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Efficacy and Tolerability of Phototherapy With Light-Emitting Diodes for Sensitive Skin: A Pilot Study

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Sensitive skin (SS) syndrome is defined by the occurrence of unpleasant sensations in response to stimuli that should normally not induce such sensations. It affects ~50% of women and 40% of men and can impact the quality of life. There is no consensus on therapeutic management. Phototherapy by light-emitting diodes (LEDs) is increasingly being used in dermatology for various inflammatory skin disorders with significant reduction in SS-10 and good tolerability. A Korean study suggested its efficacy in alleviating SS symptoms associated with other facial diseases. Our objective is to obtain preliminary data on the efficacy of phototherapy with LEDs for alleviating SS symptoms and increasing tolerance in subjects with SS that is not associated with other facial skin disorders. This monocentric pilot study included 30 subjects with SS who had a Sensitive Scale-10 score ≥40. The treatment consisted of red LED light exposure twice a week until significant reduction in SS-10 with a maximal treatment length of 8 weeks. The primary outcome was defined by a 60% decrease in the SS-10 score compared to the baseline. Results: Thirty subjects were included; 83% were women, and the mean age was 28.9 years. Two participants were considered lost to follow-up. The cheeks (90%) and the nose (70%) were the most frequently involved parts of the face. Cold, heat, temperature variation, water and sun were the most frequent triggering factors. Twenty-eight subjects (93.3%, 95% CI 77.9 to 99.2%) achieved the primary outcome. Significant reduction in SS-10 was achieved in 77% of subjects in six sessions or fewer. The mean (SD) SS-10 scores were 54.7 (12.1) at inclusion, 14.4 (6.0) at the last session and 13.9 (7.5) 2 months after the last session, suggesting that the benefits persist for a few weeks. Two side effects were reported: both were allergic reactions to the nickel contained in the protective goggles. This pilot study had a small sample size and no control group. LEDs were effective in treating SS in all 28 subjects who completed the study in accordance with the protocol, and the benefits persisted for 2 months after the last LED therapy session.
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ORIGINAL RESEARCH
published: 07 February 2020
doi: 10.3389/fmed.2020.00035
Frontiers in Medicine | www.frontiersin.org 1February 2020 | Volume 7 | Article 35
Edited by:
Ralf J. Ludwig,
Universität zu Lübeck, Germany
Reviewed by:
Elena Netchiporouk,
McGill University, Canada
Peter Wolf,
Medical University of Graz, Austria
*Correspondence:
Emilie Brenaut
emilie.brenaut@chu-brest.fr
Specialty section:
This article was submitted to
Dermatology,
a section of the journal
Frontiers in Medicine
Received: 02 April 2019
Accepted: 23 January 2020
Published: 07 February 2020
Citation:
Sonbol H, Brenaut E, Nowak E and
Misery L (2020) Efficacy and
Tolerability of Phototherapy With
Light-Emitting Diodes for Sensitive
Skin: A Pilot Study. Front. Med. 7:35.
doi: 10.3389/fmed.2020.00035
Efficacy and Tolerability of
Phototherapy With Light-Emitting
Diodes for Sensitive Skin: A Pilot
Study
Haitham Sonbol 1, Emilie Brenaut 1,2
*, Emmanuel Nowak 3and Laurent Misery 1,2
1Department of Dermatology, University Hospital, Brest, France, 2Univ Brest, LIEN, Brest, France, 3CHRU Brest, INSERM
CIC 1412, Brest, France
Sensitive skin (SS) syndrome is defined by the occurrence of unpleasant sensations
in response to stimuli that should normally not induce such sensations. It affects
50% of women and 40% of men and can impact the quality of life. There is no
consensus on therapeutic management. Phototherapy by light-emitting diodes (LEDs)
is increasingly being used in dermatology for various inflammatory skin disorders with
significant reduction in SS-10 and good tolerability. A Korean study suggested its efficacy
in alleviating SS symptoms associated with other facial diseases. Our objective is to
obtain preliminary data on the efficacy of phototherapy with LEDs for alleviating SS
symptoms and increasing tolerance in subjects with SS that is not associated with other
facial skin disorders. This monocentric pilot study included 30 subjects with SS who had
a Sensitive Scale-10 score 40. The treatment consisted of red LED light exposure twice
a week until significant reduction in SS-10 with a maximal treatment length of 8 weeks.
