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

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

Red laser radiation

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, leads to a decrease in toxic metabolites of oxygen and free radicals located in the inflammatory focus. The activation of hemolymphoperfusion of irradiated tissues, inhibition of lipid peroxidation promote resolution of infiltrative exudative processes and acceleration of proliferation in the inflammatory focus.

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

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

Under the action of a low-intensity helium-neon laser, the content of urokenic acid, which is an antioxidant normalizing the synthesis of cyclic nucleotides, prostaglandins, is increased.

Indications: subacute and chronic inflammatory diseases of the skin, subcutaneous fatty tissue, burns and frostbites, coughing up wounds and ulcers, pressure sores, pustular diseases, itchy dermatoses, herpetic skin lesions.

Infrared irradiation

Infrared radiation of the least all other wavelengths is absorbed by melanin, hemoglobin, oxyhemoglobin, water, skin; is dispersed by water, the skin is 2 times smaller than the light of a helium-neon laser. The main absorbing component is the blood proteins. The concentration of absorbed energy in the blood is several times greater than that in muscle tissue. With close contact of the laser emitter with the skin and a small compression of soft tissues, laser radiation reaches all dermal and subdermal vascular plexuses and structures, including muscle layers. With the absorption of infrared radiation, 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 surface vascular network. The vascular reaction develops phasally. First, there is a short-term (up to 30 s) insignificant spasm of the surface vessels of the skin, which is replaced by an increase in local blood flow and an increase in the volume of blood circulating in the tissues. There is hyperemia of the irradiated parts of the body, caused by an increase in the flow of blood in the tissues. It appears red spots without clear boundaries and disappears without a trace 20-30 minutes after irradiation. The heat energy released during this process significantly accelerates the metabolic processes in the skin and subcutaneous tissue. Some of the liquid is released with sweat and evaporates, which leads to dehydration and an increase in skin turgor.

Infrared laser radiation is selectively absorbed by molecules of nucleic acids and oxygen, induces reparative tissue regeneration and enhances their metabolism. With infrared laser light, the fibroblasts stimulate fibroblasts, the maturation of the granulation tissue border with the focus of tissue inflammation or wound edges. Penetrating deep into tissues at 6-7 cm, infrared laser radiation activates the glands of internal secretion, hemopoiesis, enhances the activity of immunocompetent organs and systems, leads to an increase in cellular and humoral immunity.

Therapeutic effects: decongestant, catabolic, vasodilating.

Indications, subacute and chronic inflammatory skin diseases, burns and frostbites, flaccid wounds and ulcers, pressure sores, pustular diseases, itchy dermatoses, diseases accompanied by joint damage (psoriatic polyarthritis).

Atopic dermatitis

Atopic dermatitis is a chronic inflammatory disease, manifested by a lesion that is widespread and accompanied by intense itching. In some patients, the disease occurs with sleep disturbances and emotional lability. Atopic dermatitis is characterized by seasonality, frequent exacerbations, often resistance to ongoing therapy. During periods of exacerbation in the lichenoid form of atopic dermatitis, there are areas of pink inflammatory neostroinflammatory erythema with exfoliation on the skin, infiltration, swelling, dryness, skin dyshromia, severe lichenification, intense itching of the skin.

The presence of the same conductive pathways for the feeling of pain and itching and the pronounced neurotropic action of laser light, which determines its analgesic and antipruritic effect, allow using laser radiation according to the paravertebral technique to the corresponding reflex-segmental zones.

It should be noted that laser therapy is most effective in the lichenoid form of atopic dermatitis. M. A. Karagezyan et al. (1986), treatment of patients with diffuse and limited neurodermatitis with helium-neon laser radiation on erythematoskvamous eruptions and foci of lichenification was noted in 11.1% of patients with clinical cure, in 62.5% significant improvement. Laser therapy led to the restoration of functional defects of neutrophils; increase in the content of cationic proteins, myeloperoxidase, chloroacetate-ASD-esterase; decrease in activity of alkaline and normalization of acid phosphatase; improvement of T-cell immunity. Yu. S. Butov et al. (1996) observed a decrease in skin pruritus and lichenification with a scanning effect on the foci of atopic dermatitis with red laser radiation. AM Krasnopolskaya and co-authors. (1996) obtained good results when defocused infrared laser light was applied to the lesions. Treatment of atopic dermatitis with a laser is performed by a dermatovenereologist. In the conditions of a cosmetology institution, atopic dermatitis is not treated.

