Laser therapy: mechanism of action, methodology, indications and contraindications

Currently, red or helium-neon (wavelength 0.63-0.67 μm) and infrared (wavelength 0.8-1.3 μm) lasers are used to treat skin diseases in therapeutic dermatocosmetology. The penetration depth of red laser radiation does not exceed several millimeters (2-8 mm). The wavelength of the near infrared radiation range allows for tissue exposure to a depth of up to 7 cm.

Red laser light

Red laser radiation is selectively absorbed by DNA molecules, cytochrome oxidase, cytochrome, superoxide dismutase and catalase. It stimulates cellular respiration and the antioxidant system of lipid peroxidation, leading to a decrease in toxic oxygen metabolites and free radicals found in the inflammatory focus. The activity of hemolymphoperfusion of irradiated tissues, inhibition of lipid peroxidation contribute to the resolution of infiltrative-exudative processes and acceleration of proliferation in the inflammation focus.

The use of a helium-neon laser to a greater extent ensures the activation of vascularization processes of the pathological focus.

Thus, the use of a helium-neon laser provides a vasoconstrictor and vasodilating effect, affects the rheological properties of the blood, activates metabolism and immunity at various levels, and stimulates tissue reparation.

When exposed to a low-intensity helium-neon laser, the content of urokenic acid increases, which is an antioxidant that normalizes the synthesis of cyclic nucleotides and prostaglandins.

Indications: subacute and chronic non-purulent inflammatory diseases of the skin, subcutaneous fat, burns and frostbite, slow-healing wounds and ulcers, bedsores, pustular diseases, itchy dermatoses, herpetic skin lesions.

Infrared irradiation

Infrared radiation is absorbed by melanin, hemoglobin, oxyhemoglobin, water, and skin the least of all other wavelengths; it is scattered by water and skin 2 times less than the light of a helium-neon laser. The main absorbing component is blood proteins. The concentration of absorbed energy in the blood is several times higher than that in muscle tissue. With close contact of the laser emitter with the skin and slight compression of soft tissues, the laser radiation reaches all dermal and subdermal vascular plexuses and structures, including muscle layers. When infrared radiation is absorbed, heat is generated, which leads to a local increase in the temperature of the irradiated skin by 1-2° C and causes local thermoregulatory reactions of the superficial vascular network. The vascular reaction develops in phases. At first, a short-term (up to 30 sec) insignificant spasm of the superficial vessels of the skin occurs, which is replaced by an increase in local blood flow and an increase in the volume of blood circulating in the tissues. Hyperemia of the irradiated areas of the body occurs, caused by an increase in blood flow to the tissues. It manifests itself as red spots without clear boundaries and disappears without a trace 20-30 minutes after irradiation. The thermal energy released during this significantly accelerates metabolic processes in the skin and subcutaneous tissue. Some of the liquid is released with sweat and evaporates, which leads to dehydration and increased skin turgor.

Infrared laser radiation is selectively absorbed by nucleic acid and oxygen molecules, induces reparative tissue regeneration and enhances their metabolism. With infrared laser irradiation of tissues bordering the inflammation site or wound edges, fibroblasts are stimulated and granulation tissue matures. Penetrating 6-7 cm deep into tissues, infrared laser radiation activates endocrine glands, hematopoiesis, enhances the activity of immunocompetent organs and systems, and leads to increased cellular and humoral immunity.

Therapeutic effects: anti-edematous, catabolic, vasodilatory.

Indications: subacute and chronic non-purulent inflammatory skin diseases, burns and frostbite, slow-healing wounds and ulcers, bedsores, pustular diseases, itchy dermatoses, diseases accompanied by joint damage (psoriatic polyarthritis).

Atopic dermatitis

Atopic dermatitis is a chronic inflammatory disease characterized by widespread lesions and intense itching. Some patients experience sleep disturbances and emotional instability. Atopic dermatitis is characterized by seasonality, frequent exacerbations, and often resistance to therapy. During periods of exacerbation in the lichenoid form of atopic dermatitis, there are areas of non-acute inflammatory erythema of a pink color with peeling, infiltration, swelling, dryness, skin dyschromia, pronounced lichenification, and intense itching of the skin.

The presence of the same conduction pathways for the sensation of pain and itching and the pronounced neurotropic effect of laser light, which determines its analgesic and antipruritic effect, make it possible to use laser radiation using the paravertebral technique on the corresponding reflex-segmental zones.