The primary outcome was defined by a 60% decrease in the SS-10 score compared to
the baseline.
Results: Thirty subjects were included; 83% were women, and the mean age was 28.9
years. Two participants were considered lost to follow-up. The cheeks (90%) and the
nose (70%) were the most frequently involved parts of the face. Cold, heat, temperature
variation, water and sun were the most frequent triggering factors. Twenty-eight subjects
(93.3%, 95% CI 77.9 to 99.2%) achieved the primary outcome. Significant reduction in
SS-10 was achieved in 77% of subjects in six sessions or fewer. The mean (SD) SS-10
scores were 54.7 (12.1) at inclusion, 14.4 (6.0) at the last session and 13.9 (7.5) 2 months
after the last session, suggesting that the benefits persist for a few weeks. Two side
effects were reported: both were allergic reactions to the nickel contained in the protective
goggles. This pilot study had a small sample size and no control group. LEDs were
effective in treating SS in all 28 subjects who completed the study in accordance with
the protocol, and the benefits persisted for 2 months after the last LED therapy session.
Keywords: sensitive skin, light-emitting diode, LED, pilot study, reactive skin
Sonbol et al. Light-Emitting Diodes for Sensitive Skin
INTRODUCTION
Sensitive skin (SS) was mentioned in the medical literature for
the first time in the 1940’s (1). However, its definition was
not clearly established until 2016, thanks to the International
Forum for the Study of Itch (2). It is defined as the occurrence
of unpleasant sensations (stinging, burning, pain, pruritus, and
tingling sensations) in response to stimuli that normally should
not provoke such sensations. These unpleasant sensations cannot
be explained by lesions attributable to any skin disease. The skin
can appear normal or be accompanied by erythema. Sensitive
skin can affect all body locations. Eighty-five percent of cases
involve the face (3). SS is frequent affecting 50% European
women and 40% men (4). A French study found that it affects
half of the population with a slight predominance in women
(60%) (5). Its diagnosis and evaluation can be performed in
different ways, most frequently via a questionnaire, such as
the Sensitive Scale-10 (SS-10) (6). There is no consensus on
therapeutic management; it is generally recommended to limit
the use of cosmetics or to use products with high tolerability.
Low-level laser/light therapy (LLLT), including light emitting
diodes (LEDs), is increasingly used with significant reduction in
SS-10 and without any side effects in many cutaneous or mucosal
disorders, such as diabetic leg ulcers (7), acne (8), and alopecia
areata (9), as well as for skin rejuvenation (10). Phototherapy
by LED and other sources of LLLT have been used in medicine
since the 1960’s due to their non-thermal biostimulative effects.
Several studies have shown that LLLT is capable of inducing a
photobiostimulatory cascade favoring cellular metabolism and
tissue repair. It provokes an anti-inflammatory effect in many
medical conditions. A Korean study suggested the efficacy of
phototherapy with LEDs for SS that is associated with other
facial dermatoses (11). In addition, LLLT has showed promise
in the treatment of chronic back pain and chronic myofascial
cervical pain and chronic back pain (12,13). Its efficacy may
be explained by the capability of LLLT of slowing neurological
transmission in the peripheral nerves (14). Other studies have
demonstrated its efficacy and high tolerability in the treatment
of chronic back pain.
Our study evaluates the efficacy and tolerability of red LEDs
for SS without any other associated facial dermatoses.
MATERIALS AND METHODS
This study was a pilot study. The participants were recruited
between June and August 2018 among outpatients from our
department of dermatology. The inclusion criteria were as
follows: subjects between 20 and 50 years of age, skin phototype
II or III, SS-10 score 40, following one’s understanding of the
instructions, and written consent. The exclusion criteria were
as follows: subjects with a facial dermatosis (e.g., acne, rosacea,
seborrheic dermatitis) with a known neurological or psychiatric
disease or receiving a photosensitizing, analgesic, psychiatric or
neurological medication or pregnancy. The cut-off for sensitive
skin on the SS-10 score is not consensual. In a previous study
including 2,966 subjects with SS, the mean SS-10 was 37/100 and
a score>40 represented about 40% of the population with SS skin.
