DrFritz PDT Omnilux

8/10/2019 DrFritz PDT Omnilux

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Photodynamic Rejuvenationcomparison of LLLT with10% and 20 % ALA PDT

Carmen Solavastru and Klaus Fritz

University Carol Davila Bukarest (Ro) andDermatology and Laser Center Landau (D)


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PDT Treatment effects :

Reduces signs of exogenous

skin ageing such as AK,pigmentation, alwaysimproves skin texture, too

Induces collagenneogenesis resulting insmoothening and tighteningof the skin

Light sources themselfmay decreasepigmentation,solarlentigines andteleangiectasia

Background:

Ageing skin ageing is caused significantly by photoageing,actinic keratoses occur.


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Omnilux light Technology1. Light Emitting Diode

matrix

2. LEDs are chips that

directly convertelectricity to light

Background device/ light source


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Omnilux blue

415nm wavelength

with 5 ALA for Actinic Keratosis

Omnilux revive 633nm wavelength

for primary skin rejuvenation alone or in

combination with 5 ALA for photodamage

Omnilux plus

830nm wavelength for wound healing



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Types of light reaction

1. Activation of cell receptors

in the mitichondria or on the cell membrane lead to

increased cell metabolism = photobiostimulation:

Skin rejuvenation, wound healing, , tissue regeneration

2. In combination with ALA as a topically applied

photosensitiserFor the treatment of non melanoma skin cancers, acne

and photodamaged skin



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Role of LLLT (Low level light therapy)

data of Randomised Clinical

Trials and laboratory based

research show improved

Collagen synthesis Anti bacterial

Background device/ light source LLLT alone

oWound healing and tissue repairoangiogenisisoRelief of inflammation

oneuroregenerationoCytoprotection


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633nm (Visible red light) alone

Left

(Covered)

Right

(Treated)

Before treatment 12 weeks after treatment

National Medical CenterRepublic of Korea



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Control group

830nm alone

830nm+633nm

Percentage reduction

Change in the severity of wrinkles (Visiometer Results: profilometry value)

< R3 value = The Average Roughness >

Time

(- 36%)50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

105%

Before

Treatment

2 weeks

post treatment

4 weeks

post treatment

8 weeks

post treatment

12 weeks

post treatment

633nm

alone



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Treatment Results 67% (4/6)significant treatment response

Reduction in fine lines and wrinkles Skin softness improved


Lowe N. Lowe P (2005) J. Cosmetic and Laser Therapy volume

7 issue : Pilot Study to determine the efficacy of ALA-PDTphotorejuvenation for the treatment of facial ageing


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The effect of combination Omnilux

phototherapy on fine lines and wrinkles

Russell B Journal of Cosmetic and Laser Therapy 2005; 7: 196

200


Reduction in valley depth (st) or wrinkles atweek 12.

83% and 81% reporting a softening of fine linesand wrinkles at weeks 9 and 12 respectively.


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Studies and case reports on rejuvenationTouma DJ, Gilchrest BA.

Topical photodynamic therapy: a new tool in

cosmetic dermatology.Semin Cutan Med Surg.

2003 Jun;22(2):124-30.

Gold MH, Goldman MP.5-aminolevulinic acidphotodynamic therapy: where we have been and

where we are going. Dermatol Surg. 2004

Aug;30(8):1077-83; discussion 1083-4.

Zakhary K, Ellis DA.

Applications of aminolevulinic Acid-based

photodynamic therapy in cosmetic facial plasticpractices.Facial Plast Surg. 2005 May;21(2):110-6

Touma D, Yaar M, Whitehead S et al.A trialof short incubation, broad-areaphotodynamic therapy for facial

actinic keratoses and diffusephotodamage.Arch Dermatol 2004; 140:33-40.

Ruiz-Rodriquez R, Sanz-Sanchez T,CordoboS. Photodynamicphotorejuvenation. Dermatol Surg2002; 28:742-744.

Gold MH.Intense pulsed light therapyfor photorejuvenation enhanced with20%aminolevulinic acid photodynamictherapy.J Laser Med Surg 2003; 15(S):47.

ALA +Light

Background light source + ALA
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Touma+DJ%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Gilchrest+BA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Gold+MH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Goldman+MP%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Zakhary+K%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Ellis+DA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Ellis+DA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Zakhary+K%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Goldman+MP%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Gold+MH%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Gilchrest+BA%22%5BAuthor%5Dhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term=%22Touma+DJ%22%5BAuthor%5D


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Fink Puches R, Soyer.H.-P.,Hofer A et a. Long-term follow-up andhistological changes of superficial

non melanoma skin cancers treat-ed with topical delta-aminolevulinic acid

photodynamic therapy, ArchDermatal. 1998;134:821-826.

