As dermatology expands its understanding of aesthetics and aging, an increasing body of scientific and clinical evidence highlights the key role that atmosphere and pollution play in skin health, wellness, and aging. Oxidative stress injury to skin cells and tissues play a central role in skin health and wellness.
Our research team has published on the important role that UV light has in terms of damaging skin tissue at the cellular, molecular, and structural level that translates to visible and tangible evidence of skin aging. Using a panel of immunohistochemical assays, our team demonstrated that oxidative injury results in damage to lipids that serve a key role in skin barrier protection in the stratum corneum; and damages DNA and proteins in the dermis.1 Oxidative DNA damage is associated with both aging and skin cancers. Therefore, prevention of oxidative stress is essential and may decrease signs of skin aging and lower the risk for skin cancer.
Previously, the understanding of environmental assaults to skin was limited to UV radiation damage. It is crucial that dermatologists embrace the fact that skin aging extends beyond UV-induced skin damage alone. Significant attention has recently centered around how atmospheric conditions, including pollution and ozone, contribute to skin health, wellness, appearance, and disease.
Atmospheric Skin Aging
Atmospheric skin aging is a collective term for visible aging caused by regular exposure to a combination of sun and pollution. Particulate matter and ozone contribute to aging skin and increases in hyperpigmentation, wrinkling, rough texture, dullness, and laxity. One of the key aspects to appreciate is that various environmental factors that extend beyond UV damage also increase cellular reactive oxygen-free radicals in skin tissues, resulting in oxidation and changes consistent with molecular and clinical features associated with extrinsic aging.
Ozone has an important role in the extrinsic aging process. Ozone, once widely discussed in the 1980s and 1990s in environmental discussions, is now making new waves in the skin health arena because of the impact on aesthetics. Ozone is a highly reactive gas that occurs due to natural and man-made processes. Globally and nationally, ozone is often highest in densely populated urban areas. Suburban and rural areas may also feature high amounts of ozone. Ozone occurs in the Earth’s upper (stratosphere) and lower (troposphere) atmospheres. At ground level, in the Earth’s lower atmosphere, ozone is created by pollutants emitted by cars, power plants, industrial processes, and other sources. In addition to ozone serving as a source of skin aging, there is evidence that ozone may serve as a carcinogen.
A significant portion of our laboratory’s research efforts have centered around the study of antioxidants, alone and in combination, to counter skin oxidative stress. This field of scientific study is important to our specialty and our patients. Nearly all of the treatments that include antioxidants fall within the burgeoning category of cosmeceuticals. When recommending cosmeceutical products to friends, patients, and colleagues, I highlight products that have a cohesive and meaningful scientific story complete with documented clinical results that support use and will yield clinical patient benefit.
Recent research demonstrates that ozone damages skin cells, depleting the natural antioxidants, in particular, vitamins C and E, leaving the skin vulnerable to harmful environmental agents. Published in vitro and in vivo translational and clinical research emphasizes that ozone and other environmental factors that harm the skin can be mitigated. When paired with SkinCeuticals broad-spectrum sunscreens, both antioxidants provide comprehensive protection against appreciable signs of aging caused by exposure to ozone and pollution. Research2-4 conducted in partnership with academician Giuseppe Valacchi, PhD, a leading expert and researcher in the study of ozone, and cosmeceutical company SkinCeuticals, has for the first time demonstrated in live skin 3-D cultures and in vivo that ozone pollution may cause extrinsic skin aging. Dr Valacchi’s findings indicate that the application of antioxidants CE Ferulic and Phloretin CF helped prevent and reduce cellular damage caused by ozone exposure. Both CE Ferulic and Phloretin CF protected against ozone-induced type III collagen degradation.
Based upon years of clinical research, we know that a daily regimen of well-studied and clinically-proven antioxidant serum combined with a broad-spectrum sunscreen daily will provide comprehensive skin protection from UV and atmospheric aging. As dermatologists, educating and empowering patients to prevent skin aging and skin cancer is the critical first step toward healthy skin.