A score superior to 40 was correlated to a DLQI of five or more
in a previous study, which corresponds to a moderate effect on
quality of life (6).
The trial was registered on ClinicalTrials.gov, with the title
“Study of the Efficacy and Tolerance of Light Therapy in Sensitive
Skin” (SENSILED) and the identifier NCT03279003. The study
protocol was approved by the Jurisdictional Ethics Committee
(Comité de Protection des Personnes Sud-Ouest et Outre Mer,
France). Written consent was obtained from all participants.
Procedure
During the inclusion visit, the participants completed a
questionnaire about SS that included questions regarding the
following: the sensitivity of the skin, the facial SS symptom
frequency, the duration of SS, suspected triggering factors of SS,
the localization of SS on the face, the use of products dedicated
to SS, and the impact of SS on cosmetic product use. Then,
the participants completed the validated questionnaire on a
sensitive skin scale named the SS-10 (6). The 10 items were skin
irritability, stinging, burning, sensation of heat, tautness, itching,
pain, general discomfort, flushes and redness, in the past 3 days.
The total score ranges from 0 to 100. We considered a 60%
reduction of the initial SS-10 score to be clinically significant.
The protocol for each treatment session was performed twice
a week and consisted of facial cleansing by using cotton gauze
filled with Tolerance Extreme R
cleansing lotion (Laboratoires
Dermatologiques Avène, Boulogne-Billancourt, France) and a
3 min session of perpendicular red LED light exposure on
the cheeks, with a fluence of 7 J/cm2and at a distance of
10 centimeters from the cheek. The red LED source used in
this study was an Aktilite CL128 lamp (Galderma, Lausanne,
Switzerland), which is typically used for photodynamic therapy
(PDT) in different indications in dermatology, including the
treatment of actinic keratoses. This LED source uniformly emits
a narrow spectrum of non-polarized and non-pulsed red light
of 630 nm with a modifiable fluence. Sessions were stopped
when the subject achieved a 60% reduction in his initial SS-10
score within a maximum of 8 weeks of treatment. As soon as
this endpoint was reached, the sessions were stopped. Goggles
were worn to protect the retina from direct illumination. The
SS-10 score was evaluated at every other session and then
at 2 months after the end of the sessions. Participants were
asked not to apply any product on the face during the study
duration without permission to avoid any possible influence
on the results. No particular discussion or recommendation
was made to patients on skin hygiene or topical products
to use.
Objectives and Outcomes
Our objective was to obtain preliminary data on the effectiveness
of phototherapy with LEDs in alleviating SS symptoms and
improving tolerance. The primary outcome was defined as a
decrease of 60% in the initial SS-10 score within 8 weeks,
which was the criteria to stop the LED sessions. The secondary
outcomes were the evaluation of pain and itch (extracted from
the SS-10 questionnaire) and the tolerance of treatment.
Frontiers in Medicine | www.frontiersin.org 2February 2020 | Volume 7 | Article 35
Sonbol et al. Light-Emitting Diodes for Sensitive Skin
FIGURE 1 | Flow chart.
Statistical Analysis
The frequency of subjects who achieved the primary endpoint
was estimated with exact 95% confidence intervals given
by the Clopper-Pearson method based on a binomial
distribution. All subjects were included in the analysis,
regardless of their adherence to the protocol, according
to the intention-to-treat principle. Subjects who withdrew
prematurely before achieving the primary endpoint were
analyzed as a failure. For this pilot study, we decided to include
30 subjects.
RESULTS
Thirty participants were enrolled in the study. Two participants
were considered lost to follow-up, one after day 0 (the subject
received one session of treatment) and the other after day
21 (the subject received six sessions of treatment; Figure 1).