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 with passive movements, morning stiffness, restriction of movement in the joints. Against the backdrop of traditional treatment, reocorrecting, detoxifying therapy, external use of permissives, a course of laser therapy consisting of 20-25 sessions is prescribed. After the laser therapy course 80% of patients in the affected joints had a decrease in pain syndrome and inflammatory phenomena; increased volume of movements. In patients with lesion of the distal joints, involving the nail plates and the development of psoriatic onychodystrophy, there was a distinct decrease in edema, hyperemia of the tissues surrounding the nail plate. According to VM Leshchenko et al. (1991), exposure to helium-neon laser (HNL) on affected nail plates in patients with psoriasis helped normalize the capillaroscopic picture of the skin of the nail ridges. According to VD Grigorieva and NG Badalova, local exposure of the IR laser to patients with psoriatic arthritis with active articular inflammation led to a significant improvement in clinical symptoms.

Positive results were obtained in the treatment of arthropathic psoriasis by IR radiation in combination with a permanent magnetic field induced by a special magnetic nozzle. The data of A. Mester also testify to the effectiveness of continuous near-IR laser radiation on the projection of articular joints.

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

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

Treatment of psoriasis with a laser is performed by a dermatovenereologist. In the conditions of a cosmetic facility, psoriasis is not treated.

Eczema

Against the backdrop of laser therapy, there is a decrease in erythema, infiltration, mocculation, and epithelization of erosion. Positive clinical dynamics is accompanied by normalization of indices of nonspecific antimicrobial resistance: bactericidal activity of blood serum, complement content, lysozyme and B-lysim.

Treatment of eczema with a laser is performed by a dermatovenereologist. In the conditions of a cosmetological institution, eczema is not treated.

Red flat lichen

Against the backdrop of laser therapy, there is an anti-inflammatory, regenerative and analgesic effect, a tendency toward normalization of the immunological parameters of the blood; in the electron microscope study, the decrease in the phenomena of hypergranular and acanthosis in the granular and prickly layers of the epidermis, restoration of the integrity of the basal membrane, expansion of the microvessels of the papillary dermis layer, an increase in the functional activity of mast cells, lymphocytes, macrophages, fibroblasts.

Treatment of red flat laser hair loss is done by a dermatologist. In the conditions of the cosmetic establishment, the treatment of red flat lichen is not performed.

Herpesvirus infection

Laser therapy is one of the effective methods of treatment of both herpes simplex and herpes zoster. Laser therapy against the use of external antiviral drugs (interferon, oxoline and tebrofen ointments, "Zoviraks", "Acyclovir", etc.) helps to speed up the resolution of rashes, reduce pain syndrome, itching and the phenomena of postherpetic neuralgia. There is an increase in the duration of remission, a decrease in the duration of relapses. However, evidence of the effect of low-intensity laser radiation from the red and infrared ranges is not directly obtained for viral activity. The clinical effect of laser radiation is due not to direct action 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 / cm ²; Exposure 6-8 minutes, the course of 25-30 procedures.

Method 2.

IR irradiation by a remote stable technique (a gap between the radiator and the skin of 1 cm) in a pulsed mode, with a power density of 7-10 mW / cm ², a frequency of 1500 Hz; exposure of 1-2 minutes on the field, the total time of action is 10 minutes, for a course of 10 daily procedures.

Method 3.

Irradiation of the foci of shinging with helium-neon laser light (power 8.5 mW, power density 27 mW / cm ², exposure 5 min, scanning method, for a course of 5-19 sessions).

It is recommended for the treatment of postherpetic neuralgia.

Method 4.

The exposure by contact method with a diode GaAlAs laser (wavelength 830 μm), in a constant 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 Treatment of herpesvirus infection with a laser is performed by a dermatovenereologist. In the conditions of a cosmetic facility, the treatment of herpesvirus infection is possible only in the case of complications and any cosmetic procedures, subject to the appropriate conditions, experience and qualifications of the medical staff.

