5 colors infrared · light is a range of electromagnetic waves electromagnetic waves consist of...
TRANSCRIPT
THE UNPARALLELED LED LIGHT
PHOTOTHERAPY
Medical Aesthetic DeviceClinical Training
5 COLORSINFRARED
Welcome to APOLOMED Medical Device Clinical Training
▶ How does phototherapy work ? ▶ What is light? ▶ Mechanisms of Blue, Red, Green, Yellow, Pink & Near Infra-red light ▶ Blue, Red & Near Infra-red clinical evidence base
▶ APOLOMED Advanced LED Phototherapy
▶ Clinical Procedure
▶ APOLOMED Practical Session
▶ Treatment Indications▶ Skin rejuvenation
▶ Rosacea▶ Acne & spot-prone skin
▶ Reduced melanin production ▶ Accelerated healing & bruise resolution
▶ Reduced inflammation & pain relief
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▶ Light is a range of electromagnetic waves
▶ Electromagnetic waves consist of particles called photons (packets of energy that move through space)
▶ Each wave has amplitude (the brightness of the light) and a wavelength (the colour of the light)▶ Light waves come in a variety of wavelengths, frequencies & energies
▶ Visible light is detected by the human eye as colours, ranging from violet (390nm) to red (700nm)
▶ The electromagnetic spectrum is made up of visible light, Infra-red, UV, X-rays, Gamma rays & Radio waves
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▶ Phototherapy evidence base is dominated by 3 key wavelengths:
▶ Blue light 415nm ▶ Light energy absorbed by photoacceptors within bacteria ▶ Triggers release of ROS leading to destruction of the bacteriaAshkenazi et al, 2003
▶ Red 630nm & Near Infra-red 830nm light ▶ Light energy absorbed by photoacceptors within cell membrane and mitochondria ▶ Triggers a natural biochemical process that stimulates the cell and the release of growth factors & cytokines, and proliferation (without inducing inflammation)Karu et al, 1995; Yu et al, 2014
▶ Mixed light: Green 520nm, yellow 630+520nm, Pink 630+415nm
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Singlet oxygen destroys P. acnes bacteria
Red light 633nm can stimulate anti-inflammatory cellular processes
Significant reduction in inflammatory lesions
P. acnes bacteria contain an intracellular substance called coproporphyrin III which absorbs Blue light 415nm
Blue light 415nm reacts with coproporphyrin lll producing singlet oxygen
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“Recharging Cellular Energy”▶ All cells need an energy supply ATP▶ 90% ATP manufactured by the mitochondria Key for healthy cellfunction, rejuvenation & repair▶ Mitochondrial activity & ATP levels decline with ageing
▶ Cytochrome c oxidase is a component of the cellular respiratory chain▶ Primary photoacceptor for Red light 630nm & NIR light 830nm in mammalian cells▶ Absorbs light energy Stimulates mitochondrial activity & increasedATP (energy) production▶ Increase in cellular activity
Karu et al, 1995; Yu et al, 2014
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Phototherapy provides clinically proven skin rejuvenation & resolution of problem skin conditionsRed light 630nm, Green light 520nm, Blue light 415nm, Yellow 630+520nm, Pink 630+415nm & Near infra-red light 830nm are the most clinically evidenced wavelengths
Blue light 415nm▶ Anti-bacterial action▶ Effectively treats acne▶ Helps control sebumproduction
▶ Increases fibroblast activity▶ Increases collagen & elastic fibre production▶ Reduces wrinkles &increases skin elasticity▶ Improves skin brightness▶ Accelerates wound healing & bruise resolutiona▶ Reduces redness &inflammation
Ashkenazi et al, 2003; Papageorgiouet al, 2000; Kawada et a,, 2002
Lee et al, 2007; Trelles, 2006
Lee et al, 2007; Calderhead et al, 2008; Min et al, 2013; Kim et al, 2012
Near infrared light 830nm▶ Increases fibroblast activity
▶ Increases collagen & elastic fibreproduction
▶ Reduces wrinkles & increasesskin elasticity
▶ Anti-inflammatory properties▶ Accelerates wound healing
▶ Reduces chronic inflammation &pain
▶ Stimulates vascular repair▶ Reduces melanin production
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“Blue light inactivates P. acnes bacteria”▶ Blue light 405-415nm is absorbed by porphyrins within the P. acnes bacteria▶ Porphyrins become photosensitised, releasing ROS that destroy the P. acnes bacteriaAshkenazi et al, 2003
“Blue light improves inflammatory & non-inflammatory acne lesions”▶ Blue light 415nm provides 63% improvement in inflammatory lesions & 45% improvement in comedonesPapageorgiou et al, 2000