The participants’ characteristics are shown in Table 1. The
localizations of SS is presented in Figure 2, and the triggering
factors are presented in Figure 3. Concerning the intensity of the
different items of the SS-10 at inclusion, the mean (SD) of each
symptom (scale from 0 to 10) were as follows: skin irritability
6.2 (1.3), stinging 5.4 (1.9), burning 4.9 (3.1), sensation of heat
5.2 (2.7), tautness 7.2 (1.5), pain 2.6 (2.7), general discomfort
6.7 (2.0), flushes 4.3 (3.5), and redness 6.8 (1.9). Concerning
secondary endpoints, itching was at 5.5 (2.6) at the beginning,
1.3 (1.2) at the last session, and 0.9 (1.0) at the last visit. Pain was
at 2.6 (2.7) at the beginning, 0.3 (0.6) at the last session, and 0.1
(0.3) at the last visit.
For the 28 participants of the 30 that were included, the
LED therapy was efficient with a SS-10 score reduction of
more than 60% between the inclusion visit and the last session.
In the intention-to-treat analysis, the frequency of significant
reduction in SS-10 was 93.3% (95% CI 77.9 to 99.1%). The
progression of the SS-10 score is presented in Table 2. The
primary outcome was achieved in 77% of subjects in six sessions
or fewer. The Figure 4 represents the evolution of SS-10 score
for each subject. The number of sessions was two at a minimum
and eight sessions at a maximum. Two benign side effects were
TABLE 1 | Participants’ characteristics.
N=30
Sex Male 5 (16.7%)
Female 25 (83.3%)
Age Mean (SD) 28.9 (6.2)
Median (Q1–Q3) 29.5 (24–33)
Min-max 20–40
Initial SS-10 score Mean (SD) 54.7 (12.1)
Median (Q1–Q3) 53.5 (45–61)
Min-max 40–85
Skin type Very sensitive 9 (30.0%)
Fairly sensitive 15 (50.0%)
Slightly sensitive 6 (20%)
Not sensitive 0
Frequency of SS symptoms of
the face
Constantly 9 (30.0%)
Frequently 21 (70.0%)
Rarely 0
Never 0
Duration of SS More than 10 years 15 (50.0%)
5–10 years 8 (26.7%)
3–5 years 5 (16.7%)
1–3 years 2 (6.7%)
6 months to 1 year 0 (0%)
<6 months 0 (0%)
Impact on the use of cosmetics
since the appearance of SS
Use of more cosmetics 6 (20.0%)
Use of less cosmetics 16 (53.3%)
Use of well-adapted products 23 (76.7%)
Increase of budget for
cosmetics
16 (53.3%)
No impact on cosmetic
consumption
4 (13.3%)
Utilization of dedicated products
for SS
Cleansing products 26 (86.7%)
Skin care products 26 (86.7%)
Makeup products 9 (30.0%)
Sunscreen 22 (73.3%)
reported: both were allergic reactions to the nickel contained in
the goggles.
DISCUSSION
The results of this pilot study suggest that the red LED therapy
is associated with a significant decrease in facial SS symptoms
quantified by the reduction in the initial SS-10 score by a
minimum of 60%. This reduction occurred in 77% of subjects in
six sessions or fewer, which is less than what we expected at the
beginning of the study (a maximum of 16 sessions was planned).
The subjects were delighted with the rapid treatment results
without any side effects and that the treatment did not involve
any topically applied, synthesized chemical, or oral medication.
The effectiveness persisted over time; indeed, the mean SS-10
score was lower 2 months after the last visit compared to the
last visit.
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Sonbol et al. Light-Emitting Diodes for Sensitive Skin
The validated SS-10 allowed us to attempt to objectively
quantify the efficacy of the offered treatment for this subjective
syndrome. We decided to include subjects between 20 and
50 years of age because it is the most prevalent SS age
group and we wanted to have a more homogeneous group
(15). Despite the frequency of SS, there is not yet an
available therapeutic option that relieves symptoms other
than dedicated cosmetic products that have transitory and
mediocre results.