Extending beyond antioxidants, devices have an important role in aesthetic and medical dermatology. As a laser surgeon, I can share that patients can benefit tremendously from treatment with ablative and nonablative lasers and other impactful energy-based devices. One of the most exciting developments in medical and aesthetic skin therapy is the increasing use of light emitting diodes for the treatment of dermatologic conditions, including skin rejuvenation and wound healing.5
Light Emitting Diodes
There is a renaissance and renewed interest in light emitting diodes in the field of dermatology and discovery of new uses of light emitting diodes for skin care. New treatments of aesthetic and medical skin conditions such as skin scarring and psoriasis are on the horizon.6 Additionally, the combination of light emitting diodes with topical therapeutic products represents a burgeoning subfield in dermatology that includes photodynamic therapy and photobotanical therapy.7
Our laboratory’s decade-long research into the realm of light emitting diode phototherapy for the benefit of patient skin care started with the concept that our skin has photoacceptors embedded into our cells that can be photomodulated to help achieve enhanced skin wellness and health. Light emitting diodes represent a therapeutic opportunity for our patients—they are relatively inexpensive compared with lasers, compact, flexible, portable (easily moved from room to room), have an excellent safety profile, and are easy to combine with topical and systemic therapies.
Furthermore, light emitting diode arrays can be used safely in-office or at home. The professional use models differ from the home-use versions. The professional models feature larger treatment areas and increased power density, allowing for fast, effective treatment. The home-use light emitting diode phototherapy models have a benefit and represents a significant future aspect of dermatology therapy that includes home-use devices.
In our research in the laboratory and clinic, we used the Omnilux (GlobalMed Technologies) light emitting diode systems.8 We found that these light sources had the greatest body of published clinical data, and our own laboratory testing at the University of California, Davis demonstrated that these lights were highly reliable, provided the high output energies sought, and produced consistent high quality results.
Within the realm of aesthetics and medical dermatology, we made several key discoveries that have the potential to positively impact patient skin care moving forward. First, light emitting diode red and infrared light can penetrate the skin in a meaningful manner to reach the target cells of interest.8 Second, visible red light alone has the power to decrease skin cell proliferation; this can be translated to impact patient care for skin conditions such as fibrosis and psoriasis that feature an increase in proliferating fibroblasts and keratinocytes as pathologic hallmark features of the disease.6 The third finding was based upon the concept that combining topical and light therapy can yield synergistic outcomes compared with either alone. This combination approach of using topicals and light is not new in dermatology, however, the use of light emitting diodes as the light source is very exciting.7
Light emitting diodes are not all built the same, as our research team discovered when we partnered with the Department of Biomedical Engineering at the University of California, Davis in an attempt to build our own light emitting diode arrays. Building units that generate consistent power density across a large field ended up being more challenging than we imagined. After significant research into commercially available systems, we quickly reverted to using the FDA-cleared commercially available Omnilux units for our research. From a research standpoint, there is also a benefit to the scientific community due to our use of commercially available light sources, wherein other researchers may build off of our findings and can use the same commercially available lights for their phototherapy research, providing continuity in this emerging arena and momentum in moving the ball forward in this exciting space.
The next frontier that may be expanded is wearable skin phototherapy technology, powered by light emitting diodes for monitoring, treatment, and diagnosis. For example, the Apple Watch features light emitting diode technology that is used to monitor the wearer’s vitals and health metrics. The Apple Watch shows that diagnostic and therapeutic wearable light emitting diode technology in dermatology may be much closer than imagined.
Furthermore, light emitting diodes in dermatology may revolutionize phototherapy and fill an important niche in the future. The adoption of light emitting diodes in dermatology could parallel the adoption of light emitting diodes in society, which are now very common in homes and the environment.