It should be noted that laser therapy is most effective in the lichenoid form of atopic dermatitis. M. A. Karagizyan et al. (1986) in the treatment of patients with diffuse and limited neurodermatitis with helium-neon laser radiation on erythemosquamous rashes and lichenification foci noted clinical cure in 11.1% of patients, significant improvement in 62.5%. Laser therapy led to the restoration of functional defects of neutrophils; an increase in the content of cationic proteins, myeloperoxidase, chloroacetate-ASD esterase; a decrease in the activity of alkaline and normalization of acid phosphatase; improvement in T-cell immunity. Yu. S. Butov et al. (1996) observed a decrease in skin itching and lichenification with scanning action on the foci of atopic dermatitis with red laser radiation. A. M. Krasnopolskaya et al. (1996) obtained good results when treating lesions with a defocused infrared laser beam. Laser treatment of atopic dermatitis is performed by a dermatovenerologist. Treatment of atopic dermatitis is not performed in a cosmetology facility.

Psoriasis. Laser therapy is most effective in psoriatic arthritis in patients with synovial and synovial-bone polyarthritis, arthralgia. Patients complain of pain in the joints during passive movements, morning stiffness, limited movement in the joints. Against the background of traditional treatment, reocorrective, detoxifying therapy, external use of resolving agents, a course of laser therapy is prescribed, consisting of 20-25 sessions. After a course of laser therapy, 80% of patients in the affected joints noted a decrease in pain syndrome and inflammatory phenomena; the range of motion increased. In patients with damage to the distal joints, with involvement of the nail plates in the process and the development of psoriatic onychodystrophy, a distinct decrease in swelling, hyperemia of the tissues surrounding the nail plate was noted. According to V. M. Leshchenko et al. (1991), the effect of helium-neon laser (HNL) light on the affected nail plates in patients with psoriasis contributed to the normalization of the capillaroscopic picture of the skin of the nail folds. According to V. D. Grigorieva and N. G. Badalova, local exposure to an IR laser in patients with psoriatic arthritis with active joint inflammation led to a reliable improvement in clinical symptoms.

Positive results were obtained in the treatment of arthropathic psoriasis with IR radiation in combination with a constant magnetic field induced by a special magnetic attachment. A. Mester's data also indicate the effectiveness of continuous laser radiation of the near IR range on the projection of articular joints.

Good results were observed with the combined use of GNL radiation and phonophoresis of Pelan ointment in patients with psoriatic arthritis. V. G. Kolyadenko et al. (1984) used a combined effect on the lesions and paravertebral ganglia with red and infrared radiation using an intermittent method, which led to a marked clinical improvement.

Along with the positive dynamics of clinical symptoms, laser therapy leads to the normalization of cellular immunity indicators, lipid peroxidation, antioxidant activity and the level of medium molecular peptides in the blood serum.

Laser treatment of psoriasis is performed by a dermatovenerologist. Psoriasis treatment is not performed in a cosmetology facility.

Eczema

Against the background of laser therapy, a decrease in erythema, infiltration, oozing and epithelialization of erosions is noted. Positive clinical dynamics are accompanied by normalization of non-specific antimicrobial resistance indicators: bactericidal activity of blood serum, content of complement, lysozyme and B-lyzyme.

Laser treatment of eczema is performed by a dermatovenerologist. Eczema treatment is not performed in a cosmetology facility.

Lichen planus

Against the background of laser therapy, anti-inflammatory, regenerative and analgesic effects are observed, as well as a tendency to normalize immunological parameters of the blood; in electron microscopic examination, there is a decrease in the phenomena of hypergranulosis and acanthosis in the granular and spinous layers of the epidermis, restoration of the integrity of the basement membrane, expansion of microvessels of the papillary layer of the dermis, an increase in the functional activity of mast cells, lymphocytes, macrophages, and fibroblasts.

Treatment of lichen planus with a laser is performed by a dermatovenerologist. Treatment of lichen planus is not performed in a cosmetology facility.

Herpesvirus infection

Laser therapy is one of the effective methods of treating both herpes simplex and shingles. Laser therapy against the background of the use of external antiviral drugs (interferon, oxolinic and tebrofen ointments, Zovirax, Acyclovir, etc.) helps to accelerate the resolution of rashes, reduce pain, itching and postherpetic neuralgia. An increase in the duration of remissions and a decrease in the duration of relapses are noted. However, evidence of the effect of low-intensity laser radiation of the red and infrared ranges directly on viral activity has not been obtained. The clinical effect of laser radiation is due not to a direct effect on viruses, but to the activation of sanogenetic processes in the patient's body.

Method 1.

Irradiation with a helium-neon laser at a power density of 2.5 mW/cm2 ^; exposure 6-8 min, course of 25-30 procedures.

