Photobiomodulation Therapy: A New Light in the Treatment of Systemic Sclerosis Skin Ulcers
Tóm tắt
Skin ulcers (SU) represent one of the most frequent manifestations of systemic sclerosis (SSc), occurring in almost 50% of scleroderma patients. SSc-SU are often particularly difficult to treat with conventional systemic and local therapies. In this study, a preliminary evaluation of the role and effectiveness of blue light photobiomodulation (PBM) therapy with EmoLED® in the treatment of scleroderma skin ulcers (SSc-SU) was performed. We retrospectively analyzed 12 consecutive SSc patients with a total of 15 SU on finger hands. All patients were treated with adequate systemic therapy and local treatment for SU; after a standard skin ulcer bed preparation with debridement of all lesions, EmoLED® was performed. All patients were locally treated every week during 2 months of follow-up; SU data were collected after 4 weeks (T4) and 8 weeks (T8). Eight SSc patients with comparable SU were also evaluated as controls. The application of EmoLED® in addition to debridement apparently produced faster healing of SU. Complete healing of SU was recorded in 41.6% cases during EmoLED® treatment. Significant improvements in SU area, length, and width, wound bed, and related pain were observed in EmoLED® patients from T0 to T8. Control subjects treated with standard systemic/local therapies merely showed an amelioration of SU area and width at the end of the follow-up. No procedural or post-procedural adverse events were reported. The positive clinical results and the absence of side effects suggest that EmoLED® could be a promising tool in the management of SSc-SU, with an interesting role to play in the healing process in addition to conventional systemic and local treatments.
Tài liệu tham khảo
Hachulla E, Launay D. Diagnosis and classification of systemic sclerosis. Clin Rev Allergy Immunol. 2011;40(2):78–83. https://doi.org/10.1007/s12016-010-8198-y (PMID: 20143182).
van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 Classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheumatol. 2013;65(11):2737–47.
Ferri C, Sebastiani M, Lo Monaco A, Iudici M, Giuggioli D, Furini F, et al. Systemic sclerosis evolution of disease pathomorphosis and survival. Our experience on Italian patients’ population and review of the literature. Autoimmun Rev. 2014;13(10):1026–34.
Steen V, Denton CP, Pope JE, Matucci-Cerinic M. Digital ulcers: overt vascular disease in systemic sclerosis. Rheumatology. 2009;48(Suppl 3):19–24.
Amanzi L, Braschi F, Fiori G, Galluccio F, Miniati I, Guiducci S, et al. Digital ulcers in scleroderma: staging, characteristics and sub-setting through observation of 1614 digital lesions. Rheumatology (Oxford). 2010;49:1374–82.
Giuggioli D, Manfredi A, Colaci M, Lumetti F, Ferri C. Scleroderma digital ulcers complicated by infection with fecal pathogens. Arthritis Care Res (Hoboken). 2011;64:295–7.
Giuggioli D, Manfredi A, Vacchi C, Sebastiani M, Spinella A, Ferri C. Procedural pain management in the treatment of scleroderma digital ulcers. Clin Exp Rheumatol. 2015;33:5–10.
Matucci-Cerinic M, Krieg T, Guillevin L, Schwierin B, Rosenberg D, Cornelisse P, et al. Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry. Ann Rheum Dis. 2016;75:1770–6.
Giuggioli D, Manfredi A, Lumetti F, Colaci M, Ferri C. Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature. Autoimmun Rev. 2018;17:155–64.
Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11:S1-28.
Kowal-Bielecka O, Landewé R, Avouac J, Chwiesko S, Miniati I, Czirjak L, et al. EULAR recommendations for the treatment of systemic sclerosis: a report from the EULAR Scleroderma Trials and Research Group (EUSTAR). Ann Rheum Dis. 2009;68:620–8.
Giuggioli D, Lumetti F, Spinella A, Cocchiara E, Sighinolfi G, Citriniti G, et al. Use of neem oil and Hypericum perforatum for treatment of calcinosis-related skin ulcers in systemic sclerosis. J Int Med Res. 2020;48(4):300060519882176.