From an aesthetic perspective, combining light emitting diodes with topical agents such as aminolevulinic acid may hold promise for photorejuvenation and acne therapy, in addition to the currently accepted treatment of precancerous actinic keratoses and certain skin cancers. Additionally, our laboratory research demonstrates that synergistic benefits are potentially achievable for the treatment of scarring skin diseases through the combination of high doses of light emitting diode generated red light and the antioxidant resveratrol. We look forward to continuing our investigation of light emitting diodes, alone and in combination with topical agents, that may transform the way dermatologists provide care for patients in the future.
Dr Jagdeo is associate professor in the department of dermatology at the University of California, Davis in Sacramento, CA.
Disclosure: The author has received honoraria from L’Oreal, and is on the scientific advisory board of GlobalMed Technologies. He has received honoraria from GlobalMed Technologies.
References
1. Mamalis A, Fiadorchanka N, Adams L, et al. An immunohistochemical panel to assess ultraviolet radiation-associated oxidative skin injury. J Drugs Dermatol. 2014;13(5):574-578.
2. Valacchi G, Pecorelli A, Belmonte G, et al. Protective effects of topical vitamin C compound mixtures against ozone-induced damage in human skin [published online February 17, 2017]. J Invest Dermatol. doi:10.1016/j.jid.2017.01.034
3. Valacchi G, Sticozzi C, Zanardi I, et al. Ozone mediators effect on “in vitro” scratch wound closure. Free Radic Res. 2016;50(9):1022-1031.
4. Valacchi G, Muresan XM, Sticozzi C, et al. Ozone-induced damage in 3D-Skin Model is prevented by topical vitamin C and vitamin E compound mixtures application. J Dermatol Sci. 2016;82(3):209-212.
5. Tchanque-Fossuo CN, Ho D, Dahle SE, et al. A systematic review of low-level light therapy for treatment of diabetic foot ulcer. Wound Repair Regen. 2016;24(2):418-426.
6. Mamalis A, Koo E, Garcha M, Murphy WJ, Isseroff RR, Jagdeo J. High fluence light emitting diode-generated red light modulates characteristics associated with skin fibrosis. J Biophotonics. 2016;9(11-12):1167-1179.
7. Mamalis A, Jagdeo J. The combination of resveratrol and high-fluence light emitting diode-red light produces synergistic photobotanical inhibition of fibroblast proliferation and collagen synthesis: a novel treatment for skin fibrosis. Dermatol Surg. 2017;43(1):81-86.
8. Jagdeo JR, Adams LE, Brody NI, Siegel DM. Transcranial red and near infrared light transmission in a cadaveric model. PLoS One. 2012;7(10):e47460. doi:10.1371/journal.pone.0047460
As dermatology expands its understanding of aesthetics and aging, an increasing body of scientific and clinical evidence highlights the key role that atmosphere and pollution play in skin health, wellness, and aging. Oxidative stress injury to skin cells and tissues play a central role in skin health and wellness.
Our research team has published on the important role that UV light has in terms of damaging skin tissue at the cellular, molecular, and structural level that translates to visible and tangible evidence of skin aging. Using a panel of immunohistochemical assays, our team demonstrated that oxidative injury results in damage to lipids that serve a key role in skin barrier protection in the stratum corneum; and damages DNA and proteins in the dermis.1 Oxidative DNA damage is associated with both aging and skin cancers. Therefore, prevention of oxidative stress is essential and may decrease signs of skin aging and lower the risk for skin cancer.
Previously, the understanding of environmental assaults to skin was limited to UV radiation damage. It is crucial that dermatologists embrace the fact that skin aging extends beyond UV-induced skin damage alone. Significant attention has recently centered around how atmospheric conditions, including pollution and ozone, contribute to skin health, wellness, appearance, and disease.