Method 2.

IR irradiation using a remote stable method (the gap between the emitter and the skin is 1 cm) in pulsed mode, at a power density of 7-10 mW/cm2 ^, frequency of 1500 Hz; exposure 1-2 min per field, total exposure time 10 min, per course of 10 daily procedures.

Method 3.

Irradiation of herpes zoster lesions with light from a helium-neon laser (power 8.5 mW, power density 27 mW/cm2 ^, exposure 5 min, scanning method, 5-19 sessions per course).

Recommended for the treatment of postherpetic neuralgia.

Method 4.

Contact exposure using a diode GaAlAs laser (wavelength 830 μm), in continuous mode, with an output power of 60 mW and a power density of 3 W/cm ², 8-10 sessions. Recommended for the treatment of postherpetic neuralgia. Laser treatment of herpesvirus infection is performed by a dermatovenerologist. In a cosmetology facility, treatment of herpesvirus infection is possible only in the event of complications and any cosmetic procedures, provided that the appropriate conditions, experience and qualifications of the medical staff are available.

Acne.

With oily skin, dysfunction of sweat and sebum secretion leads to the formation of acne, pustular skin diseases. Laser irradiation, stimulating microcirculation and lymph circulation, activating the antioxidant system of cells, corrects this condition, increasing tone, improving the trophism of irradiated tissues, their regenerative function and the ability to exchange with the external environment. Laser therapy prepares the patient for the next stage of treatment - cleansing and therapeutic massage.

Method 1.

Irradiation of lesions with a helium-neon laser with a power density of 1-5 mW/cm2 ^and a gradual increase in exposure time from 1-5 to 15-20 minutes.

Recommended for the treatment of patients with juvenile and rosacea.

Method 2.

IR irradiation with a pulse power of 3.0-5.5 W, frequency for superficial forms of 300-600 Hz, for abscessing, phlegmonous and conglobate - 1500-3000 Hz; exposure 10 min. The procedure regimen is established depending on the course of the skin process; in the acute period - daily, in the subacute - every other day, in chronic processes - 2 times a week; a course of 10 sessions.

The use of low-intensity laser radiation for abscessing acne prevents the formation of keloid scars.

Method 3.

Combined local irradiation with coherent and incoherent polarized red light with a wavelength of 0.63-0.65 μm. Irradiation is performed in a continuous mode, with a daily increase in exposure from 1 to 10 min, at a dose of 0.16 J/cm2 ^, for a course of 10-30 sessions. Recommended for patients with acne vulgaris and rosacea.

Scleroderma

This disease is from the group of connective tissue diseases. It manifests itself as sclerosis of the connective tissue of the skin.

Low-intensity laser radiation (LILR) has a pronounced local trophic, antifibrotic and anti-inflammatory effect. Against the background of LILR application in scleroderma, positive dynamics of clinical symptoms are observed: abatement of inflammatory phenomena and a decrease in the compaction of lesions, blanching of the pigmentation zone, an increase in local temperature and tissue mobility. Along with the positive dynamics of the skin process, normalization of lipid and phospholipid metabolism indices is observed in the blood serum and erythrocyte membranes of patients: a decrease in the level of free cholesterol, cholesterol esters and triglycerides; normalization of immune status indices and metabolism of the interstitial substance of connective tissue: an increase in the number of T-lymphocytes, a decrease in B-lymphocytes, IgG, circulating immune complexes. Rheovasograms reveal a statistically significant increase in blood flow velocity and a decrease in the spastic state of blood vessels.

A rapid and lasting effect was obtained in the treatment of plaque scleroderma using laser magnetic therapy: combined exposure to IR radiation and a constant magnetic field. Normalization of immune status indicators and metabolism of the interstitial substance of connective tissue was noted.

Laser therapy is combined with basic drug treatment, including injections of unitiol, D-penicillamine, nicotinic acid, vitamins A and E.

Laser treatment of scleroderma is performed by a dermatovenerologist. Scleroderma treatment is not performed in a cosmetology facility.

Trophic ulcers

Trophic ulcers are caused by chronic venous insufficiency of the shins (against the background of varicose veins, with diabetic angiopathy). Patients complain of pain at rest and when walking, clinically abundant purulent discharge is determined, in some cases necrotic decay. Before a laser therapy session, ulcerative defects are treated with a 3% solution of hydrogen peroxide. The procedures are carried out using a barovacuum nozzle with the capture of healthy tissue. After irradiation, epithelializing and bactericidal ointment dressings are applied to the ulcers.

