Photomedicine is an interdisciplinary branch of medicine that involves the study and application of light

with respect to health and disease. Photomedicine may be related to the practice of various fields of
medicine including dermatology, surgery, interventional radiology, optical diagnostics, cardiology, and
oncology.

A branch of photomedicine is light therapy.

Light therapy or phototherapy (classically referred to as heliotherapy) consists of exposure to daylight or
to specific wavelengths of light using polychromatic polarized light, lasers, light-emitting diodes,
fluorescent lamps, dichroic lamps or very bright, full-spectrum light, usually controlled with various
devices. The light is administered for a prescribed amount of time and, in some cases, at a specific time
of day.

There are multiple layers of muscle to the human body ranging from superficial (visible) to deep (nonvisible). Traditional massage therapy can be helpful, but the positive results may not last long because
the deeper muscle structures were not treated as effectively as the superficial ones. Thus giving you
only temporary relief. Laser massage on the other hand helps restore normal cellular function to the allimportant deeper muscles of the body.
The deeper muscles are called 'stabilizers'. Meaning they keep bones and joints in proper alignment. The
superficial muscles are called 'prime movers'. Meaning they are design to move your body from point A
to point B, while the stabilizers keep you from falling apart during that move!
If the deeper muscles are overloaded or tired, the body puts too much emphasis on the prime movers
and you end up with chronic muscle spasm, tightness, and pain. So the key of laser massage is the ability
to reach those stabilizers so you feel incredible.

Connecting every cell and tissue of the body is a fish-net like material known as 'fascia'. This connective
tissue should glide smoothly between structures, but often times can stick to muscles causing
discomfort and pain. Laser massage therapy loosens up the 'fascia' preventing the development of
'sticking'. The warmth and smooth glide of the therapy is relaxing, giving you increased mobility and
stability.
Most any painful condition can benefit from laser massage therapy since 'fascia' is connected to every
part of your body. Sessions can be body part and condition specific or you may also experience our full
body therapy program.
Average therapy sessions last from as little as 10-minutes to 1-hour
Common use of the term is associated with the treatment of skin disorders (chiefly psoriasis), sleep
disorder and some psychiatric disorders. Light therapy directed at the skin is also used to treat acne
vulgaris, eczema and neonatal jaundice. Light therapy which strikes the retina of the eyes is used to
treat circadian rhythm disorders such as delayed sleep phase disorder and can also be used to treat
seasonal affective disorder, with some support for its use also with non-seasonal psychiatric disorders.
Laser therapy is the application of red or near infra-red light over injuries where it is absorbed and
causes cellular stimulation to occur restoring normal cell function. It helps to reduce pain and
inflammation and enhances the body's natural healing process.
Laser medicine is the use of various types of lasers in medical diagnosis, treatment, or therapy. Types of
lasers used in medicine include in principle any laser design, but especially:

CO2 lasers
Diode lasers
Dye lasers
Excimer lasers
Fiber lasers

Gas lasers
Free electron lasers
Optical parametric oscillators
Medical areas that employ lasers include:
Angioplasty
Cancer diagnosis cancer treatment
Cosmetic applications such as laser hair removal, tattoo removal, and laser liposuction reference
needed
Dermatology
Lithotripsy
Mammography
Medical imaging
Microscopy
Ophthalmology (includes Lasik and laser photocoagulation)
Optical coherence tomography
Prostatectomy
Surgery

What can they be used for?

Arthritis (rheumatoid and osteoarthritis)

Tendonitis, ligament and tendon tears
Repetitive Strain Injuries (Carpel tunnel, bursitis)
Soft tissue and sports injuries
Back, neck and knee pain
Wound healing and tissue repair.

Photodynamic therapy

Photodynamic therapy (PDT), sometimes called photochemotherapy, is a form of phototherapy using

nontoxic light-sensitive compounds that are exposed selectively to light, whereupon they become toxic
to targeted malignant and other diseased cells. PDT has proven ability to kill microbial cells, including
bacteria, fungi and viruses. PDT is popularly used in treating acne.
It is used clinically to treat a wide range of medical conditions, including wet age-related macular
degeneration and malignant cancers, and is recognized as a treatment strategy which is both minimally
invasive and minimally toxic.
Most modern PDT applications involve three key components: a photosensitizer, a light source and
tissue oxygen. The combination of these three components leads to the chemical destruction of any
tissues which have either selectively taken up the photosensitizer or have been locally exposed to light.
The wavelength of the light source needs to be appropriate for exciting the photosensitizer to produce
reactive oxygen species. These reactive oxygen species generated through PDT are free radicals (Type I
PDT) generated through electron abstraction or transfer from a substrate molecule and highly reactive
state of oxygen known as singlet oxygen (Type II PDT).
In understanding the mechanism of PDT it is important to distinguish it from other light-based and laser
therapies such as laser wound healing and rejuvenation, or intense pulsed light hair removal, which do
not require a photosensitizer.