Atmospheric Skin Aging
Atmospheric skin aging is a collective term for visible aging caused by regular exposure to a combination of sun and pollution. Particulate matter and ozone contribute to aging skin and increases in hyperpigmentation, wrinkling, rough texture, dullness, and laxity. One of the key aspects to appreciate is that various environmental factors that extend beyond UV damage also increase cellular reactive oxygen-free radicals in skin tissues, resulting in oxidation and changes consistent with molecular and clinical features associated with extrinsic aging.
Ozone has an important role in the extrinsic aging process. Ozone, once widely discussed in the 1980s and 1990s in environmental discussions, is now making new waves in the skin health arena because of the impact on aesthetics. Ozone is a highly reactive gas that occurs due to natural and man-made processes. Globally and nationally, ozone is often highest in densely populated urban areas. Suburban and rural areas may also feature high amounts of ozone. Ozone occurs in the Earth’s upper (stratosphere) and lower (troposphere) atmospheres. At ground level, in the Earth’s lower atmosphere, ozone is created by pollutants emitted by cars, power plants, industrial processes, and other sources. In addition to ozone serving as a source of skin aging, there is evidence that ozone may serve as a carcinogen.
A significant portion of our laboratory’s research efforts have centered around the study of antioxidants, alone and in combination, to counter skin oxidative stress. This field of scientific study is important to our specialty and our patients. Nearly all of the treatments that include antioxidants fall within the burgeoning category of cosmeceuticals. When recommending cosmeceutical products to friends, patients, and colleagues, I highlight products that have a cohesive and meaningful scientific story complete with documented clinical results that support use and will yield clinical patient benefit.
Recent research demonstrates that ozone damages skin cells, depleting the natural antioxidants, in particular, vitamins C and E, leaving the skin vulnerable to harmful environmental agents. Published in vitro and in vivo translational and clinical research emphasizes that ozone and other environmental factors that harm the skin can be mitigated. When paired with SkinCeuticals broad-spectrum sunscreens, both antioxidants provide comprehensive protection against appreciable signs of aging caused by exposure to ozone and pollution. Research2-4 conducted in partnership with academician Giuseppe Valacchi, PhD, a leading expert and researcher in the study of ozone, and cosmeceutical company SkinCeuticals, has for the first time demonstrated in live skin 3-D cultures and in vivo that ozone pollution may cause extrinsic skin aging. Dr Valacchi’s findings indicate that the application of antioxidants CE Ferulic and Phloretin CF helped prevent and reduce cellular damage caused by ozone exposure. Both CE Ferulic and Phloretin CF protected against ozone-induced type III collagen degradation.
Based upon years of clinical research, we know that a daily regimen of well-studied and clinically-proven antioxidant serum combined with a broad-spectrum sunscreen daily will provide comprehensive skin protection from UV and atmospheric aging. As dermatologists, educating and empowering patients to prevent skin aging and skin cancer is the critical first step toward healthy skin.
Extending beyond antioxidants, devices have an important role in aesthetic and medical dermatology. As a laser surgeon, I can share that patients can benefit tremendously from treatment with ablative and nonablative lasers and other impactful energy-based devices. One of the most exciting developments in medical and aesthetic skin therapy is the increasing use of light emitting diodes for the treatment of dermatologic conditions, including skin rejuvenation and wound healing.5
Light Emitting Diodes
There is a renaissance and renewed interest in light emitting diodes in the field of dermatology and discovery of new uses of light emitting diodes for skin care. New treatments of aesthetic and medical skin conditions such as skin scarring and psoriasis are on the horizon.6 Additionally, the combination of light emitting diodes with topical therapeutic products represents a burgeoning subfield in dermatology that includes photodynamic therapy and photobotanical therapy.7
Our laboratory’s decade-long research into the realm of light emitting diode phototherapy for the benefit of patient skin care started with the concept that our skin has photoacceptors embedded into our cells that can be photomodulated to help achieve enhanced skin wellness and health. Light emitting diodes represent a therapeutic opportunity for our patients—they are relatively inexpensive compared with lasers, compact, flexible, portable (easily moved from room to room), have an excellent safety profile, and are easy to combine with topical and systemic therapies.
