Faculty Bibliography

BACKGROUND AND OBJECTIVE: LED photomodulation has been shown to profoundly influence cellular behavior. A variety of parameters with LED photomodulation can alter cellular response in vitro. The effects of one visible and one infrared wavelength were evaluated to determine the optimal ratio to produce a net increase in dermal collagen by altering the ratio of total energy output of each wavelength. The ratio between the two wavelengths (590 and 870 nm) was shifted in 25% increments. STUDY DESIGN/MATERIALS AND METHODS: Human skin fibroblasts in culture were exposed to a 590/870 nm LED array with total combined energy density fixed at 4.0 mW/cm.. The ratio of 590/870 nm tested parameters were: 100/0%, 75/25%, 50/50%, 25/75%, and 0/100%. These ratios were delivered using pulsed duty cycle of exposure (250 milliseconds 'on' time/100 milliseconds 'off' time/100 pulses) for a total energy fluence of 0.1 J/cm.. Gene expression was examined using commercially available extra cellular matrix and adhesion molecule RT PCR Arrays (SA Biosciences, Frederick, MD) at 24 hours post-exposure. RESULTS: Different expression profiles were noticed for each of the ratios studied. Overall, there was an average (in an 80 gene array) of 6% expression difference in up or downregulation between the arrays. The greatest increase in collagen I and decrease in collagenase (MMP-1) was observed with 75/25% ratio of 590/870 nm. The addition of increasing proportions of IR wavelengths causes alteration in gene expression profile. The ratios of the wavelengths caused variation in magnitude of expression. CONCLUSIONS: Cell metabolism and gene expression can be altered by simultaneous exposure to multiple wavelengths of low energy light. Varying the ratios of specific wavelength intensity in both visible and near infrared light therapy can strongly influence resulting fibroblast gene expression patterns

BACKGROUND AND OBJECTIVE: Tuberous sclerosis (TS) is a well-described genetic disorder that is classically associated with up to hundreds of facial angiofibromas. Due to the progressive nature of the skin lesions and the early clinical presentation, a safe and effective technique for treating these disfiguring skin lesions is needed. STUDY DESIGN/PATIENTS AND METHODS: We report a combinatorial technique for treating the angiofibromas of TS. We present a case series of three TS patients treated with this technique combining pinpoint electrosurgery, pulsed-dye laser treatment, and ablative fractional resurfacing (AFR). RESULTS: In all presented cases, improvement in the number and appearance of facial angiofibromas and erythema is noted. No scarring or adverse events were reported. CONCLUSION: The technique of electrosurgery, pulsed-dye laser treatment, and AFR represents a new and safe therapeutic option for treating facial angiofibromas associated with TS.

BACKGROUND: Despite the proven effectiveness of the 595-nm pulsed dye laser (PDL) in treating superficial infantile hemangiomas, many physicians are reluctant to treat such lesions involving the eyelid. OBJECTIVE To examine the safety and efficacy of the 595-nm PDL for the treatment of superficial infantile hemangiomas of the eyelid. MATERIALS & METHODS: Records were reviewed for patients with superficial infantile hemangiomas of the eyelid treated with 595-nm PDL. Pre- and post-treatment photographs were compared. Reviewers rated the degree of improvement of the hemangioma as excellent (76-100%), good (51-75%), moderate (26-50%), or poor (0-25%) and indicated whether the hemangioma was 100% clear. Side effects of scarring, atrophy, hyperpigmentation, and hypopigmentation were assessed. RESULTS: Twenty-two patients met the study criteria. Eight (36.4%) demonstrated complete clearance of their hemangioma, 17 (77.3%) received an improvement rating of excellent, and five (22.7%) received a rating of good. No scarring, atrophy, or hypopigmentation was noted. Two patients (9.1%) were noted to have hyperpigmentation in the treated area. CONCLUSION: Early treatment with the 595-nm PDL can safely and effectively diminish proliferative growth and hasten resolution of superficial infantile hemangiomas of the eyelid.

OBJECTIVE: To assess the safety and efficacy of ablative fractional resurfacing (AFR) for nonacne atrophic scarring. DESIGN: In this before-and-after trial, each scar received 3 AFR treatments and 6 months of follow-up. SETTING: Private academic practice. PATIENTS: Fifteen women with Fitzpatrick skin types I to IV, aged 21 to 66 years, presented with 22 nonacne atrophic scars between June 1 and November 30, 2007. Three patients (3 scars) were excluded from the study after receiving 1 AFR treatment and not returning for follow-up visits. The remaining 12 patients (19 scars) completed all 3 treatments and 6 months of follow-up. INTERVENTIONS: Each scar received 3 AFR treatments at 1- to 4-month intervals. MAIN OUTCOME MEASURES: Erythema, edema, petechiae, scarring, crusting, and dyschromia were graded after treatment and through 6 months of follow-up. Skin texture, pigmentation, atrophy, and overall appearance were evaluated after treatment and through 6 months of follow-up by the patient and a nonblinded investigator. A 3-dimensional optical profiling system generated high-resolution topographic representations of atrophic scars for objective measurement of changes in scar volume and depth. RESULTS: Adverse effects of treatment were mild to moderate, and no scarring or delayed-onset hypopigmentation was observed. At the 6-month follow-up visit, patient and investigator scores demonstrated improvements in skin texture for all scars (patient range, 1-4 [mean, 2.79]; investigator range, 2-4 [mean, 2.95]), pigmentation for all scars (patient range, 1-4 [mean, 2.32]; investigator range, 1-4 [mean, 2.21]), atrophy for all scars (patient range, 1-4 [mean, 2.26]; investigator range, 2-4 [mean, 2.95]), and overall scar appearance for all scars (patient range, 2-4 [mean, 2.89]; investigator range, 2-4 [mean, 3.05]). Image analysis revealed a 38.0% mean reduction of volume and 35.6% mean reduction of maximum scar depth. CONCLUSION: The AFR treatments represent a safe, effective treatment modality for improving atrophic scarring due to surgery or trauma.