Several studies have demonstrated that low-level light therapy
is capable of inducing a photobiostimulatory cascade favoring
cellular metabolism and tissue repair (16,17). Moreover, it
has an anti-inflammatory effect in medical conditions such as
arthritis (18). This method of treatment is a non-traumatic
and non-thermal phototherapy, which can explain its high
tolerability compared to other methods of phototherapy (ablative
FIGURE 2 | Localization of SS on the face.
and non-ablative thermal laser), which frequently induce
pain during and after treatment sessions with sometimes
considerable downtime (due to erythema, peeling, crusting,
and viral, or bacterial infections). LED is classified as an
LLLT source. LLLT causes an anti-inflammatory effect called
photobiomodulation, which stimulates collagen and elastic
fiber synthesis by activating fibroblasts. Increases in the tissue
inhibitor of metalloproteinases -1 and -2, as well as the mRNA
levels of IL-1ß, TNF-α, ICAM-1, and Cx43 have been observed.
Reduction of the VEGF levels produced by irritated keratinocytes
following LLLT has been reported. This cytokine is increased
in the epidermis in many inflammatory dermatoses, such as
psoriasis, rosacea, contact dermatitis, and atopic dermatitis.
It is thought that this molecule could be responsible for the
hyperpermeability that results in the marked erythema of these
dermatoses (10).
There is increasing evidence for the involvement of nerve
endings in SS, which should be considered as a small-fiber
neuropathy (19,20). Consequently, the length of altered nerve
endings is decreased. Red and near-infrared LEDs have been
shown to accelerate neurite growth of neurons from the
dorsal-root ganglia (21) and to affect neurons by upregulating
cytochrome c oxidase (22).
TABLE 2 | Progression of the SS-10 score.
At inclusion Last session 2 months after
the last visit
Mean (SD) 54.7 (12.1) 14.4 (6.0) 13.9 (7.5)
Median
(Q1–Q3)
53.5
(45.0–61.0)
14.0 (10.5–18.0) 11.5 (8.0–18.5)
Min-max 40.0–85.0 2.0–29.0 3.0–30.0
FIGURE 3 | Triggering factors of SS.
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Sonbol et al. Light-Emitting Diodes for Sensitive Skin
FIGURE 4 | SS-10 score according to the number of LED sessions for each patient.
A Korean study has suggested the efficacy of the Bioptron R
lamp, which emits polarized polychromatic light in the visible
and infrared range (480–3,400 nm) for alleviating SS symptoms
associated with other facial dermatoses (acne, rosacea and contact
dermatitis) (11). However, the definition of SS was not precise,
and patients presented with SS associated with dermatosis, which
probably influenced the results. Moreover, the light source used
in that study is different from the one that we used (ours
was quasi-monochromatic with a non-polarized and non-pulsed
narrow spectrum of 630 nm).
Phototherapy with LEDs is considered to be non-thermal
and non-traumatic, which stimulates various cellular functions
and activities through photobiomodulation, which is a process
by which the incident photons are absorbed by certain
chromophores to modulate several cellular functions (10).
Furthermore, the Aktilite CL128 lamp is available in the majority
of dermatology departments and numerous private practices
given its uses, such as in the treatment of actinic keratoses,
superficial basal cell carcinoma and other off-label utilizations,
such as in verruca vulgaris and post-pulsed dye laser sessions. To
the best of our knowledge, this is the first study to evaluate the
tolerability and efficacy of the Aktilite CL128 lamp and any other
LLLT sources with a narrow spectrum of 630 nm for alleviating
the symptoms of SS.
The main limitation of this study is the small sample
size without a control group. We decided to first conduct
a pilot study because the data in the literature are scarce.
The frequency of the sessions was irregular, which is often
encountered in phototherapy studies by virtue of the multiple
treatment sessions required to eventually obtain the results.
Despite this limitation, as in the cases of phototherapy with
UVB or PUVA, the prevailing factor in the evaluation of
phototherapy is the total number of treatment sessions rather
than the frequency, which is often tailored according to the
patients’ free time (23). Moreover, despite we recommended
to patients not to change the use of cosmetics products,
patients may have modified and/or reduced the use of topical
products which may have affected the study results. We
used for all patients the Tolerance Extreme cleansing lotion
to have the same protocol of cleaning, but this cosmetic
could have contributed to the improvement of the sensitivity
of the skin. These results are encouraging and motivate
us to perform a larger double-blind randomized placebo-
controlled trial.