Mechanisms of Actions
Most cells of the human body can transform ALA or MAL into porphyrins. However, significant
differences exist in porphyrins accumulation between various tissues and cell types. After the
application of MAL or ALA to human skin, porphyrins accumulate mostly in sebaceous glands and the
epidermis. Neoplastic cells accumulate more porphyrins than normal cells, which has prompted the
development of ALA and MAL photodynamic therapy (PDT) for the treatment of actinic keratosis (AKs),
Bowen disease, and basal cell carcinoma (BCC).
Light at a wavelength corresponding to a peak of the porphyrin excitation spectrum in tissues is used to
most efficiently generate a therapeutic effect. The Soret band (approximately 405-420 nm) is the most
important excitation peak of protoporphyrin IX and is included in the spectral output of the US Food and
Drug Administration (FDA)approved Blu-U device, which is used with ALA.
Another peak in the excitation spectrum of porphyrins includes a red peak at approximately 635 nm,
which is targeted by different devices, including those approved to be used with MAL.
Following blue or red light activation, porphyrins are excited to a higher energy triplet state, which can
either emit light (fluorescence) or generate reactive oxygen species, such as singlet oxygen or free
radicals. The generation of singlet oxygen species, labeled type 2 photochemical reactions, are believed
to predominate in photodynamic therapy. Because singlet oxygen does not travel very far within a cell,
the molecular effects are influenced by the intracellular localization of the photosensitizer at the time of
light exposure. Porphyrins derived from ALA are mainly localized in the vicinity of mitochondria, which
can lead to apoptosis or necrosis of malignant cells upon light exposure. Both phenomena have been
shown to be induced following ALA photodynamic therapy.
For the treatment of acne, preferential targeting of sebaceous glands and Propionic-bacterium- acnes
reduction are believed to be the main mechanisms involved. Because P.acnes has been shown to
naturally accumulate porphyrins, blue or red light alone can also have a direct therapeutic
photodynamic effect on the bacteria. The exact mechanisms involved in ALA photodynamic therapy for
the treatment of photoaging are not well known, but increased collagen synthesis has been
demonstrated following ALA photodynamic therapy.
Beyond direct phototoxic effects on target tissue, photodynamic therapy with various photosensitizers
has been shown to modify cytokine expression and induce immune-specific responses. Immunologic
effects include the production of interleukin 1-beta, interleukin 2, tumor necrosis factor-alpha, and
granulocyte colony-stimulating factor. Photodynamic therapy generally has a low potential for causing
DNA damage, mutations, and carcinogenesis.

PROCEDURE
In order to achieve the selective destruction of the target area using PDT while leaving normal tissues
untouched, either the photosensitizer can be applied locally to the target area or photosensitive targets
can be locally excited with light. For instance, in the treatment of skin conditions, including acne,
psoriasis, and also skin cancers, the photosensitizer can be applied topically and locally excited by a light
source. In the local treatment of internal tissues and cancers, after photosensitizers have been
administered intravenously, light can be delivered to the target area using endoscopes and fiber optic
catheters
Photosensitizers can also target many viral and microbial species, including HIV and MRSA. Using PDT,
pathogens present in samples of blood and bone marrow can be decontaminated before the samples
are used further for transfusions or transplants. PDT can also eradicate a wide variety of pathogens of
the skin and of the oral cavities. Given the seriousness that drug resistant pathogens have now become,
there is increasing research into PDT as a new antimicrobial therapy.