▶ Blue light 407-420nm reduces comedones by 57.8%, papules by 69.3% & pustules by 73.3%▶ One month follow up showed only 6% increase in totallesion countKawada et al, 2002
Thirty two year old female with marked clical improvement in acne treatment
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“Combined Blue & Red light reduces total number of acne lesions”▶ Blue light 415nm & Red light 633nm reduces total acnelesion count by 81%Goldberg & Russell, 2006
“Combined Blue & Red light improves inflammatory & non-inflammatory acne lesions”▶ Blue light 415nm & Red light 633nm providesimprovements in inflammatory lesions by 77.93% &non-inflammatory lesions by 34.28%▶ Brightened skin tone & improved skin texture were alsospontaneously reported in 58% of patientsLee et al, 2007
Twenty five year old female with marked clical improvement in acne treatment on forehead
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“Red light stimulates fibroblasts to reduce wrinkles & increase skin elasticity”▶ Red light 630nm activates fibroblasts & increasescollagen & elastic fibre production▶ This leads to significant reductions in wrinkles &increases in skin elasticity▶ Red light 630nm also improves brightness of skinLee et al, 2007
“Red light accelerates wound healing, pain & bruise resolution”▶ Red light 630nm reduces erythema, oedema,bruising, pain & daays to heal following eyelidsurgery by one-half to one-thirdTrelles, 2006
Fifty four year old female with radiant skin after 2 weeks LED treatment
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Near Infra-red light stimulates fibroblasts to reduce wrinkles & increase skin elasticity”▶ NIR light 830nm activates fibroblasts & increases collagen & elastic fibre production▶ This leads to significant reductions in wrinkles & increases in skin elasticity▶ NIR light 830nm also improves telangiectasiaLee et al, 2007
Near Infra-red light reduces melanin production”▶ NIR light 830nm significantly reduces tyrosinase expression & melanin production▶ NIR light 830nm has the greatest effect on
Effect of varying wavelengths on tyrosinase expression by human melanocytes, as shown by western blot analysis.
Kim et al, 2012
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“Near Infra-red light activates key immune cells & stimulates tissue regeneration”▶ NIR light 830nm increases the activity of mast cells,macrophages & leukocytes▶ NIR light 830nm stimulates an inflammatory responsesimilar to the first phase of wound-healing which causes collagen synthesis & tissue proliferation▶ This activity also enhances the wound healing processCalderhead et al, 2008
“Near Infra-red light accelerates wound healing & reduces pain & irritation”▶ NIR light 830nm seems to accelerate the resolution of trauma wounds & reduce associated pain, erythema & irritationMin et al, 2013
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“Red and Near Infra-red light improves signs of ageing including periorbital wrinkles”▶ Red 630nm & NIR light 830nm improves periorbital wrinkles in 81% of patients▶ 52% patients displayed a 25-50% improvement & 13% patients displayed a 50%-75% improvement inphotoaging scoresRussel et al, 2005
▶ Red and Near Infra-red light provides a greater reduction in wrinkles than either light alone”▶ Red 630nm & NIR light 830nm reduces wrinkles by 36%▶ It also provides the highest patient satisfaction rates at 95.5%
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“Near Infra-red light reduces telangiectasia”▶ NIR light 830nm improves visible telangiectasia & facial flushingLee et al, 2007
▶ “Near Infra-red light improves acne rosacea”▶ NIR light 830nm provides improvement in redness &resolution of papulesKim et al, 2011
Rosea improvement after 1 month
▶ “Red light enhances rosacea treatment outcomes with IPL”▶ “Red light 630nm improves results achieved treating rosacea with IPL vs IPL alone”Goldberg, 2008
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“Blue light reduces severity of psoriasis”▶ Blue light 415nm provides significant reduction in psoriasis severity in patients with mild to moderate plaque psoriasisWeinstabl et al, 2011
▶ “Red and Near Infra-red light improves psoriasis”▶ Red 630nm & NIR light 830nm improves recalcitrant psoriasis in patients resistant to conventional treatments▶ Clearance rates range from 60% to 100%Ablon, 2007
▶ “Blue light improves atopic eczema”▶ Blue light induces a significant clinical improvement in atopic hand & foot eczemaKrutmann et al, 2005
Images courtesy from Dr. Mario, Spain