DATA AVAILABILITY STATEMENT
The datasets generated for this study are available on request to
the corresponding author.
ETHICS STATEMENT
The study protocol was approved by the Jurisdictional Ethics
Committee (Comité de Protection des Personnes Sud-Ouest et
Outre Mer, France).
AUTHOR CONTRIBUTIONS
HS, EB, and LM contributed to the design and implementation of
the research. EN did the analysis of the results. HS and EB wrote
the paper. LM and EN read the paper.
ACKNOWLEDGMENTS
We thank the Laboratoires Dermatologiques Avène for providing
us with the Tolerance Extrême R
cleansing lotion.
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Sonbol et al. Light-Emitting Diodes for Sensitive Skin
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Conflict of Interest: HS and LM: Galderma.
The remaining authors declare that the research was conducted in the absence of
any commercial or financial relationships that could be construed as a potential
conflict of interest.
Copyright © 2020 Sonbol, Brenaut, Nowak and Misery. This is an open-access article
distributed under the terms of the Creative Commons Attribution License (CC BY).
The use, distribution or reproduction in other forums is permitted, provided the
original author(s) and the copyright owner(s) are credited and that the original
publication in this journal is cited, in accordance with accepted academic practice.
No use, distribution or reproduction is permitted which does not comply with these
terms.
Frontiers in Medicine | www.frontiersin.org 6February 2020 | Volume 7 | Article 35
... 78 The association of inhibitors of neurogenic inflammation might be valuable. 79 Alternatively, low level laser/light therapy 80,81 and botanical anti-inflammatories 82 have shown beneficial effects in sensitive skin. ...
... pressure ulcers. While in the study of Deen [14] report how More effective treatment of polarization in accelerating the healing of diabetic foot grade II ulcer from diode laser treatment [31][32][33][34][35][36][37][38][39]. ...
... pressure ulcers. While in the study of Deen [14] report how More effective treatment of polarization in accelerating the healing of diabetic foot grade II ulcer from diode laser treatment [31][32][33][34][35][36][37][38][39]. ...
... 78 The association of inhibitors of neurogenic inflammation might be valuable. 79 Alternatively, low level laser/light therapy 80,81 and botanical anti-inflammatories 82 have shown beneficial effects in sensitive skin. ...
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The special interest group on sensitive skin of the International Forum for the Study of Itch previously defined sensitive skin as a syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus and tingling sensations) in response to stimuli that normally should not provoke such sensations. This additional paper focuses on the pathophysiology and the management of sensitive skin. Sensitive skin is not an immunological disorder but is related to alterations of the skin nervous system. Skin barrier abnormalities are frequently associated, but there is no cause and direct relationship. Further studies are needed to better understand the pathophysiology of sensitive skin – as well as the inducing factors. Avoidance of possible triggering factors and the use of well‐tolerated cosmetics, especially those containing inhibitors of unpleasant sensations, might be suggested for patients with sensitive skin. The role of psychosocial factors, such as stress or negative expectations, might be relevant for subgroups of patients. To date, there is no clinical trial supporting the use of topical or systemic drugs in sensitive skin. The published data are not sufficient to reach a consensus on sensitive skin management. In general, patients with sensitive skin require a personalized approach, taking into account various biomedical, neural and psychosocial factors affecting sensitive skin.
