Photobiomodulation in clinical practice

Abstract

For the past few years, we have been witnessing a gradual, but rapid change in the management of skin wounds: the so-called 'advanced' dressings have been joined, and partly replaced, by interactive dressings, in which the dressing itself interacts with the wound bed and perilesional skin, modulating one or more aspects of the tissue repair mechanism through the interaction with cells, chemical mediators and factors hindering healing. The even more recent introduction of high-tech devices has definitively propelled Wound Care into the modern era of Tech Treatment, in which one or more technologies are employed in the management of the wound and the reparative process. In this field, Regenerative Medicine and Surgery represent the most recent frontier reached by this 'technological expansion', through the use of dermo/epidermal substitutes and material stimulating the healing process in its different phases. In the early 2000s, considerable interest was aroused by the attempt to apply 'phototherapy' to wound management: taking their cue from the results obtained some time ago in the treatment of certain lesions, cutaneous and otherwise, neoplastic and not, with the use of Photodynamic Therapy (by means of red light and 5 amino-levulinic acid), a Florentine research group (to which some of the Authors of this paper belonged) began to study its effects on venous ulcers, with extremely encouraging results in terms of resumption of the reparative process, with evidence of increased angiogenesis, fibroblast number and antigen-presenting cells, amongst other things. Over the years, other types of biophotonic treatment have been developed, with the introduction of monochromatic light sources (red, green, blue), capable of selectively interacting with the different tissue chromophores, and of triggering effects (so-called photobiomodulation) in the treated tissues, which differ according to the wavelength used and the chromophores stimulated each time. More recent is the application of exogenous fluorophores, which can absorb radiant light and convert it into light of different wavelengths through a phenomenon known as fluorescence. The enormous therapeutic possibilities offered by different treatments have led to exciting results from a tissue regeneration point of view. However, as it often happens when a technology is affected by such sudden changes and developments, clinical practice currently suffers from certain biases, mainly related to the presence of uncoordinated protocols of use, for each technology, in the absence, therefore, of algorithms of use that would make their clinical application homogeneous, establishing, for each type of light stimulation, its role and real potential, setting its limits and indications, also on the basis of clinical risk. We felt it was time to sit around a table, bringing together some of the top experts in each field of this discipline, trying to clarify all the aspects that characterise the interaction of light with tissues, in a dialogue that brought together physicists, chemists, clinicians and experts in statistics and literature (among the best in the country, and with proven experience in the field in question), in order to find a common language and try to provide information for the correct indications for the use of this method of tissue regeneration, free from corporate and institutional influences, without any sponsorship and, above all, dictated by real experience developed in the various sectors, supported by data from literature.

Keywords

• Photobiomodulation
• Clinical practice
• Veins