Touma DJ,Szeimis RM:Topical PDT in Krutmann Skin Ageing2006 (157-166)

studies have also demonstrated

increased fibrosis and

New collagen formation in the dermis several months

after 5 ALA~PDT for the treatment of basal cell and squamouscell carcinomas.

Photo s co urtes y of Mark S. Nestor, M.D., Ph.D.



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Min Young Park, MD, Seonghyang Sohn, PhD, Eun-So Lee, MDand You Chan Kim, MD

Journal of the American Academy of DermatologyVolume 62, Issue 1, Pages 85-95(January 2010)

Photorejuvenation induced by 5-aminolevulinic acidphotodynamic therapy in patients with actinic keratosis:

A histologic analysis

14 patients with actinic keratoses treated twice with ALA-PDT by using a 1200 W

metal halogen lamp at 1-month intervals.

Skin biopsy before and 1 month after the PDT

routine and immunohistochemical stainingparameters associated with photoaging by using image analysis.

http://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstract


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Source: Journal of the American Academy of Dermatology 2010; 62:85-95)

Mean expression of TGF-, TR II, procollagen I,procollagen III, and total collagen volume

increased with each session of ALA-PDT.

TGF-does not only up-

regulate procollagensynthesis,but it also down-regulates theexpression of MMPs



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Source: Journal of the American Academy ofDermatology 2010; 62:85-95)

Procollagen type I and

type III

The expression of collagenprecursors was alsoincreased, especially in the

papillary dermis and upperreticular dermis.

The average increase was

significantly different


Fi 5
http://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstracthttp://www.eblue.org/article/S0190-9622(09)00694-X/abstract


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Fig 5

Source: Journal of the American Academy of Dermatology 2010; 62:85-95)

Mean expression of TGF-, TR II, procollagen I,procollagen III, and total collagen volume

increased with each session of ALA-PDT.

TGF-does not only up-

regulate procollagensynthesis,but it also down-regulates theexpression of MMPs


k d l h


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After ALA-PDT, the mean epidermal thickness and dermal inflammatory

infiltrate were reduced.

The total collagen volume in the dermis significantly increased with expressionof type I and III procollagen.

The level of transforming growth factor and transforming growth factor typeII receptors in the epidermis also increased.

The elastotic material with co-localizing fibrillin-1 and tropoelastin expression inthe dermis decreased after treatment.

The expression of matrix metalloproteinases-1, -3, and -12 also decreased.



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Two sessions of MAL-PDT increases

immunohistochemical expression of MMP-9 in the

dermis at 3 months after treatment, and also of

Collagen type I.


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Method: 10 patients each group

Group A

was treated with bluelight of 415 nm+633 each side

( Omnilux ) 8-12times 1x/week for 10min eachwavelenghth andside of the face

Group B

received classic ALAtreatment with

20 % ALA (prescription),

applied for 3 h andtreated with 415 nm 10min +10min of 633 nm

Group C

received 10 % ALA for 30 min and

415 nm 10 min + 633 nm 10 min

Own results

12 i O il


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A 12 times Omnilux

= 415 nm + 633 nm

improvedsignificantly

radiancy ,

skin toneand

pore size

Courtesy Dr Klaus Fritz


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B classic 20 % ALA , 3 h and treated with

415 + 633 nm 10 min each/side

reduced actinic keratoses more than 90 %,

reduced dyschromia significantly and

resulted in a smoother skin texture ,

all signs of skin ageing reduced significantly


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B classic 20 % ALA , 3 h and treated with

415 + 633 nm 10 min each/side

reduced actinic keratoses more than 90 %,

reduced dyschromia significantly and

resulted in a smoother skin texture ,

all signs of skin ageing reduced significantly


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C 10 % ALA for 30 min , 415 nm +633 nm 10 min each/side

improved same parameters up to 70 % astreatment No. B

but allowed less redness, crusting ,pain and

irritation .


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C 10 % ALA for 30 min , 415 nm +633 nm 10 min each/side

improved same parameters up to 70 % astreatment No. B

but allowed less redness, crusting ,pain and

irritation .


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conclusion and summary

modified application of PDT of 10% and 30 minusing the 415 + 633 nm Omnilux with its anti-inflammatory effects are very effective inrejuvenation of ageing skin .This protocol

allows both, a cosmetic improvement and thepreventive effects in actinic keratoses.

LLLT with 415 nm and 633 nm only can

improve radiancy and smoothness of the skineven without ALA


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conclusion and summary

Compared to other procedures such as lasers orchemical peels PDT needs 1 2 sessions only

every 1- 3 years, need few visits ,and combinehighly effective cosmetic improvements with a lowrisk of side effects at comparibly low costs.

Ph t d i R j ti


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Carmen Solavastru and Klaus Fritz

University Carol Davila Bukarest (Ro) andDermatology and Laser Center Landau (D)

Thank You

Photodynamic Rejuvenationcomparison of LLLT with10% and 20 % ALA PDT

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DrFritz PDT Omnilux