Photobiomodulation, photomedicine, and laser surgery最新文献

Purpose: To systematically review and meta-analyze the efficacy of photobiomodulation therapy (PBMT) for temporomandibular disorders (TMDs), focusing on the influence of intensity, frequency, and duration on pain reduction and functional improvement. Methods: Through a systematic search of PubMed, Cochrane, and EMBASE, we identified randomized controlled trials (RCTs) involving adults with TMD who were treated with PBMT. Ultimately, 40 RCTs were included, and a meta-analysis was conducted using Review Manager 5.4. The primary outcomes included pain, pain-free opening (PFO), maximum-unassisted opening, and maximum-assisted opening (MAO). Results: PBMT significantly reduced pain at the third assessment (T2). The optimal parameters included wavelengths (951-1070 nm) and output power (below 100 mW). Additionally, PFO and MAO significantly improved at T2. Treatment durations exceeding 10 weeks were most effective for articular-muscular TMDs, whereas shorter durations were more beneficial for purely articular or muscular TMDs. Three to four sessions per week yielded the best outcomes. Conclusion: Effective pain reduction was achieved with high wavelengths (951-1070 nm), low power (<100 mW), and frequent, long-term treatment (3-4 times per week over 10 weeks). Avoiding high energy consumption over a short period was crucial. This approach is more effective for articular-muscular TMDs than for purely articular or muscular conditions.

Background: Vitiligo is a chronic autoimmune skin disorder characterized by depigmented macules and patches due to melanocyte destruction. Traditional therapies include topical corticosteroids, calcineurin inhibitors, phototherapy, and systemic immunomodulators. Objective: There is growing interest in alternative and adjunctive light-based therapies, such as 308 nm excimer light and red light, for promoting repigmentation and modulating the immune response. Methods: We report the case of a 37-year-old male patient with non-segmental vitiligo, affecting the arm and hands, who demonstrated significant repigmentation following treatment with 308 nm excimer light and 635 nm red light therapy. Results: The patient had a 3-year history of vitiligo and had previously been unresponsive to topical treatment and 308 nm excimer light monotherapy. However, with the combination of 308 nm excimer light and red light, gradual repigmentation was observed over 3 months. The patient tolerated the therapy well with no adverse effects. Conclusion: This case suggests that the combination of 308 nm excimer light and red light therapy may offer a promising treatment option for vitiligo.

Background: Phototherapy is a well-established treatment for various chronic inflammatory dermatoses, yet data on its safety and efficacy in geriatric populations remain limited. Older adults face unique clinical challenges due to age-related physiological changes, comorbidities, and polypharmacy, which may impact treatment responses and tolerance. Objective: This study aimed to evaluate the safety, efficacy, and clinical outcomes of phototherapy in elderly patients treated over a 10-year period at a tertiary dermatology center. Materials and Methods: A retrospective analysis was conducted on patients aged ≥65 years who received ≥8 sessions of phototherapy between 2013 and 2023. Narrowband UVB (NB-UVB), systemic psoralen plus ultraviolet A (PUVA), and localized PUVA therapies were administered using standardized protocols. Diagnosis-specific clinical criteria were used to assess treatment response. Data on adverse events, recurrence, and the need for additional sessions were recorded. Results: The study included 149 patients (mean age 70.2 ± 5.0 years; 44.3% female, 55.7% male) with 19 distinct dermatologic diagnoses. The most common indications were psoriasis (24.8%), generalized pruritus (18.1%), mycosis fungoides (11.4%), and lichen planus (6.7%). NB-UVB was used in 85.2% patients, while 10.1% received local PUVA and 4.7% underwent systemic PUVA. Overall, 83.2% of patients demonstrated clinical improvement. The highest treatment durations and cumulative doses were observed in mycosis fungoides (mean 9.3 months, 88.7 J/cm²) and lichen planus (9.5 months, 59.6 J/cm²). Adverse events occurred in 12.8%, predominantly mild erythema and pruritus. Recurrence was noted at 18.1%, and 16.1% required additional sessions. Despite 40.9% of patients using photosensitizing medications, no severe phototoxic reactions were observed. Conclusions: Phototherapy is a safe, effective, and well-tolerated treatment option for elderly patients with a variety of dermatologic conditions. The high clinical response rates, even in complex and refractory cases, support its continued use in this population. With its favorable safety profile and non-systemic nature, phototherapy remains a particularly suitable modality in the context of multimorbidity and polypharmacy. Further large-scale, multicenter prospective studies are warranted to establish standardized protocols tailored for geriatric populations.

