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 effective 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. Such as classical UVB phototherapy, PUVA, Narrowband UVB phototherapy. However, the lack of a specific radiation wavelength for diseases and the exposure of the whole body to radiation were the main problems in these treatments. 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. Targeted 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 in a short time only to the diseased area to be treated.
The monochromatic-single wavelength of 308 nm, which is included in Targeted Phototherapy, has come to the fore recently. These are called 308 nm MEI systems. (MEI means monochromatic, that is, light with 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 consistent energy 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 radiation varies between 14 mm and 30 mm according to the laser models used. However, these application dimensions mean low application area and long treatment time for skin diseases with extensive area involvement. Another disadvantage is that the energy density in the center of the application area is approximately 1.3-1.8 times higher than the surrounding area. This means overdose accumulation in the application center and areas that overlap with the shots, and side effects such as burns and blisters. Laser systems are expensive systems.
non-laser MEI treatment systems; These disease-specific and consistent systems have been developed by using monochromatic light sources with a single wavelength. The 308 nm wavelength is the most commonly used. It is applied to the diseased area with a flexible cable. The application area varies between 30 cm2, 2 cm2 and 1 cm2. Thus, rapid application to larger areas is provided in treatments. Clinical comparative studies show that its effectiveness 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 patient age limit. It can be used safely 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 hypersensitive 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 for these cancers.
* Increases sensitivity to the 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 during the sun period.
* It can be used comfortably and safely in pregnant and lactating mothers.
How the treatment is administered;
* Treatment applications and patient evaluations are completely done by the doctor.
* It is extremely important to examine the patient’s whole body system and full dermatological evaluation in terms of diseases. Diseased areas are measured with dermatological scoring methods, and body prevalence indexes and disease severity are measured. Diseased areas are photographed before treatment. All information and data 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 duration 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 made easily, comfortably and quickly even in difficult and small areas of the body (such as underarm, scalp, genital area and between the fingers).
* Disease-specific wavelength is applied to all diseased areas one by one.
* During the application, disease-free healthy skin is protected by special methods.
* During the treatment, the patient may only feel a slight increase in temperature at the application site. There is absolutely no burning or pain.
* A patient-specific treatment program is drawn up according to the diseases, the doses started, and the social issue of the patient.
* The patient is re-evaluated and photographed in each session.
* The application time is maximum 1.5 minutes in an anatomical area of 30 cm2.
* Session intervals vary between 1-3 per week. After the clinical response is obtained in the diseases, the session intervals are extended to be every 1-2 months.
* After the treatment, there are no restrictions in 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 incorrect administration or the physician choosing high doses for clinical efficacy. This developing burn does not leave any traces and improves with simple treatments.
* Darkening of color (hypigmentation); Darkening of color develops, especially in dark-skinned people, more prominently at the application site and on the surrounding normal skin. (Like tanning.)
* 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.
* No other serious side effects of the skin and general systems of the patients were observed during the follow-up of these treatments.