Pignatti M, Spinella A, Cocchiara E, Boscaini G, Lusetti IL, Citriniti G, et al. Autologous fat grafting for the oral and digital complications of systemic sclerosis: results of a prospective study. Aesthet Plast Surg. 2020;44(5):1820–32.
Pignatti M, Spinella A, Cocchiara E, Boscaini G, Lusetti IL, Citriniti G, et al. Invited response on: Comments on “Autologous fat grafting for the oral and digital complications of systemic sclerosis: results of a prospective study.” Aesthet Plast Surg. 2021;45(3):1344–5.
Giuggioli D, Spinella A, Cocchiara E, de Pinto M, Pinelli M, Parenti L, et al. Autologous fat grafting in the treatment of a scleroderma stump-skin ulcer: a case report. Case reports. Plast Surg Hand Surg. 2021;8(1):18–22.
Kuffler DP. Photobiomodulation in promoting wound healing: a review. Regen Med. 2016;11(1):107–22. https://doi.org/10.2217/rme.15.82 (Epub 2015 Dec 18 PMID: 26681143).
Cicchi R, Rossi F, Alfieri D, Bacci S, Tatini F, De Siena G. Observation of an improved healing process in superficial skin wounds after irradiation with a blue-LED haemostatic device. J Biophotonics. 2016;9(6):645–55.
Mosca RC, Ong AA, Albasha O, Bass K, Arany P. Photobiomodulation therapy for wound care: a potent, noninvasive photoceutical approach. Adv Skin Wound Care. 2019;32(4):157–67.
Magni G, Tatini F, Bacci S, Paroli G, De Siena G, Cicchi R, et al. Blue LED light modulates inflammatory infiltrate and improves the healing of superficial wounds. Photodermatol Photoimmunol Photomed. 2020;36(2):166–8.
Magni G, Banchelli M, Cherchi F, Coppi E, Fraccalvieri M, Rossi M, et al. Experimental study on blue light interaction with human keloid-derived fibroblasts. Biomedicines. 2020;8(12):573.
Rossi F, Magni G, Tatini F, Banchelli M, Cherchi F, Rossi M, et al. Photobiomodulation of human fibroblasts and keratinocytes with blue light: implications in wound healing. Biomedicines. 2021;9(1):41.
de Abreu PTR, de Arruda JAA, Mesquita RA, Abreu LG, Diniz IMA, Silva TA. Photobiomodulation effects on keratinocytes cultured in vitro: a critical review. Lasers Med Sci. 2019;34(9):1725–34.
Lopez A, Brundage C. Wound photobiomodulation treatment outcomes in animal models. J Vet Med. 2019;28(2019):6320515.
Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years? Int Wound J. 2012;9(Suppl 2):1–19.
Denton CP, Hughes M, Gak N, Vila J, Buch MH, Chakravarty K, et al. BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline for the treatment of systemic sclerosis. Rheumatology (Oxford). 2016;55:1906–10.
Dini V, Romanelli M, Oranges T, Davini G, Janowska A. Blue light emission in the management of hard-to-heal wounds. Ital J Dermatol Venerol. 2021;156(6):709–13.
Fraccalvieri M, Amadeo G, Bortolotti P, Ciliberti M, Garrubba A, Mosti G et al. Effectiveness of blue light photobiomodulation therapy in the treatment of chronic wounds. Results of the Blue Light for Ulcer Reduction (B.L.U.R.) Study. Ital J Dermatol Venerol. 2021.
Galluccio F, Allanore Y, Czirjak L, Furst DE, Khanna D, Matucci-Cerinic M. Points to consider for skin ulcers in systemic sclerosis. Rheumatology (Oxford). 2017;56:v67-71.
Fujimoto M, Asano Y, Ishii T, Ogawa F, Kawakami T, Kodera M, et al. The wound/burn guidelines—4: guidelines for the management of skin ulcers associated with connective tissue disease/vasculitis. J Dermatol. 2016;43:729–57.