Furthermore, light emitting diode arrays can be used safely in-office or at home. The professional use models differ from the home-use versions. The professional models feature larger treatment areas and increased power density, allowing for fast, effective treatment. The home-use light emitting diode phototherapy models have a benefit and represents a significant future aspect of dermatology therapy that includes home-use devices.
In our research in the laboratory and clinic, we used the Omnilux (GlobalMed Technologies) light emitting diode systems.8 We found that these light sources had the greatest body of published clinical data, and our own laboratory testing at the University of California, Davis demonstrated that these lights were highly reliable, provided the high output energies sought, and produced consistent high quality results.
Within the realm of aesthetics and medical dermatology, we made several key discoveries that have the potential to positively impact patient skin care moving forward. First, light emitting diode red and infrared light can penetrate the skin in a meaningful manner to reach the target cells of interest.8 Second, visible red light alone has the power to decrease skin cell proliferation; this can be translated to impact patient care for skin conditions such as fibrosis and psoriasis that feature an increase in proliferating fibroblasts and keratinocytes as pathologic hallmark features of the disease.6 The third finding was based upon the concept that combining topical and light therapy can yield synergistic outcomes compared with either alone. This combination approach of using topicals and light is not new in dermatology, however, the use of light emitting diodes as the light source is very exciting.7
Light emitting diodes are not all built the same, as our research team discovered when we partnered with the Department of Biomedical Engineering at the University of California, Davis in an attempt to build our own light emitting diode arrays. Building units that generate consistent power density across a large field ended up being more challenging than we imagined. After significant research into commercially available systems, we quickly reverted to using the FDA-cleared commercially available Omnilux units for our research. From a research standpoint, there is also a benefit to the scientific community due to our use of commercially available light sources, wherein other researchers may build off of our findings and can use the same commercially available lights for their phototherapy research, providing continuity in this emerging arena and momentum in moving the ball forward in this exciting space.
The next frontier that may be expanded is wearable skin phototherapy technology, powered by light emitting diodes for monitoring, treatment, and diagnosis. For example, the Apple Watch features light emitting diode technology that is used to monitor the wearer’s vitals and health metrics. The Apple Watch shows that diagnostic and therapeutic wearable light emitting diode technology in dermatology may be much closer than imagined.
Furthermore, light emitting diodes in dermatology may revolutionize phototherapy and fill an important niche in the future. The adoption of light emitting diodes in dermatology could parallel the adoption of light emitting diodes in society, which are now very common in homes and the environment.
From an aesthetic perspective, combining light emitting diodes with topical agents such as aminolevulinic acid may hold promise for photorejuvenation and acne therapy, in addition to the currently accepted treatment of precancerous actinic keratoses and certain skin cancers. Additionally, our laboratory research demonstrates that synergistic benefits are potentially achievable for the treatment of scarring skin diseases through the combination of high doses of light emitting diode generated red light and the antioxidant resveratrol. We look forward to continuing our investigation of light emitting diodes, alone and in combination with topical agents, that may transform the way dermatologists provide care for patients in the future.
Dr Jagdeo is associate professor in the department of dermatology at the University of California, Davis in Sacramento, CA.
Disclosure: The author has received honoraria from L’Oreal, and is on the scientific advisory board of GlobalMed Technologies. He has received honoraria from GlobalMed Technologies.
References
1. Mamalis A, Fiadorchanka N, Adams L, et al. An immunohistochemical panel to assess ultraviolet radiation-associated oxidative skin injury. J Drugs Dermatol. 2014;13(5):574-578.
2. Valacchi G, Pecorelli A, Belmonte G, et al. Protective effects of topical vitamin C compound mixtures against ozone-induced damage in human skin [published online February 17, 2017]. J Invest Dermatol. doi:10.1016/j.jid.2017.01.034
3. Valacchi G, Sticozzi C, Zanardi I, et al. Ozone mediators effect on “in vitro” scratch wound closure. Free Radic Res. 2016;50(9):1022-1031.