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UV-based phototherapy (including psoralen plus UVA (PUVA), UVB and UVA1) has a long, successful history in the management of numerous cutaneous disorders. Photoresponsive diseases are etiologically diverse, but most involve disturbances in local (and occasionally systemic) inflammatory cells or abnormalities in keratinocytes that trigger inflammation. UV-based phototherapy works by regulating the inflammatory component and inducing apoptosis of pathogenic cells. This results in a fascinating and complex network of simultaneous events–immediate transcriptional changes in keratinocytes, immune cells, and pigment cells; the emergence of apoptotic bodies; and the trafficking of antigen-presenting cells in skin—that quickly transform the microenvironment of UV-exposed skin. Molecular elements in this system of UV recognition and response include chromophores, metabolic byproducts, innate immune receptors, neurotransmitters and mediators such as chemokines and cytokines, antimicrobial peptides, and platelet activating factor (PAF) and PAF-like molecules that simultaneously shape the immunomodulatory effects of UV and their interplay with the microbiota of the skin and beyond. Phototherapy's key effects—proapoptotic, immunomodulatory, antipruritic, antifibrotic, propigmentary, and pro-prebiotic—promote clinical improvement in various skin diseases such as psoriasis, atopic dermatitis (AD), graft-versus-host disease (GvHD), vitiligo, scleroderma, and polymorphic light eruption (PLE) as well as cutaneous T-cell lymphoma (CTCL). As understanding of phototherapy improves, new therapies (UV- and non-UV-based) are being developed that will utilize agonists and antagonists as well as antibodies targeting soluble molecules such as cytokines and chemokines, transcription factors, and a variety of membrane-associated receptors.
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Sensitive skin is a frequent complaint in the general population, patients, and among subjects with itch. The International Forum for the Study of Itch (IFSI) decided to initiate a special interest group (SIG) on sensitive skin. Using the Delphi method, sensitive skin was defined as "A syndrome defined by the occurrence of unpleasant sensations (stinging, burning, pain, pruritus, and tingling sensations) in response to stimuli that normally should not provoke such sensations. These unpleasant sensations cannot be explained by lesions attributable to any skin disease. The skin can appear normal or be accompanied by erythema. Sensitive skin can affect all body locations, especially the face". This paper summarizes the background, unresolved aspects of sensitive skin and the process of developing this definition.
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Sensitive skin is a clinical syndrome characterized by the occurrence of unpleasant sensations, such as pruritus, burning or pain, in response to various factors, including skincare products, water, cold, heat, or other physical and/or chemical factors. Although these symptoms suggest inflammation and the activation of peripheral innervation, the pathophysiogeny of sensitive skin remains unknown. We systematically analysed cutaneous biopsies from 50 healthy women with non-sensitive or sensitive skin and demonstrated that the intraepidermal nerve fibre density, especially that of peptidergic C-fibres, was lower in the sensitive skin group. These fibres are involved in pain, itching and temperature perception, and their degeneration may promote allodynia and similar symptoms. These results suggest that the pathophysiology of skin sensitivity resembles that of neuropathic pruritus within the context of small fibre neuropathy, and that environmental factors may alter skin innervation.
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Sensitive skin is common but until now there has been no scale for measuring its severity. The Sensitive Scale is a new scale with a 14-item and a 10-item version that was tested in 11 countries in different languages on 2,966 participants. The aim of this study was to validate the pertinence of using the Sensitive Scale to measure the severity of sensitive skin. The internal consistency was high. Correlations with the dry skin type, higher age, female gender, fair phototypes and Dermatology Life Quality Index were found. Using the 10-item version appeared to be preferable because it was quicker and easier to complete, with the same internal consistency and the 4 items that were excluded were very rarely observed in patients. The mean initial scores were around 44/140 and 37/100. The use of a cream for sensitive skin showed the pertinence of the scale before and after treatment.
Article
Background Sensitive skin syndrome (SSS) is defined as the occurrence of unpleasant sensations (itch, pain, burnings, prickling…) in response to stimuli that should not normally cause such sensations. Previous studies show that SSS could be a small‐fiber neuropathy but quantitative sensory testing (QST) is lacking. Objectives Using QST, the aim of the study was to determine the presence or absence of tactile sensitivity disorder, mainly heat‐pain threshold (HPT), in subjects with SSS. Neuropathic pain was assessed by two questionnaires: the DN4 and the Neuropathic Pain Symptom Inventory (NPSI). Methods This monocentric case‐control study included 21 subjects with SSS and 21 controls. The subjects underwent quantitative sensory testing. Neuropathic pain was assessed by two questionnaires: the DN4 and the Neuropathic Pain Symptom Inventory (NPSI). Results Forty‐two subjects were included in the study. The HPT was significantly lower in the cases (14.5+/‐2.8) than in the controls (17.8+/‐2.5) (p<0.001). Intermediate pain (HPT 5.0) was also significantly decreased in SSS. The DN4 and NPSI scores were significantly higher in the cases compared to the controls. Conclusion The decrease in HPT in subjects with SSS compared to controls suggests the presence of hyperalgesia, probably due to the damage of C‐fibers. These findings, as well as the increased DN4 and NPSI scores, strengthen the neuronal hypothesis of SSS and are new arguments for consideration of SSS as small fiber neuropathy. This article is protected by copyright. All rights reserved.