Background: Delivery of pulsed or continuous wave 590/870 nm LED light modulates the production of procollagen I by human dermal fibroblasts in vitro. In pulsed mode, the number of pulses and exposure or on time of the LED pulsed mode the duty cycle determines the energy fluence delivered to the target. In continuous wave mode, the cumulative exposure time determines the energy fluence delivered to the target. Study: Human dermal fibroblasts in culture were exposed to a 590/870 nm LED array with an energy density of 3.8 mW/cm².In the pulsed mode, a matrix of exposure parameters were tested including: msec 'on times of 1 (single pulse), 10, 100, 250, 500, 1000; msec with 'of f times of 10, 100, 250, 500, 1000; and total number of pulses of 1, 10, 100, 250, 500, 1000. In continuous wave mode, a range of fourteen exposure times from 0.5 to 10⁶ msec were tested. Four days after exposure, supernatants from the exposed fibroblasts were assayed by ELISA for procollagen I production. Results: For pulsed parameters, procollagen production was highest for energy fluence of 0.01-0.24 J/cm² with a peak around 0.1 J/cm² for parameters of 250/100/100 (msec on/msec/of f/# pulses). Continuous wave highest peaks were at 100 msec and 10,000 msec (0.0004 and 0.04 J/cm² respectively. Conclusion: 0.1 J/cm² using a pulsed 590/870 nm LED parameters of 250 msec 'on' 100 msec 'of f 100 pulses was selected as most effective for procollagen I production

Background: A variety of parameters with LED photomodulation can alter cellular response in vitro. The effects of one visible and one infrared wavelength were evaluated to determine the optimal ratio to produce a net increase in dermal collagen by altering the ratio of total energy output of each wavelength. The ratio between the two wavelengths (595 nm and 870 nm) was shifted in 25% increments. Study: Human dermal fibroblasts in culture were exposed to a 595/870 nm LED array with total combined energy density fixed at 4.0 mW/cm². The ratio of 595/870 nm parameters were: 100%/ 0%; 75%/25%; 50%/50%; 25%/75%; and 0%/100%. These ratios were tested using pulsed duty cycle of exposure (250 msec 'on' time/100 msec 'of f time/100 pulses) and examined using commercially available extra cellular matrix and adhesion molecule RT PCR Arrays (SI Biosciences) for gene expression 24 hours post exposure. Results: There were different expression prof iles noticed for each of the ratios studied. Overall, there was an average (in an 80 gene array) of 6% directional expression difference. The greatest increase in Collagen I and decrease in Collagenase (MMP-1) was observed with 75%/25% ratio of 595/870 nm. The addition of increasing ratios of IR wavelengths causes an alteration in the gene expression prof ile. Even when the genes followed the same directional change, the ratios of the wavelengths caused variation in magnitude of expression. Conclusion: Varying the ratios of specific wavelength intensity in multiwavelength light therapy can alter the resulting gene expression patterns

Background: LED photomodulation effects on human dermal fibroblasts have been well documented. The effects of various wavelengths of light, on other cell types were evaluated using human dermal papillae, adipose, and retinal pigment epithelial cells. Study: Human dermal papillae (DP), adipocytes, and retinal pigment epithelial (RPE) cells were grown to near confluence in vitro and exposed to selected LED wavelengths in the visible and near IR light range. For DP cells the endpoint measurements were MTT assay, VEGF ELISA and hair growth-related gene expression using RT-PCR. Adipocyte endpoint measurements were leptin ELISA, total glycerol assay, and cytotoxicity measured by adenylate kinase. RPE cells were exposed to 425 nm or UVA1 light to cause cellular damage, post-treated with LED arrays, and stained with fluorescent Annexin V for apoptosis/ necrosis levels; VEGF and IL6 gene expression RT-PCR. Results: A variety of responses were seen in all studies. DP cells demonstrated increased clinically relevant responses in the 623-660 nm range, particularly at 660 nm using selected pulsed or continuous wave modes. Adipocytes demonstrated altered glycerol and leptin levels at 625 nm and 880 nm using pulsed mode. RPE cells showed a 30% decrease in staining and a downregulation of VEGF expression using 590/870 nm pulsed mode. Apotosis and necrosis of RPE cells was decreased from 92% untreated to 62-5% with various wavelengths. Conclusion: LED photomodulation demonstrated the ability to alter the expression of genes of known significance. Further investigation and optimization of parameters is warranted