4. Valacchi G, Muresan XM, Sticozzi C, et al. Ozone-induced damage in 3D-Skin Model is prevented by topical vitamin C and vitamin E compound mixtures application. J Dermatol Sci. 2016;82(3):209-212.
5. Tchanque-Fossuo CN, Ho D, Dahle SE, et al. A systematic review of low-level light therapy for treatment of diabetic foot ulcer. Wound Repair Regen. 2016;24(2):418-426.
6. Mamalis A, Koo E, Garcha M, Murphy WJ, Isseroff RR, Jagdeo J. High fluence light emitting diode-generated red light modulates characteristics associated with skin fibrosis. J Biophotonics. 2016;9(11-12):1167-1179.
7. Mamalis A, Jagdeo J. The combination of resveratrol and high-fluence light emitting diode-red light produces synergistic photobotanical inhibition of fibroblast proliferation and collagen synthesis: a novel treatment for skin fibrosis. Dermatol Surg. 2017;43(1):81-86.
8. Jagdeo JR, Adams LE, Brody NI, Siegel DM. Transcranial red and near infrared light transmission in a cadaveric model. PLoS One. 2012;7(10):e47460. doi:10.1371/journal.pone.0047460
As dermatology expands its understanding of aesthetics and aging, an increasing body of scientific and clinical evidence highlights the key role that atmosphere and pollution play in skin health, wellness, and aging. Oxidative stress injury to skin cells and tissues play a central role in skin health and wellness.
Our research team has published on the important role that UV light has in terms of damaging skin tissue at the cellular, molecular, and structural level that translates to visible and tangible evidence of skin aging. Using a panel of immunohistochemical assays, our team demonstrated that oxidative injury results in damage to lipids that serve a key role in skin barrier protection in the stratum corneum; and damages DNA and proteins in the dermis.1 Oxidative DNA damage is associated with both aging and skin cancers. Therefore, prevention of oxidative stress is essential and may decrease signs of skin aging and lower the risk for skin cancer.
Previously, the understanding of environmental assaults to skin was limited to UV radiation damage. It is crucial that dermatologists embrace the fact that skin aging extends beyond UV-induced skin damage alone. Significant attention has recently centered around how atmospheric conditions, including pollution and ozone, contribute to skin health, wellness, appearance, and disease.
Atmospheric Skin Aging
Atmospheric skin aging is a collective term for visible aging caused by regular exposure to a combination of sun and pollution. Particulate matter and ozone contribute to aging skin and increases in hyperpigmentation, wrinkling, rough texture, dullness, and laxity. One of the key aspects to appreciate is that various environmental factors that extend beyond UV damage also increase cellular reactive oxygen-free radicals in skin tissues, resulting in oxidation and changes consistent with molecular and clinical features associated with extrinsic aging.
Ozone has an important role in the extrinsic aging process. Ozone, once widely discussed in the 1980s and 1990s in environmental discussions, is now making new waves in the skin health arena because of the impact on aesthetics. Ozone is a highly reactive gas that occurs due to natural and man-made processes. Globally and nationally, ozone is often highest in densely populated urban areas. Suburban and rural areas may also feature high amounts of ozone. Ozone occurs in the Earth’s upper (stratosphere) and lower (troposphere) atmospheres. At ground level, in the Earth’s lower atmosphere, ozone is created by pollutants emitted by cars, power plants, industrial processes, and other sources. In addition to ozone serving as a source of skin aging, there is evidence that ozone may serve as a carcinogen.
A significant portion of our laboratory’s research efforts have centered around the study of antioxidants, alone and in combination, to counter skin oxidative stress. This field of scientific study is important to our specialty and our patients. Nearly all of the treatments that include antioxidants fall within the burgeoning category of cosmeceuticals. When recommending cosmeceutical products to friends, patients, and colleagues, I highlight products that have a cohesive and meaningful scientific story complete with documented clinical results that support use and will yield clinical patient benefit.