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APOLOMED utilises Light Emitting Diode ( PDT LED) technology
▶ APOLOMED phototherapy systems deliver narrowband, spectrally pure light of the optimum intensity, wavelength & dose to achieve clinical skin rejuvenation & resolution.
▶ Using state-of-the-art technology, APOLOMED delivers the 6 most clinically proven wavelengths in a single treatment head
▶ Blue light 415nm▶ Red light 630nm▶ Green light 520nm▶ Yellow light 630+520nm▶ Pink light 630+415nm▶ Near Infra-red light 830nm
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LED Phototherapy Treatment Profile▶ Non-invasive treatment without downtime▶ No side effects, pain, redness or irritation▶ Safe for all skin types (I to VI) including tanned skin▶ Offers treatment options for many key clinical indications▶ Significant results with compromised, reactive & sensitive skins
▶ Long term benefits: ‘not just a quick fix’
▶ Excellent adjunctive therapy to enhance clinical results▶ Quick & simple procedure (20 minutes)
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Apolomed PDT LED Features▶ Clinically proven wavelengths: 630nm, 520nm, 415nm & 830nm▶ TUV Medical CE approved system▶ ‘Wrap around' treatment head (270 degree coverage) can treat face, neck and back in one session▶ 180 or 240 diodes over 3 or 4 panels enables uniform irradiation▶ Independently powered 12W/LEDs for precise & high energy output▶ Friendly pre-set 9 kinds treatment options with recommended treatment time▶ Automated treatment head height & position control for easy positioning and patient comfort
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Blue light 415nm▶ Anti-bacterial action▶ Effectively treats acne▶ Helps control sebum production
Output density: 120mW/cm2
Red light 633nm▶ Increases fibroblast activity▶ Increases collagen & elastic fibre production▶ Reduces wrinkles & increases skin elasticity▶ Improves skin brightness▶ Accelerates wound healing & bruise resolution▶ Reduces redness & inflammation
Output density: 120mW/cm2
Yellow light 630+520nm▶ Improve skin tone ▶ Shrinking pore▶ Improve Lymph circulation▶ Pigment removal
Pink light 630+415nm▶ Improve skin tone▶ Rejuvenation
Green light 520nm▶ Improve Oily skin▶ Improve Lymph circulation▶ Body firming
Infrared light 830nm▶ Increases fibroblast activity▶ Increases collagen & elastic fibre production▶ Reduces wrinkles & increases skin elasticity▶ Anti-inflammatory properties▶ Accelerates wound healing▶ Reduces chronic inflammation & pain▶ Stimulates vascular repair▶ Reduces melanin production▶ Hair regrowth
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Thirty two year old female with marked clical improvement in blue light acne treatment
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Twenty six male with blue & red light helped to reduce breakouts & inflammation
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Fourty eight year old femal with improvement in telagiectasia 3 weeks after treatment completion
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Rocesa treatment before and after combined Blue & NIR light
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vascular treatment before and after with blue light
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Twenty three female with blue light helped to anti-inflamatory and acne treatment
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Back skin tone improvement with red & NIR light
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Body contouring with green light
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Psoriasis with red & NIR light
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Wound healing after two months treatment
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POTENTIAL PATIENT ISSUES & CONTRAINDICATIONS
Patient Issues & Contraindications can be classified into 2 groups‣ Patient Safety Issues/Concerns: Proceed with caution or treat as contraindication and avoidtreatment based on patient and risk assessment‣ Contraindications: Do not treat based on patient safety
When assessing a patient prior to a procedure, it is important to consider:‣ Condition being treated: Is the patient likely to see an improvement following treatment?‣ Past or current medication: If being taken, will this affect the procedure and/or clinical outcomes?‣ Past or current medical conditions: If any, will these affect the procedure and/or clinical outcomes?‣ History of surgery/interventions: If any, will these affect the procedure and/or clinical outcomes?