Treatment of trophic ulcers with a laser is performed by a surgeon or a dermatovenerologist. Treatment of trophic ulcers is not performed in a cosmetology facility.

Alopecia

Low-intensity laser irradiation is a pathogenetically conditioned method of therapy for this pathology. When exposed to infrared irradiation, there is a local increase in the temperature of the irradiated skin, an increase in local blood flow and an increase in the volume of circulating blood of the superficial vascular network, improved trophism of the scalp and nutrition conditions of the hair roots. A course of laser applicator massage of the scalp was carried out on patients aged 26 to 44 years with the following diagnoses: focal alopecia, androgenic alopecia, diffuse alopecia, increased hair loss. The procedure is carried out using an applicator massager on dry or damp hair. To increase the effectiveness of the procedure, it is recommended to apply medicinal hair balms.

Methodology

The laser output power is 20 mW, the massager speed is 1-2 cm/s, the total procedure time is 10-15 min. The course consists of 15-20 sessions. The massage is performed in the direction of hair growth, combing and lightly pressing the massager on the scalp.

Mycoses

At present, the question of whether laser radiation has a fungicidal and fungistatic effect is being discussed. The clinical effect of red and IR light in the treatment of patients with mycosis is due not to the direct effect on fungi, but to its effect on inflammation and tissue trophism.

The method of supravascular laser irradiation of blood has proven itself well for the correction of vascular disorders in Reine's disease and in complex therapy for severe forms of onychomycosis.

Laser treatment of mycosis is performed by a dermatovenerologist. Mycosis treatment is not performed in a cosmetology facility.

Laser phonophoresis

The essence of the method lies in the simultaneous use of low-intensity laser radiation and a drug, which results in increased tissue permeability and the entry of the drug into the body.

At present, there is no clear justification for the mechanisms of action of low-intensity laser radiation. Most studies are empirical. However, it is obvious that the use of low-intensity laser radiation in the complex treatment of chronic dermatoses allows for a significant improvement in the clinical picture, a reduction in the number of relapses and an extension of the periods of clinical remission.

Laser cosmetology

Laser radiation is used in cosmetology for toning procedures, resorption of scars, drying of acne, removal of irritations and residual effects after surgical and cosmetic procedures.

The main objectives of laser therapy in the period after laser surgical manipulations in skin plastic surgery and cosmetology during operations to remove excess soft tissues of the face, neck, after blepharoplasty, otoplasty are:

1. Acceleration and completion of tissue defect regeneration processes due to:
   • stimulation of regeneration of damaged tissue, growth of granulation and marginal epithelialization;
   • improving blood circulation in the wound;
   • bactericidal and dehydrating action.
2. Elimination or reduction of pain syndrome.
3. Normalization of trophism, prevention of contractures and development of keloid scars, formation of delicate elastic postoperative scars.
4. Reducing the risk of developing postoperative complications and transplant rejection.
5. Rapid restoration of working capacity and reduction of rehabilitation periods for patients.

Methodology

Laser therapy after face and neck lifting is performed with an infrared laser in the temporal region, in front of the auricle and on the neck. The irradiation time for each area is 2 minutes, at a frequency of 1200 Hz, a power density of 0.8 J/cm2 ^, the total exposure time is 12 minutes; the course consists of 10-12 sessions.

In operations on the upper and lower eyelids, in the postoperative period, a helium-neon laser is used with a radiation power at the output of the light guide of 20 mW; power density of 0.02 J/cm2 ^. The total exposure time is 8 minutes; the course consists of 6-8 sessions.

Possible complications of laser therapy

When externally irradiating wounds with a helium-neon laser, as a result of exposure violation, granulation necrosis and exacerbation of the purulent process may develop, therefore it is necessary to strictly adhere to the methodological recommendations.

If there are contraindications to the use of laser therapy, an exacerbation of the intercurrent disease may be observed.

Treatment of keloid and hypertrophic skin scars

For conservative treatment of keloid and hypertrophic skin scars, it is recommended to use a helium-neon laser. Laser therapy helps stop scar growth, promotes regression, and relieves subjective sensations (itching, burning, pain). Laser therapy is most effective during the first year after the formation of a keloid. The older the scar, the less effective laser therapy. It is very important to monitor the condition of scars during the first 3-6 months after surgery. The approach to laser therapy should be individual and depends on the nature of the scar and the parameters of the lesion. It is recommended to carry out laser procedures at the same time of day, since vascular reactions and metabolic changes have a rhythmic, phased nature.

Methodology

A helium-neon laser is used, using a contact method, 2-4 points on one scar are affected per session, radiation power is 20 mW, frequency is 20 Hz, exposure is 40 sec per point; a course of 12-13 procedures.