Recent research demonstrates that ozone damages skin cells, depleting the natural antioxidants, in particular, vitamins C and E, leaving the skin vulnerable to harmful environmental agents. Published in vitro and in vivo translational and clinical research emphasizes that ozone and other environmental factors that harm the skin can be mitigated. When paired with SkinCeuticals broad-spectrum sunscreens, both antioxidants provide comprehensive protection against appreciable signs of aging caused by exposure to ozone and pollution. Research2-4 conducted in partnership with academician Giuseppe Valacchi, PhD, a leading expert and researcher in the study of ozone, and cosmeceutical company SkinCeuticals, has for the first time demonstrated in live skin 3-D cultures and in vivo that ozone pollution may cause extrinsic skin aging. Dr Valacchi’s findings indicate that the application of antioxidants CE Ferulic and Phloretin CF helped prevent and reduce cellular damage caused by ozone exposure. Both CE Ferulic and Phloretin CF protected against ozone-induced type III collagen degradation.
Based upon years of clinical research, we know that a daily regimen of well-studied and clinically-proven antioxidant serum combined with a broad-spectrum sunscreen daily will provide comprehensive skin protection from UV and atmospheric aging. As dermatologists, educating and empowering patients to prevent skin aging and skin cancer is the critical first step toward healthy skin.
Extending beyond antioxidants, devices have an important role in aesthetic and medical dermatology. As a laser surgeon, I can share that patients can benefit tremendously from treatment with ablative and nonablative lasers and other impactful energy-based devices. One of the most exciting developments in medical and aesthetic skin therapy is the increasing use of light emitting diodes for the treatment of dermatologic conditions, including skin rejuvenation and wound healing.5
Light Emitting Diodes
There is a renaissance and renewed interest in light emitting diodes in the field of dermatology and discovery of new uses of light emitting diodes for skin care. New treatments of aesthetic and medical skin conditions such as skin scarring and psoriasis are on the horizon.6 Additionally, the combination of light emitting diodes with topical therapeutic products represents a burgeoning subfield in dermatology that includes photodynamic therapy and photobotanical therapy.7
Our laboratory’s decade-long research into the realm of light emitting diode phototherapy for the benefit of patient skin care started with the concept that our skin has photoacceptors embedded into our cells that can be photomodulated to help achieve enhanced skin wellness and health. Light emitting diodes represent a therapeutic opportunity for our patients—they are relatively inexpensive compared with lasers, compact, flexible, portable (easily moved from room to room), have an excellent safety profile, and are easy to combine with topical and systemic therapies.
Furthermore, light emitting diode arrays can be used safely in-office or at home. The professional use models differ from the home-use versions. The professional models feature larger treatment areas and increased power density, allowing for fast, effective treatment. The home-use light emitting diode phototherapy models have a benefit and represents a significant future aspect of dermatology therapy that includes home-use devices.
In our research in the laboratory and clinic, we used the Omnilux (GlobalMed Technologies) light emitting diode systems.8 We found that these light sources had the greatest body of published clinical data, and our own laboratory testing at the University of California, Davis demonstrated that these lights were highly reliable, provided the high output energies sought, and produced consistent high quality results.
Within the realm of aesthetics and medical dermatology, we made several key discoveries that have the potential to positively impact patient skin care moving forward. First, light emitting diode red and infrared light can penetrate the skin in a meaningful manner to reach the target cells of interest.8 Second, visible red light alone has the power to decrease skin cell proliferation; this can be translated to impact patient care for skin conditions such as fibrosis and psoriasis that feature an increase in proliferating fibroblasts and keratinocytes as pathologic hallmark features of the disease.6 The third finding was based upon the concept that combining topical and light therapy can yield synergistic outcomes compared with either alone. This combination approach of using topicals and light is not new in dermatology, however, the use of light emitting diodes as the light source is very exciting.7
Light emitting diodes are not all built the same, as our research team discovered when we partnered with the Department of Biomedical Engineering at the University of California, Davis in an attempt to build our own light emitting diode arrays. Building units that generate consistent power density across a large field ended up being more challenging than we imagined. After significant research into commercially available systems, we quickly reverted to using the FDA-cleared commercially available Omnilux units for our research. From a research standpoint, there is also a benefit to the scientific community due to our use of commercially available light sources, wherein other researchers may build off of our findings and can use the same commercially available lights for their phototherapy research, providing continuity in this emerging arena and momentum in moving the ball forward in this exciting space.
