Micro Phototherapies in Skin Diseases
Today, Laser and Light systems are used successfully in Psoriasis – Psoriasis, Vitiligo-Ala, Alopecia – Hair loss, eczema and many skin diseases with active clinical results and wide safety.
Sun and artificial solar light sources have been used in skin diseases since the past. These treatments are classified under the heading “Photo-therapy”. Photo-treatments are carried out with special lamps whose wavelengths are determined. Like classical UVB phototherapy, PUVA, Narrowband UVB phototherapy. However, in these treatments, the absence of a specific radiation wavelength for diseases and the exposure of the whole body to radiation were the main burdens. In the long-term follow-up of patients receiving these treatments, premature aging of the skin and an increase in the risk of developing skin cancers have been observed. Based on these results, “Target-Oriented Phototherapy” was developed. Purposeful Phototherapy is also called “micro-phototherapy” or “selective phototherapy”. With this method, much higher ultraviolet-UV doses than can be given in conventional phototherapy can be applied only to the diseased area to be treated in a short time.
The monochromatic-single wavelength of 308 nm, which is included in Targeted Phototherapy, comes to the fore in the last period. These are called 308 nm MEI systems. (MEI means monochromatic, that is, light containing a single wavelength.) In many clinical studies, very successful results have been reported in many dermatological diseases, especially psoriasis and vitiligo.
Two different types of MEI Treatment systems have been developed as Laser and non-Laser MEI.
Laser MEI treatment systems; It is an ideal and balanced power source that can be used in laser treatments. It is applied to the diseased area with a fiber optic cable. The application area size of the laser beam varies between 14 mm and 30 mm compared to the laser models used. However, these application dimensions mean low application area and long treatment time for skin diseases with large area involvement. Another disadvantage is that the power density in the center of the application area is about 1.3-1.8 times higher than the surrounding area. This means side effects such as excessive dose accumulation and burns and water collection in the application center and areas that overlap with the shots. Laser systems are valuable systems.
non-laser MEI treatment systems; These diseases-specific and balanced systems have been developed by using monochromatic light sources with a single wavelength. The wavelength of 308 nm is the most commonly used. It is applied to the diseased area with a flexible cable. The application area changes in the middle of 30 cm2, 2 cm2 and 1 cm2. Thus, the ease of rapid application to larger areas is provided in treatments. Clinical comparative studies show that its activity in diseases is equivalent to laser. Treatment costs are cheaper than laser systems.
Clinical usage areas of MEI treatment systems;
* Psoriais- Psoriasis
* Vitiligo- Ala Disease
* Alopecia- Hair Breaker Disease
* Atopic Dermatitis-Chronic eczema
* Seborrheic Detaititis-Oily eczema
* Local eczema resistant to treatments; especially palm and sole eczema
* Skin rejuvenation
* Spots such as lentigo due to sun damage
* Precancerous skin diseases such as Actinic Keratosis, Seborrheic Caratosis
* Skin lymphomas called mycosis fungoides and lymphomatoid papilosis
* Oral lichen planus
* Hypopigmentation (reduction of skin color); Stria alba and Guttate hypomelanosis, scar-scar, wound and skin discoloration after burns.
* Leucoderma(discoloration of the skin); Skin discoloration after injury, trauma, laser epilation or other laser treatments
In order to use MEI treatment systems;
* There is no age limit for the patient. It can be used with faith in children.
* In order for the treatment to be started, the diseases should be stable, that is, new lesions should not appear and the complaints should not increase in old lesions. First of all, medical treatments are started for the patients in this period. After the disease is stable, MEI treatments are started.
* Patients should not be very sensitive to sun and artificial light sources.
* The patient should not have previously had skin cancers such as “Maling Melanoma, BCC and SCC” or should not carry risks in the direction of these cancers.
* Increases sensitivity to sun and light; ACE inhibitor, NSAI, amodarone, phenothiazide, ciproflaxacine, protriptyline, nalidic acid, sulfonamides, tetracycline, nifedipine, thiazide, tar, psoralene, griseofulvin, halogenated salicycanilide, some food dyes and food additives should not be used.
* MEI treatment systems are not restricted in the summer period as in other laser treatments and the patient is not asked to be protected from the sun. On the contrary, treatments are more successful in the solar period.
* It can be used comfortably and safely in pregnant and lactating mothers.
How the treatment is administered;
* Treatment practices and patient evaluations are entirely made by the physician.
* The patient’s entire body system and full dermatological evaluation and examination in the direction of diseases are extremely valuable. Body prevalence indices and disease severity are measured by measuring diseased areas with dermatological scoring procedures. Diseased areas are photographed before treatment. All information and information are archived in computer environment.
* Before starting the treatment, the skin type of the patient is determined. MED (minimal erythem dose = minimal redness-producing dose) test is performed to calculate the initial appropriate dose. For this, the patient’s healthy skin is applied to 3 different points according to the skin type. 1-2 days after this application, the test areas are evaluated and patient-specific doses and application time are determined.
* Specific values and treatment protocols to be applied are determined for each patient and disease.
* The ergonomic structure of the system used and the variety of application head diameters ensure that the application can be done easily, comfortably and quickly even in the power (armpit, scalp, genital area and middle of the finger) and small areas of the body.
* Disease-specific wavelength is applied to all diseased areas one by one.
* During the application, disease-free healthy skin is protected with special systems.
* During the treatment, the patient can only feel a slight increase in temperature at the application site. Burning and pain do not necessarily occur.
* A patient-specific treatment program is prepared according to the diseases, the doses started, and the social issue of the patient.
* The patient is re-evaluated and photographed in each session.
* Application time is maximum 1.5 minutes in an anatomical area of 30 cm2.
* Session intervals change in the middle of 1-3 per week. After a clinical response is obtained in diseases, the session intervals are extended to be once every 1-2 months.
* After the treatment, there are no restrictions on the daily and social life of the patient.
* MEI treatment systems can be used with other medical treatments.
What are the side effects?
* Erythema-flushing; Redness occurs at the application site within 12-24 hours after the session. This is very similar to sunburn. It depends on the disease and the dose of administration. (For example, more erythema develops in vitiligo patients.) After a few days, the flushing disappears with mild skin dryness and dandruff.
* Blister(water collection); There may be burns at the application site. This is entirely due to the wrong application or the physician’s choice of high doses for clinical activity. This developing burn does not leave any traces and heals with easy treatments.
* Color intensification (hypigmentation); Intensification of color develops, especially in dark skinned people, more evidently at the application site and the surrounding normal skin. (About to tan.)
* Longer lasting redness, edema and dryness develop in the treatment of diseases located on the palms and soles. In some patients, itching is added to this side effect. With the use of moisturizer, these side effects are relieved and disappear within 2-3 days.
* In the follow-up of these treatments, no other significant side effects of the skin and general systems of the patients were found.