Acne.

With oily skin, the disruption of the function of sweat and sebum leads to the formation of acne, pustular skin diseases. Laser irradiation, stimulating microcirculation and lymph circulation, activating the antioxidant system of cells, corrects this state, increasing the 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 - cleaning and therapeutic massage

Method 1.

Irradiation of foci of damage by a helium-neon laser with a power density of 1-5 mW / cm ² and a gradual increase in time by 1-5 to 15-20 min.

It is recommended for treatment of patients with youthful and pink acne.

Method 2.

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

The use of low-intensity laser radiation with abscessed 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 carried out in a continuous mode, with a daily increase in exposure from 1 to 10 min, with a dose of 0.16 J / cm ², for a course of 10-30 sessions. It is recommended for patients with common and pink acne.

Scleroderma

This disease is from a group of connective tissue diseases. It is manifested by sclerosing the connective tissue of the skin.

Low-intensity laser radiation (LIL) has a pronounced local trophic, antifibrotic and anti-inflammatory effect. Against the backdrop of the application of NLI in scleroderma, the positive dynamics of clinical symptoms is marked: the abatement of inflammatory phenomena and a decrease in 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 in the blood serum of the erythrocyte membranes, normalization of lipid and phospholipid metabolism is observed: a decrease in the level of free cholesterol, cholesterol esters and triglycerides; normalization of the immune status and metabolism of the interstitial substance of the connective tissue: an increase in the number of T-lymphocytes, a decrease in B-lymphocytes, IgG, circulating immune complexes. On the rheovasograms, a statistically significant increase in the blood flow velocity and a decrease in the spastic vascular state are revealed.

A fast and persistent effect was obtained in the treatment of plaque scleroderma by laser magnetotherapy: the combined effect of IR radiation and a constant magnetic field. Normalization of immune status indicators and metabolism of interstitial substance of connective tissue was noted.

Laser therapy is combined with basic medicamental treatment, including injections of unithiol, D-penicillamine. Nicotinic acid, vitamins A and E

Treatment of scleroderma with a laser is performed by a dermatovenereologist. In the conditions of a cosmetology institution, scleroderma treatment is not performed.

Trophic ulcers

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

Treatment of trophic ulcers with a laser is performed by a surgeon or doctor dermatovenereologist. In the conditions of a cosmetological institution, trophic ulcers are not treated.

Alopecia

Low-intensity laser irradiation is pathogenetically conditioned by the method of therapy of this pathology. Infrared exposure causes a local increase in the temperature of the irradiated skin, an increase in local blood flow and an increase in the volume of the circulating blood of the superficial vasculature, the trophic skin of the scalp and the nutritional conditions of the hair roots are improved. The course of the laser implicated scalp skin massage was performed in patients aged 26-44 years with diagnoses: alopecia areata, androgenic alopecia, diffuse alopecia, increased hair loss. The procedure is performed using an applicator massager for dry or wet hair. To improve the effectiveness of the procedure, it is recommended to apply medical balms for hair.

Methodology

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

Mycosis

At the moment, the question is debated whether the laser radiation has a fungicidal and fungistatic effect. The clinical effect of red and infrared light in the treatment of mycosis patients is due not to exposure to fungi directly, but to its influence on inflammation and tissue trophism.

The technique of supra-vascular laser irradiation of blood has proven itself for correction of vascular disorders in the Rhine disease and in complex therapy in severe forms of onychomycosis.

Treatment of mycoses with a laser is performed by a dermatovenereologist. In the conditions of a cosmetology institution, the treatment of mycosis is not carried out.

Laser Phonophoresis

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

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

Laser cosmetology

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

The main tasks of laser therapy in the period after laser-surgical manipulations in skin and plastic surgery and cosmetology in operations to eliminate excess soft tissue 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 granulations and marginal epithelization;
   • improvement of blood circulation in the wound;
   • bactericidal and dehydrating action.
2. Elimination or reduction of pain syndrome.
3. Normalization of trophism, prevention of contracture formation and development of keloid scars, the formation of tender elastic postoperative scars.
4. Reducing the risk of postoperative complications, transplant rejection.
5. Rapid recovery of working capacity and shortening of the rehabilitation period for patients.