Laser puncture of "rejuvenation points"

Laser puncture of "rejuvenation points" due to reflex action has a general strengthening, stimulating effect on the body and slows down the aging process; enzymatic systems are activated, which wean off the tone of tissues (skin and subcutaneous tissue).

"Rejuvenation points" Zu-san-li (E36 - according to the French notation system) are localized below the upper edge of the lateral condyle of the tibia by 3 cun (cun is the size of the middle phalanx of the middle finger of the patient's right hand), at the outer edge of the anterior tibialis muscle. After finding the points on the right and left shins, they are marked with a pen or felt-tip pen. An acupuncture attachment is attached to the laser device, the laser output power is set to 5 mW (the radiation power at the end of the acupuncture attachment, taking into account the attenuation coefficient, will be 3-4 mW). Irradiation is carried out by contact, perpendicular to the irradiated surface, exposure is 20-40 sec per point, radiation is continuous or modulated, with a frequency of 30 Hz, the course consists of 10-15 procedures (daily or every other day).

Toning treatments

Exposure to low-intensity laser radiation improves capillary blood flow, arterial and venous circulation, lymphatic drainage in the tissues of the face and neck, which not only slows down the aging process, but also creates a rejuvenating effect. Toning procedures are combined with the application of a nourishing cream for better penetration of biologically active complexes into the skin tissue. After applying the cream, a "laser" shower is performed, existing wrinkles are "ironed" with laser light. It is necessary to move the emitter along the skin lines of the forehead, chin and neck (scanning method),

Laser light increases the effectiveness of medicinal or cosmetic products for external use (ointments, creams, emulsions, etc.) by increasing the tissue permeability of the skin. Laser radiation does not violate the structural integrity of the preparations and promotes deeper penetration of the required amount of the applied products into the tissue.

The best effect is achieved with a combination of three types of laser radiation: red, continuous infrared and intermittent pulsed infrared.

Laser therapy for gynoid lipodystrophy (cellulite) and body shaping

A new method of treating cellulite is laser vacuum massage, the essence of which is the effect on tissues affected by cellulite, a local vacuum with the movement of a fold formed by a vacuum manipulator in the direction of lymph drainage. When using vacuum sliding massage, due to the rolling of the fat fold and the vacuum above it, the following occurs:

• disorganization of adipocyte accumulations, unblocking of blood and lymph microcirculation, acceleration of the removal of waste products and toxins, removal of edema, improvement of oxygen supply for fat oxidation;
• changes in the structure of connective tissue (it becomes more mobile and elastic), which, in turn, reduces fibrosis and promotes further improvement of microcirculation;
• release of adipocytes from accumulated fat;
• impact on deep-lying compacted tissues that cannot be massaged manually;
• restoring the connection between the cellulite island and the body, providing the ability to immediately eliminate excess fat deposits with minimal physical activity or diet;
• cleansing the skin surface from dead cells - the skin becomes soft and elastic, eliminating stretch marks, improving sebum and sweat secretion, and oxygen respiration of the skin.

Low-intensity laser radiation, in addition to additional stimulation of microcirculation, activates enzymes and stimulates the process of fat splitting and the removal of oxidation products from irradiated tissues. Vacuum massage promotes superficial and deep tissue massage, expansion or constriction of blood and lymphatic vessels, opens non-functioning capillaries and thereby activates blood circulation and tissue nutrition, increases the release of toxic products with the secretion of sweat glands to the skin surface.

Methodology

Before the procedure, the areas of the body affected by cellulite are treated with an applicator laser massager for 5-10 minutes. The laser output power is 100 mW. The speed of the applicator massager is 3-5 cm/s. The direction of the movements corresponds to the direction of lymph flow to the lymph nodes.

Then continue the massage with a barovacuum attachment. The laser output power is 100 mW, the modulation frequency is 10 Hz, the exposures are calculated as follows: 5 min - thigh; 5 min - buttock; 5 min - abdomen; the total procedure time is 25 min. Barovacuum massage is also performed in the direction of lymph flow to the lymph nodes.

At the end of the sliding massage procedure, a calming manual massage with stroking movements is performed for 1-2 minutes. After the procedure, the patient is covered with a sheet or towel and allowed to rest for 5-10 minutes. The procedures are performed daily or every other day. The course consists of 10-15 procedures.

It should not be forgotten that it is undesirable to use laser on pigment spots, nevi and angiomas due to the biostimulating effect; before the procedure, it is recommended to cover such formations on the skin with small screens made of white loose paper napkin.

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