Background and Objectives: This study reports an adaptive experience of pigmented scar treatment management with different characteristics. It is complicated to define a single solution for all the patients. For this reason, we report a multi-modal approach combining CO₂ laser, Q-switched lasers (QSL), and dye laser to adapt to every different patient clinical situation. Materials and Methods: Thirty patients were enrolled to treat pigmented scars. Twenty patients presented scars with exogenous pigment (such as traumatic tattoos) and 10 with endogenous pigment (hyperpigmentation cases). A combination of CO₂ laser, QSL, and dye laser was used. The number of treatment sessions performed for each laser, or their combination was as follow: For keloid scars from tattoo: 1-4 combined treatment sessions with QS and dye lasers; 3-4 combined treatment sessions with dye and CO₂ laser;1-4 treatment sessions with QS followed by dye laser; for asphalt traumatic tattoo: 2-3 treatment sessions with QS; for surgical hypertrophic scars: 2-3 combined treatment sessions of QS and CO₂ laser; for burn scars (due to asphalt contact) and hyperpigmentation: one treatment session with QS followed by CO₂ laser. Six months after the final treatment, the patient's scar improvement was evaluated compared with baseline (T0) using a five-point Global Aesthetic Improvement Scale (GAIS). Results: Regardless of the type of lesion and treatment, the whole population of the study showed satisfactory clinical results. The GAIS mean value was 3.3 ± 0.6. Specifically, 47% of the patients reported good results while 43% had excellent ones. No serious side effects were observed. Conclusions: Our results suggest that a combination of CO₂, dye, and Nd:YAG lasers is a feasible strategy for treating scars, reducing the pigmentary, fibrotic, and vascular components.

Background: The major challenge in cosmetics is the ability of functional ingredients to penetrate the skin barrier. For this reason, "skin boosters" have been developed, indicating a change from the traditional application of hyaluronic acid (HA) fillers, which had been confined to increasing the volume of the skin, to a more diversified use designed to relieve dermal complications. Methods: Thirty subjects (aged between 31 and 83 years and Fitzpatrick skin types II-IV) with skin irregularities as mild wrinkles or pigmented lesions were enrolled. Patients were treated on the one side with laser and a medical repairing ointment, and on the other side with laser and postlaser exosomes booster solution. Different laser procedures were used (Q-switched laser, CO₂ laser, 675 nm nonablative laser). To analyze the effect on postprocedure laser management, patients were monitored before treatment, immediately after, 1 h after, 3 days after, and 30 days after with the imaging system. Results: All the patients treated did not show any significant side effects apart from the redness. The side of the face treated with laser and medical repairing ointment showed a more intense redness than the side treated with laser and postlaser booster solution, both immediately after and 1 h after the treatment. Conclusions: These data confirm that the use of the postprocedure laser booster solution helps in posttreatment management by reducing redness statistically significantly, thus allowing patients to return to everyday life in a shorter time.

Background: There is strong evidence supporting the effectiveness of photobiomodulation therapy (PBMT) in improving neuronal damage and enhancing neuropsychological activities. However, there is limited research on the effects of this method on cognitive function and mood disorders. This project aimed to evaluate the potential benefits of PBMT in improving cognitive status and mood disorders in patients with dementia. Methods: In this randomized, double-blinded, controlled trial, 30 patients with mild-to-moderate dementia participated. The patients were divided into two groups: the first group (n = 15) received standard treatment along with PBMT, whereas the second group (n = 15) received standard treatment along with the use of an off-device on the head. Cognitive function, anxiety, and depression levels were assessed before, immediately after treatment, and 1 month later. Results: The comparison of cognitive functional score at baseline, after completing the therapeutic regimen, as well as one later showed no difference between the two groups (Table 1). Similarly, the two groups had similar mean scores for depression and anxiety at baseline and after treatment interventions. [Table: see text] Conclusion: The treatment likely has no significant impact on improving cognitive status or mood disorders in patients with mild-to-moderate dementia.

Background: Green light photobiomodulation (GPBM, 500-565 nm) promotes tissue healing, reduces inflammation, and alleviates pain, with emerging potential in bone repair. This review evaluates GPBM's therapeutic effects on bone-related cells (proliferation, differentiation, migration), inflammation, vascularization, and neuronal responses. Methods: We assessed the influence of different GPBM parameters, possible underlying molecular mechanisms, and prospects for in vivo applications based on available studies. Results: GPBM acts through mitochondria, opsins, and transient receptor potential vanilloid (TRPV) channels. The most effective irradiation method uses low irradiance (5.3-100 mW/cm²) with a single exposure of ∼5 J/cm². Excessively low irradiance is ineffective, while excessively high irradiance may cause inhibitory effects. GPBM enhances bone-related cell functions, suppresses inflammation, and promotes vascular and neuronal responses. Conclusions: GPBM shows promise for bone repair, but further research is needed to optimize parameters, clarify molecular mechanisms, and standardize clinical trial protocols to ensure reliable in vivo outcomes.