The next frontier that may be expanded is wearable skin phototherapy technology, powered by light emitting diodes for monitoring, treatment, and diagnosis. For example, the Apple Watch features light emitting diode technology that is used to monitor the wearer’s vitals and health metrics. The Apple Watch shows that diagnostic and therapeutic wearable light emitting diode technology in dermatology may be much closer than imagined.
Furthermore, light emitting diodes in dermatology may revolutionize phototherapy and fill an important niche in the future. The adoption of light emitting diodes in dermatology could parallel the adoption of light emitting diodes in society, which are now very common in homes and the environment.
From an aesthetic perspective, combining light emitting diodes with topical agents such as aminolevulinic acid may hold promise for photorejuvenation and acne therapy, in addition to the currently accepted treatment of precancerous actinic keratoses and certain skin cancers. Additionally, our laboratory research demonstrates that synergistic benefits are potentially achievable for the treatment of scarring skin diseases through the combination of high doses of light emitting diode generated red light and the antioxidant resveratrol. We look forward to continuing our investigation of light emitting diodes, alone and in combination with topical agents, that may transform the way dermatologists provide care for patients in the future.
Dr Jagdeo is associate professor in the department of dermatology at the University of California, Davis in Sacramento, CA.
Disclosure: The author has received honoraria from L’Oreal, and is on the scientific advisory board of GlobalMed Technologies. He has received honoraria from GlobalMed Technologies.
References
1. Mamalis A, Fiadorchanka N, Adams L, et al. An immunohistochemical panel to assess ultraviolet radiation-associated oxidative skin injury. J Drugs Dermatol. 2014;13(5):574-578.
2. Valacchi G, Pecorelli A, Belmonte G, et al. Protective effects of topical vitamin C compound mixtures against ozone-induced damage in human skin [published online February 17, 2017]. J Invest Dermatol. doi:10.1016/j.jid.2017.01.034
3. Valacchi G, Sticozzi C, Zanardi I, et al. Ozone mediators effect on “in vitro” scratch wound closure. Free Radic Res. 2016;50(9):1022-1031.
4. Valacchi G, Muresan XM, Sticozzi C, et al. Ozone-induced damage in 3D-Skin Model is prevented by topical vitamin C and vitamin E compound mixtures application. J Dermatol Sci. 2016;82(3):209-212.
5. Tchanque-Fossuo CN, Ho D, Dahle SE, et al. A systematic review of low-level light therapy for treatment of diabetic foot ulcer. Wound Repair Regen. 2016;24(2):418-426.
6. Mamalis A, Koo E, Garcha M, Murphy WJ, Isseroff RR, Jagdeo J. High fluence light emitting diode-generated red light modulates characteristics associated with skin fibrosis. J Biophotonics. 2016;9(11-12):1167-1179.
7. Mamalis A, Jagdeo J. The combination of resveratrol and high-fluence light emitting diode-red light produces synergistic photobotanical inhibition of fibroblast proliferation and collagen synthesis: a novel treatment for skin fibrosis. Dermatol Surg. 2017;43(1):81-86.
8. Jagdeo JR, Adams LE, Brody NI, Siegel DM. Transcranial red and near infrared light transmission in a cadaveric model. PLoS One. 2012;7(10):e47460. doi:10.1371/journal.pone.0047460