Methodology

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

In operations on the upper and lower eyelids, a helium-neon laser with a radiation power at the output of the light guide of 20 mW is used in the postoperative period; power density 0.02 J / cm ². Total exposure time 8 min; the course consists of 6-8 sessions.

Possible complications of laser therapy

With external irradiation of wounds by a helium-neon laser, as a result of a disturbance in the exposure, granulation necrosis and an exacerbation of the purulent process may develop, therefore, it is necessary to adhere strictly to methodological recommendations

In the presence of contraindications to the use of laser therapy, there may be an exacerbation of the intercurrent disease.

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 allows to stop the growth of the scar, promotes regression, removes the subjective sensations (itching, burning, pain). Laser therapy is most effective during the first year after keloid formation. The older the scar, the less effective laser therapy. It is very important to monitor the condition of the scars during the first 3-6 months after the operation. 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 perform laser procedures at the same time of day, as vascular reactions and changes in metabolism have a rhythmic, phase character.

Methodology

A helium-neon laser is used, by contact method, for a session, 2-4 points on one rumen are exposed, the radiation power is 20 mW, the frequency is 20 Hz, the exposure is 40 s per point; on the course of 12-13 procedures.

Laser puncture of "rejuvenation points"

The laser puncture of the "rejuvenation points" due to the reflex action exerts a restorative, stimulating effect on the body and slows down the aging process; Enzymatic systems are activated, weaning for the tone of tissues (skin and subcutaneous tissue).

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

Toning procedures

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 stagnation process, but also creates a rejuvenation effect. Toning procedures are combined with the application of a nourishing cream, for better penetration of biologically active complexes in skin tissues. After the application of the cream, a "laser" shower will be wiped out, the existing wrinkles are "ironed" with laser light. It is necessary to mix the radiator along the dermal lines of the forehead, the chin and the neck (by scanning),

Laser light increases the effectiveness of medicinal or external cosmetic agents (ointments, creams, emulsions, etc.) by enhancing the skin's permeability. Laser radiation does not interfere with the structural integrity of the drugs and promotes deeper penetration of the required amount of used drugs into the tissue.

The best effect is achieved by combining three types of laser radiation: red, infrared and infrared pulsed infrared.

Laser therapy of gynoid lipodystrophy (cellulite) and in the correction of the figure

A new method of treating cellulite is a laser vacuum massage, the essence of which is the effect on the tissues affected by cellulite, a local vacuum with the displacement of the fold formed by the vacuum manipulator, in the direction of the lymphatic drainage. With the use of vacuum sliding massage, due to the rolling of the fat fold and discharging above it, the following occur:

• disorganization of adipocyte accumulations, unlocking of microcirculation of blood and lymph, acceleration of the output 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 further improves microcirculation;
• liberation of adipocytes from accumulated fat;
• Effects on deeply embedded compacted tissues that can not be massaged manually;
• restoration of cellulite islet communication with the body, providing the possibility of immediate elimination of excess fat deposits with minimal physical exertion or diet;
• cleansing the surface of the skin from keratinized cells - the skin acquires softness and elasticity, eliminates stretch marks, improves fat and perspiration, oxygen breath of the skin.

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

Methodology

Before the beginning of the procedure, the affected areas of the body for 5-10 minutes are treated with an applicator laser massager. Laser output power 100 mW The speed of the applicator massage is 3-5 cm / s. The direction of movement corresponds to the direction of lymphatic drainage to the lymph nodes

Then continue the massage with a baranovakumnoy nozzle. The output power of the laser is 100 mW, the modulation frequency is 10 Hz, the exposures are calculated at the rate of: 5 min - the thigh; 5 minutes - buttock; 5 minutes - the stomach; the total time of the procedure is 25 minutes. Barovacuum massage is also performed in the direction of the lymph flow to the lymph nodes.

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

It should not be forgotten that it is undesirable to use the laser for pigmentation spots, nevi and angiomas because of the biostimulating effect, it is recommended to cover such formations on the skin with small screens from a white, friable paper towel before the procedure.

[1], [2], [3]