Background: The combination of lasers and acoustic shock waves has shown promising results in accelerating tattoo removal. Objective: To assess the effectiveness of treatments combining lasers and shock waves regarding the number of sessions required for successful tattoo removal. Methods: A prospective, observational, real-world, single-center study including adults (>18 years) with ≥one professional tattoo of any color on any body part, excluding the head, partially removed or not. Devices were the QS laser RevLite® SI (Cynosure Lutronic, USA), the picosecond laser PicoWay® (Candela, USA), the CO₂ laser DUOGlide® with a SCAR 3 scanner (DEKA M.E.L.A. srl, Italy), and the GENTLE Pro® shock waves system (Zimmer MedizinSysteme GmbH, Germany). Treatment protocols consisted of QS/picosecond laser passes alternated with shock wave passes (three each) (classic protocol) and one QS/picosecond laser and one shock wave pass, a QS/picosecond second laser pass, and a final fractional CO₂ laser pass (reinforced protocol). Sessions were performed at two-month intervals. Results: We included 22 patients (68.2% women and 68.2% Fitzpatrick phototype III) with a mean (range) age of 42 (22-68) years and 25 tattoos in total. Most tattoos were black (92.0%) and were removed using the picosecond laser (80.0%) and following the classic (40.0%) and the reinforced (60.0%) protocols in a total of 66 treatment sessions. In 22 tattoos undergoing more than one session, results were good or excellent in 68.2% of them after 2-4 sessions, with no adverse effects. Conclusion: Acoustic shock wave therapy constitutes a safe adjuvant treatment to accelerate laser-based tattoo removal.

Background: Laser-assisted irrigation may enhance chemomechanical debridement and improve the sealing of root canals during endodontic treatment. Objective: This study aimed to address the scientific deficit in understanding the laser-assisted sequential versus continuous chelation in root canal irrigation. Methods: One hundred and twenty single-rooted teeth were prepared using Reciproc R40 instruments and randomly divided into six groups (n = 20) based on the irrigation protocol. In the sequential chelation groups, canals were irrigated with NaOCl during instrumentation, followed by 17% ethylenediaminetetraacetic acid using a needle, ultrasound, or erbium-doped yttrium aluminum garnet laser activation. In the continuous chelation groups, canals were irrigated with a mixture of 2% sodium hypochlorite and 9% hydroxyethylidene diphosphonic acid during and after instrumentation, followed by final activation using the same three techniques. Ten samples per group were used to evaluate sealer penetration with Fluo-3 dye, while the remaining samples underwent push-out bond strength testing. Statistical analyses were conducted using the Kruskal-Wallis and Friedman tests (p < 0.05). Results: No significant differences in sealer penetration were found between sequential and continuous protocols in the apical third when needle or ultrasonic activation was used. However, laser activation combined with continuous chelation resulted in significantly higher sealer penetration and bond strength (p < 0.001). Sealer penetration followed the trend: coronal > middle > apical (p < 0.05) with all irrigation techniques. Conclusions: Continuous chelation protocols, especially when combined with laser activation, were as effective or superior to conventional methods in improving sealer penetration and bond strength. Continuous chelation with laser-assisted irrigation may improve clinical efficiency and shorten treatment time in root canal procedures.

Background: Fractional carbon dioxide (CO₂) laser is the standard treatment in facial rejuvenation for light skin phototypes; nevertheless, in Latin America, it is one of the most performed procedures on phototypes III-V. Aim: The goal of this study is to evaluate the improvement in facial skin aging in Latin skins with fractional CO₂ laser and its side effects in a period of 3 months. Materials and Methods: Descriptive multicenter cross-sectional study including 165 patients from 2 medical centers in Latin America who attended from 2014 to 2021. Data were collected from medical records and assessment of facial aging was performed through photographic records by two independent investigators. An arithmetic mean was obtained for each variable and for each researcher, subsequently the obtained values were averaged to find the overall average improvement according to the intervention and skin phototype. A Cohen's Kappa Concordance Test was performed to determine the agreement between observers beyond chance. Results: Significant improvement in fine lines, mottled pigmentation, and overall skin appearance was observed in patients treated with fractional CO₂ laser with or without platelet-rich plasma. As for side effects, only one patient presented with herpes simplex. Conclusions: There are few studies to date that evaluate the use of fractional CO₂ laser in Latin skins, through this research, it is evident that this technology has good results for facial rejuvenation in this type of patients and few side effects.