cosmeceuticals, so the same results can normally be achieved in one month.
Lastly, PBM can also be used in conjunction with other skin rejuvenation measures to produce improved and faster results and more rapid healing. Healing times and resolution of any bruising may be reduced to less than half the time normally required.
Wound Healing
The use of sunlight therapy to promote healing has been practiced for centuries. In 1967, Endre Mester, a Hungarian physician, and considered the father of photobiomodulation therapy, reported that low intensity laser therapy can promote wound healing and hair regrowth in mice. He later demonstrated that photobiomodulation can also promote healing of skin ulcers in humans.
Extensive research has established that photobiomodulation promotes tissue regeneration and speeds up wound repair by modulating oxidative stress and inflammation, promoting cell migration and proliferation, and accelerating the production of essential growth factors and extracellular matrix components.
Photobiomodulation can be effectively applied to acute injuries, surgical wounds and chronic wounds of all types, including infected wounds. It reduces swelling, bruising and pain with reduced rates of hypertrophic scar formation.
With the dramatic rise in bacterial resistance, infected wounds have become a significant challenge. This can be addressed by incorporating blue light therapy along with the other healing wavelengths. This wavelength acts on a group of compounds produced by bacteria called porphyrins and is a form of photodynamic therapy.
Porphyrins are “on-board” photosensitizers which kill the bacteria once they are excited by blue light. Although highly active, light of this wavelength does not penetrate very deeply into the skin. Fortunately, the bacteria in infected wounds are on the surface and readily accessible in this case. However the response can also be amplified with a novel means of targeting the skin via the sublingual circulation. In this way the resistant bacteria can be targeted with an external light source, internally via the blood circulation or a combination of both measures at the same time for optimal results.
Additionally an external photosensitizer can be applied to the wound and stimulated by the correct power and wavelength of light to eradicate the resistant bacterial biofilm. This is highly beneficial in stubborn, non-healing wounds, where a resistant bacterial biofilm impedes healing as shown in the following example:
Hair Loss
The use of photobiomodulation for addressing hair loss was discovered by chance by a Hungarian physician-scientist called Endre Mestor in 1967. Since then, many studies have confirmed that PBM can be beneficial for many types of hair loss including male and female pattern hair loss (familial type), hair loss related to scalp inflammation, alopecia areata and chemotherapy induced alopecia.
Studies indicate that PBM reduces scalp inflammation, increases blood flow and oxygenation and promotes the active growth phase of each follicle - called the anagen phase. It not only stimulates transition to anagen, it prolongs anagen duration, increases the amount of hair cells produced in this phase and inhibits transition from anagen to the resting and shedding phase. This adds up to thicker, more visible hair follicles with better coverage.
If a follicle has already been effectively destroyed, PBM will not be effective in stimulating growth in this follicle. However it can help to inhibit further damage and loss. Early intervention is therefore very important, especially in types of hair loss which results in scarred follicles.
Although PBM is an FDA cleared means of stimulating hair growth with confirmed efficacy there are a few practical challenges with its use.
Firstly, it generally requires 2-3 treatment sessions per week for about 4 months to really see substantial change. However this can be accelerated by combining PBM with topical treatments and shampoos that also promote hair growth.
Secondly, excessive heat may be experienced in dark skin depending on the type of equipment used. However this can be avoided by tailoring the output of the treatment, so that all patients can benefit from this very helpful option for hair loss.
Treatments can be done in office, or with home treatment “laser caps”. However the high quality laser caps which provide adequate functionality and optimized output which can be safely tolerated by all skin types, may require quite a costly commitment upfront. We therefore recommend starting treatments in office for the first month or two and then deciding on a laser cap for long term use if needed.
Melasma
Melasma generally responds well to a combination of topical therapies coupled with strict sun protection. However there are several challenges with the management of this condition.
Topical therapies include hydroquinone, retinoids, vitamin C and other preparations. Hydroquinone is the most effective of these topical agents. However it’s important to strictly limit or avoid its use as far as possible in order to avoid possible adverse effects. These include exogenous ochronosis which may occur with prolonged use. Unfortunately there is no reliable method of clearing this stubborn condition once formed.
In some cases, the pigmentation may be located too deep within the skin for the topicals to access and resolve it. Furthermore, melasma is a chronic, relapsing skin condition and there is ample evidence that ongoing inflammation plays a significant role in its development.
We recommend photobiomodulation therapy as an added measure along with effective topical treatments to speed the response and as a maintenance strategy once melasma has been resolved.
Infra-red photobiomodulation offers some distinct advantages for targeting melasma. Firstly, it is a powerful suppressor of inflammation and the excessive melanogenesis that results. Infra-red is not absorbed by superficial skin structures and has a long wavelength which allows penetration deep into the dermis where it can target deep-seated, stubborn melasma. In contrast with high powered lasers, pulsed infra-red can be administered without generating excessive heat in the skin. The heat generated by high powered lasers can reverse much of the benefit obtained by the treatment or even worsen the melasma.