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The Effectiveness Of Low Level Laser Therapy (LLLT) Or Photo Modulation On Psoriasis. A Summary

Updated on February 10, 2015

Introduction:

Psoriasis

Psoriasis is a multidimensional disease of relatively unknown aetiology. Two clinical types of non-pustular psoriasis are known to us : acute guttate psoriasis and chronic type I plaque psoriasis. Bacterial infections such as streptococcal infection are a well-known exacerbating factor in acute guttate psoriasis [1-5]. Additionally, in patients with chronic plaque psoriasis, 50% harbour S. aureus on their skin [6]. Furthermore the culprit microorganisms in question are not only streptococcal but also staphylococcal super antigens are suggestive tp be responsible as a possible antigen in chronic plaque type I psoriasis [7].

Chest Lesions in Psoriasis

Risk factors and causes:

Psoriasis is considered to be an autoimmune disease that results in the overproduction of skin cells. The process is initiated when a person's immune system fights against an infection, but the antibodies it makes continue to attack normal cells. A type of white blood cell (called a T cell) that is supposed to regulate immune response fails to do its job, triggering inflammation and abnormal skin cell growth.

Those with a family history of psoriasis have an increased chance of having the disease. Some people carry genes that make them more likely to develop psoriasis. When both parents have psoriasis, the child may have a 50% chance of developing the condition. About one-third of those with psoriasis have at least one family member with the disease.

Certain factors may trigger psoriasis. Those might include

  • An injury to the skin: Injury to the skin has been associated with plaque psoriasis. For example, a skin infection, skin inflammation, or even excessive scratching can trigger psoriasis.
  • Sunlight: Most people generally consider sunlight to be beneficial for their psoriasis. However, a small minority find that strong sunlight aggravates their symptoms. A bad sunburn may worsen psoriasis.
  • Streptococcal infections: Some evidence suggests that streptococcal infections may cause a type of plaque psoriasis. These bacterial infections have been shown to cause guttate psoriasis, a type of psoriasis that looks like small red drops on the skin.
  • HIV: Psoriasis typically worsens after an individual has been infected with HIV. However, psoriasis often becomes less active in advanced HIV infection.
  • Drugs: A number of medications have been shown to aggravate psoriasis. Some examples are as follows:
    • Lithium -- used to treat depression
    • Beta-blockers -- used to treat high blood pressure
    • Antimalarials -- used to treat malaria
    • NSAIDs -- such as ibuprofen (Motrin and Advil) or naproxen (Aleve), used to reduce inflammation
  • Emotional stress: Many people see an increase in their psoriasis when emotional stress is increased.
  • Smoking: Cigarette smokers have an increased risk of chronic plaque psoriasis.
  • Alcohol: Alcohol is considered a risk factor for psoriasis, particularly in young to middle-aged males.
  • Hormone changes: The severity of psoriasis may fluctuate with hormonal changes. Disease frequency peaks during puberty and menopause. A pregnant woman's symptoms are more likely to improve than worsen, if any changes occur at all. In contrast, symptoms are more likely to flare in the postpartum period, if any changes occur at all [8].

Current treatment Standards:

While psoriasis cannot be cured and typically remains with the patient for life, there are effective management techniques which can help limit outbreaks. When outbreaks do occur, treatments help reduce their severity and duration.

There are three main ways in which psoriasis symptoms can be managed:

  • Systemic drugs. Immunosuppressants can be administered to the patient. These drugs neutralize immune system activity, which in turn limits and moderates the outbreak of symptoms. However, immunosuppressant carry significant risks to people who are not in otherwise excellent health, so they may not be recommended if you suffer from other diseases or underlying conditions. New drugs, which help manage symptoms without suppressing immune system activity, are in various stages of development, but are not yet widely available.
  • Phototherapy. Exposure to light with a wavelength of 311 to 313 nanometres is one of the most effective ways to treat psoriasis outbreaks, and the majority of cases respond favourably to light exposure. Fortunately for patients, sunlight is in the appropriate wavelength range, so simply going outside and exposing the affected area to natural light can go a long way towards helping treat the condition. Phototherapy can also be conducted in controlled indoor environments which use highly specialized lighting equipment.
  • Topical treatments. A number of topical treatments, including ointments, moisturizers and oils, can help soothe affected skin. Some of the most effective products are available over the counter, including petroleum jelly. However, if you suffer from psoriasis, you might also benefit from prescription-strength topical agents which have more aggressive modes of action[8].