Grzybowski A, Sak J, Pawlikowski J. A brief report on the history of phototherapy. Clin Dermatol. 2016;34(5):532–7.
Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus photobiomodulation therapy. Photomed Laser Surg. 2015;33(4):183–4.
Zhu Y, Xu G, Yuan J, Jo J, Gandikota G, Demirci H, et al. Light emitting diodes based photoacoustic imaging and potential clinical applications. Sci Rep. 2018;8(1):9885.
Hamblin MR, de Sousa MVP, Agrawal T. Handbook of low-level laser therapy. New York: Pan Stanford; 2016.
Martin P. Wound healing—aiming for perfect skin regeneration. Science. 1997;276(5309):75–81.
Nair HKR, Chong SSY, Selvaraj DDJ. Photobiomodulation as an adjunct therapy in wound healing. Int J Low Extreme Wounds. 2021;11:15347346211004186.
Mosca RC, Santos SN, Nogueira GEC, Pereira DL, Costa FC, Pereira JX, et al. The efficacy of photobiomodulation therapy in improving tissue resilience and healing of radiation skin damage. Photonics. 2022;9(1):10.
Maiya AG, Kumar AS, Hazari A, Jadhav R, Ramachandra L, Hande HM, Rajgopal SK, et al. Photobiomodulation therapy in neuroischaemic diabetic foot ulcers: a novel method of limb salvage. J Wound Care. 2018;27(12):837–42.
Ahmadi H, Amini A, FadaeiFathabady F, Mostafavinia A, Zare F, Ebrahimpour-Malekshah R, et al. Transplantation of photobiomodulation-preconditioned diabetic stem cells accelerates ischemic wound healing in diabetic rats. Stem Cell Res Ther. 2020;11(1):494.
Hughes M, Moore T, Manning J, Wilkinson J, Watson S, Samraj P, et al. A feasibility study of a novel low-level light therapy for digital ulcers in systemic sclerosis. J Dermatol Treat. 2019;30(3):251–7.
Serrate H, Heiskanen V, Palin WM, Cooper PR, Milward MR, Hadis M, et al. Under the spotlight: mechanisms of photobiomodulation concentrating on blue and green light. Photochem Photobiol Sci. 2019;18(8):1877–909.
Masson-Meyers DS, Bumah VV, Biener G, Raicu V, Enwemeka CS. The relative antimicrobial effect of blue 405 nm LED and blue 405 nm laser on methicillin-resistant Staphylococcus aureus in vitro. Lasers Med Sci. 2015;30(9):2265–71.
Niu T, Tian Y, Cai Q, Ren Q, Wei L. Red light combined with blue light irradiation regulates proliferation and apoptosis in skin keratinocytes in combination with low concentrations of curcumin. PLoS One. 2015;10(9).
Hamblin MR. Mechanisms and mitochondrial redox signaling in photobiomodulation. Photochem Photobiol. 2018;94(2):199–212.
Marchelli M, Perniciaro G, Granara D, et al. Photobiomodulation with blue light in non-healing wounds: case series evaluation. Wounds Int. 2019;10(3):63–6.
de Oliveira AB, Ferrisse TM, Salomão KB, Miranda ML, Bufalino A, Brighenti FL. Photobiomodulation in the treatment of xerostomia associated with hyposalivation in a pediatric patient with systemic scleroderma. Autops Case Rep. 2020;11:e2020220.
Castellano-Pellicena I, Uzunbajakava NE, Mignon C, Raafs B, Botchkarev VA, Thornton MJ. Does blue light restore human epidermal barrier function via activation of opsin during cutaneous wound healing? Lasers Surg Med. 2019;51(4):370–82.
Suh S, Choi EH, Atanaskova MN. The expression of opsins in the human skin and its implications for photobiomodulation: a systematic review. Photodermatol Photoimmunol Photomed. 2020;36(5):329–38.