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Patient Safety Issues/Concerns‣ Patients who suffer from light induced migraines.‣ Patients taking St John’s Wort or other herbal remedies.‣ Patients with eye disease or retinal abnormalities, for example glaucoma.
Contraindications‣ Patients with autoimmune or photosensitive disorders that give rise to a light-induced reaction, for example Porphyria, Lupus erythematosus.‣ Patients who suffer from epilepsy or seizures triggered by light.‣ Patients taking medication that can induce photosensitivity or phototoxic reactions, for exampleTetracycline, Methotrexate, Ciprofloxacin.‣ Patients who have taken oral Retinoids (Roaccutane) in the last 2 months.‣ Patients with or with a history of cancer. If active, treat as contraindication and do not treat. Previous incidence of cancer - treatment decision made based on medical practitioner’s risk assessment.‣ Patients who are pregnant.
Patient issues/contraindications should be covered in theconsent process completed before the procedure.
Other potential issues highlighted in the Consent Form:- Low risk of redness, itchiness or puffiness- Low risk of hyperpigmentation- Results vary on an individual patient basis
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Day of the procedure‣ Sign the consent form‣ Cleanse the skin ensuring all make-up & moisturiser is removed from the skin‣ Photograph the treatment area under constant distance & illumination
‣ Performing the procedure‣ Fit the patient with the eyewear‣ For Blue & NIR light always use the eyewear provided with the APOLOMED‣ For Red light it is at the discretion of the client (although the light is very bright, it is safe for the eyes)‣ Position the APOLOMED treatment head over the patient‣ Select the desired treatment options, e.g. Blue light for 20 minutes, & activate the Apolomed system‣ Use the button to lower the treatment head to within 2 to 4 cm of the treatment area‣ After the therapy has finished apply Heliocare SPF50
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APOLOMED TREATMENT INDICATION MATRICES: LIGHT ONLY
Indication Wavelength Treatment duration Treatment needed Maintenance
Facial Firming 2* per week for 3 weeks 6 1 x MonthlyWrinkles 2* per week for 3 weeks 6 1 x MonthlyHydration 2* per week for 4 weeks 8 1 x Monthly
Mild to Moderate Acne 2* per week for 4 weeks 8 1 x MonthlySevere, Pustular & Cystic Acne 3* per week for 4 weeks 12 As required according to serverity
Spots Removal 2* per week for 4 weeks 8 Reviews as necessaryAnti-Allergy 3* per week for 2 weeks 6 No maintenanceSkin toning 2* per week for 3 weeks 6 1 x Monthly
Body Firming 2* per week for 3 weeks 6 1 x MonthlyBody Contouring 2* per week for 8 weeks 16 Reviews as necessaryBody Lipolysis 2* per week for 12 weeks 24 Reviews as necessary
Body Skin Toning 2* per week for 3 weeks 6 1 x MonthlyWound Treatment Infected 3* per week for 4 weeks 12 No maintenance
Wound Treatment Non-Infected 3* per week for 3 weeks 9 No maintenancePain Relief 3* per week for 3 weeks 9 No maintenanceHair Growth 2* per week for 4 weeks 8 Reviews as necessary
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