How LLLT works

Anti-microbial photodynamic effects against sensitized pathogens with LLLT or photo-modulation.

Until recently, photodynamic therapy (PDA) with topical application of 5-ALA followed by broadband visible light radiation was tested in patients with chronic stage plaque psoriasis [9,10]. Selectivity of protoporphyrin IX accumulation in plaque psoriasis after topical application of 5-ALA and photo bleaching during PDT was established [10]. However, the clinical response of patients with plaque psoriasis after PDT with topical application of 5-ALA revealed no clear correlation between clearance of plaque areas and the delivered irradiation dose [11,12]. More recently, an open non-randomised phase I and II study in 20 patients with chronic stage plaque psoriasis revealed that after intravenous administration of the photosensitizer verteporfin and subsequent irradiation, all patients exhibited improved clinical response [13].These preliminary results are encouraging to develop new regimes of systemic application of photosensitizers avoiding an associated prolonged photosensitivity.


Treatment of psoriasis area with Laser:

The cold Laser therapy is accomplished using standard laser therapy treatment protocols. The laser source is capable of delivering uniform power and our standard wavelength distribution covering the entire wound area under treatment. The treatment sessions are done with illumination with single exposure of pre-assigned high powered non-invasive laser. The hand piece can be operated at any level of power, with preference given. The laser power was monitored before and after exposure to ensure proper energy delivery to the effected site. Before each session it was confirmed that the laser beam was spread out uniformly over the entire treatment area boundaries. Histological samples are taken where necessary such as from chronic pressure ulcers, diabetic foot ulcers or thermal cameras are utilized etc.etc to monitor the healing process. Additionally the lesions are measured before and after a certain number of therapy sessions to evaluate the progress of healing.

References

  1. Fry L (1988) Psoriasis. Br J Dermatol 119:445–461.
  2. Henderson CA, Highet AS (1988) Acute psoriasis associated with Lancefield Group C and Group G cutaneous streptococcal infections. Br J Dermatol 118:559–561.
  3. Marples RR, Heaton CL, Kligman AM (1973) Staphylococcus aureus in psoriasis. Arch Dermatol 107:568–570.
  4. Rosenberg EW, Belew PW (1982) Microbial factors in psoriasis. Arch Dermatol 118:143–144.
  5. Wyatt TD, Ferguson WP, Wilson TS, McCormick E (1977) Gentamicin resistant Staphylococcus aureus associated with the use of topical gentamicin. J Antimicrob Chemother 3:213–217.
  6. Leung DY, Harbeck R, Bina P, Reiser RF, Yang E, Norris DA, Hanifin JM, Sampson HA (1993) Presence of IgE antibodies to staphylococcal exotoxins on the skin of patients with atopic dermatitis. Evidence for a new group of allergens. J Clin Invest 92:1374–1380.
  7. Norris DA, Travers JB, Leung DY (1997) Lymphocyte activation in the pathogenesis of psoriasis. J Invest Dermatol 109:1–4.
  8. Psoriasis Causes from eMedicinehealth.WomensHealth.org.
  9. Collins P, Robinson DJ, Stringer MR, Stables GI, Sheehan-Dare RA (1997) The variable response of plaque psoriasis after a single treatment with topical 5-aminolaevulinic acid photodynamic therapy. Br J Dermatol 137:743–749.
  10. Stringer MR, Collins P, Robinson DJ, Stables GI, Sheehan-Dare RA (1996) The accumulation of protoporphyrin IX inplaque psoriasis after topical application of 5-aminolevulinicacid indicates a potential for superficial photodynamic therapy.J Invest Dermatol 107:76–81.
  11. Fritsch C, Lehmann P, Stahl W, Schulte KW, Blohm E, Lang K,Sies H, Ruzicka T (1999) Optimum porphyrin accumulation in epithelial skin tumours and psoriatic lesions after topical application of delta-aminolaevulinic acid. Br J Cancer79:1603–1608.
  12. Robinson DJ, Collins P, Stringer MR, Vernon DI, Stables GI,Brown SB, Sheehan-Dare RA (1999) Improved response of plaque psoriasis after multiple treatments with topical 5-aminolaevulinic acid photodynamic therapy. Acta Derm Venereol 79:451–455.
  13. Boehncke WH, Elshorst-Schmidt T, Kaufmann R (2000) Systemic photodynamic therapy is a safe and effective treatment for psoriasis. Arch Dermatol 136:271–272.

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