Photosensitizers
The most commonly used photosensitizers in photodynamic therapy (PDT) are ALA and MAL. Both ALA
and MAL are approved in several countries, including the United States, for the treatment of AKs only.
However, off-label uses such as the treatment of BCC, photoaging, and acne vulgaris are common. Each
photosensitizer is discussed below.
5-Aminolevulinic acid
ALA is currently available in a prepackaged plastic tube containing 2 sealed glass ampules, 1 with the
ALA powder and the other with the hydroalcoholic solution (Levulan). The vehicle ampule contains 1.5

mL of solution composed of ethanol (48% v/v), water, laureth-4, isopropyl alcohol, and polyethylene
glycol. The other ampule contains 354 mg of ALA hydrochloric acid as a dry powder. The applicator tube
is enclosed in a protective cardboard sleeve with a cotton applicator.
The topical solution (final ALA concentration of 20%) must be prepared just prior to application by
breaking the glass ampules with gentle pressure and subsequently mixing the contents by shaking the
applicator
Methylaminolevulinate
MAL is available in a cream containing 168 mg/g of MAL (final MAL concentration of 16.8%), glyceryl
monostearate, cetostearyl alcohol, polyoxyl stearate, methylparaben, propylparaben, disodium edetate,
glycerin, white petrolatum, cholesterol, isopropyl myristate, refined peanut oil, refined almond oil, oleyl
alcohol, and purified water.

Adverse Effects and Contraindications

Phototoxic reactions Desired and excessive.

A burning sensation or, less commonly, pruritus, is observed during light exposure after ALA or
MAL application for photodynamic therapy (PDT). These sensations usually decrease rapidly
once the light source is paused or exposure is terminated. A phototoxic reaction on AKs and BCC
is characterized by erythema, edema, crusting, vesiculation, or erosion in most patients. This is
considered a normal and desirable reaction to achieve clearance of these lesions.
When ALA photodynamic therapy is used on large skin surfaces with shorter application times,
this phototoxic reaction is less intense. It typically lasts only a few days but sometimes can last
7-10 days. Sometimes, edema may last up to 1 week and erythema may last up to 2 weeks.
Erythema and edema are often followed by peeling. The severity of this phototoxic reaction is
variable and can sometimes be severe and associated with a burning sensation, pain, crusting,
vesicles, and intense peeling. This phototoxic reaction is greatly enhanced and can be quite
severe if patients expose themselves to the sun or to powerful artificial lights during the first 2
days after topical application.
Pigmentary abnormalities and hypersensitivity reactions
Hyperpigmentation is sometimes seen after photodynamic therapy. It tends to fade over a few
months. Hypopigmentation at treated sites has also been reported. Cases of allergic contact
dermatitis and urticaria to MAL have been reported.
Systemic absorption potential

Precautions
ALA and MAL cream should only be administered in the presence of a physician who is knowledgeable in
the use of photodynamic therapy. These products should only be used in the office or clinic setting and
should never be used as self-applied treatments by patients. As a general precaution, sun exposure on
the treated lesion sites and peripheral skin should be avoided for at least 48 hours following topical
application of ALA and MAL.
Direct eye contact with ALA or MAL should be avoided. Individual cases of increased phototoxic
reactions following ALA photodynamic therapy performed on patients using topical retinoids have been
reported to the manufacturer.

PUVA is a psoralen + UVA

PUVA is a psoralen + UVA treatment for eczema, psoriasis, graft-versus-host disease, vitiligo, mycosis
fungoides, large-plaque Para-psoriasis and cutaneous T-cell lymphoma. The psoralen is applied or taken
orally to sensitize the skin, and then the skin is exposed to UVA.
Photodynamic therapy is the general use of nontoxic light-sensitive compounds that are exposed
selectively to light, whereupon they become toxic to targeted malignant and other diseased cells. Still,
PUVA therapy is often classified as a separate technique from photodynamic therapy
Side effects and complications
Some patients experience nausea and itching after ingesting the psoralen compound. For these patients
PUVA bath therapy may be a good option.
Long term use of PUVA therapy has been associated with higher rates of skin cancer.
The most significant complication of PUVA therapy for psoriasis is squamous cell skin cancer. Two
carcinogenic components of the therapy include the nonionizing radiation of UVA light as well as the
psoralen intercalation with DNA. Both processes negatively impact overall genome instability.

Endovenous laser treatment

Endovenous laser treatment (ELT) is a minimally invasive ultrasound-guided technique used for treating
varicose veins using laser energy commonly performed by a phlebologist, interventional radiologist or
vascular surgeon.

Endovenous laser treatment treats varicose veins using an optical fiber that is inserted into the vein to
be treated, and laser light, normally in the infrared portion of the spectrum,[1] shines into the interior of
the vein. This causes the vein to contract, and the optical fiber is slowly withdrawn. Some minor
complications can occur, including thrombophlebitis, pain, hematoma, edema and infection, which can
lead to cellulitis.