Article
Background: Many epidemiological studies have been performed, but a potential increase in the prevalence of sensitive skin as well as its relationship with age and skin type and the impact of sensitive skin on quality of life are still debated. Objective: TO ANSWER THESE UNRESOLVED QUESTIONS: METHODS: An opinion poll was conducted on a representative French 5000-person sample. Results: Fifty-nine percent of the people declared very sensitive or fairly sensitive skin (together: sensitive skin), and women (66%) declared sensitive skin more frequently than men (51.9%). The results also showed that sensitive skin is more common (more than 60%) in younger people (<35 years old), and there was a decrease in the following age groups. The univariate analysis demonstrated that sensitive skin was more likely to be reported by people with fair skin (OR=1.83) and by people with an atopic predisposition (OR=2.51). The risk of sensitive skin is higher for people with dry skin (OR= 6.18 compared with normal skin), but sensitive skin can occur in other skin types (OR=2.45 for mixed skin and OR=2.16 for greasy skin). Quality of life was clearly altered in patients with sensitive skin, as assessed by SF-12 and DLQI. Conclusion: This large study demonstrates that sensitive skin can alter quality of life and is more common in young people and in women as well as patients with dry skin or fair skin or an atopic predisposition. It also suggests that there is an increase in the prevalence of sensitive skin. This article is protected by copyright. All rights reserved.
Article
Background: Given the recent interest in light-emitting diode (LED) photomodulation and minimally invasive nonablative laser therapies, it is timely to investigate reports that low-level laser therapy (LLLT) may have utility in wound healing. Objectives: To critically evaluate reported in vitro models and in vivo animal and human studies and to assess the qualitative and quantitative sufficiency of evidence for the efficacy of LLLT in promoting wound healing. Method: Literature review, 1965 to 2003. Results: In examining the effects of LLLT on cell cultures in vitro, some articles report an increase in cell proliferation and collagen production using specific and somewhat arbitrary laser settings with the helium neon (HeNe) and gallium arsenide lasers, but none of the available studies address the mechanism, whether photothermal, photochemical, or photomechanical, whereby LLLT may be exerting its effect. Some studies, especially those using HeNe lasers, report improvements in surgical wound healing in a rodent model; however, these results have not been duplicated in animals such as pigs, which have skin that more closely resembles that of humans. In humans, beneficial effects on superficial wound healing found in small case series have not been replicated in larger studies. Conclusion: To better understand the utility of LLLT in cutaneous wound healing, good clinical studies that correlate cellular effects and biologic processes are needed. Future studies should be well-controlled investigations with rational selection of lasers and treatment parameters. In the absence of such studies, the literature does not appear to support widespread use of LLLT in wound healing at this time. Although applications of high-energy (10–100 W) lasers are well established with significant supportive literature and widespread use, conflicting studies in the literature have limited low-level laser therapy (LLLT) use in the United States to investigational use only. Yet LLLT is used clinically in many other areas, including Canada, Europe, and Asia, for the treatment of various neurologic, chiropractic, dental, and dermatologic disorders. To understand this discrepancy, it is useful to review the studies on LLLT that have, to date, precluded Food and Drug Administration approval of many such technologies in the United States. The fundamental question is whether there is sufficient evidence to support the use of LLLT.
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The effect of a 645 nm Light Emitting Diode (LED) light irradiation on the neurite growth velocity of adult Dorsal Root Ganglion (DRG) neurons with peripheral axon injury 4-10 days before plating and without previous injury was investigated. The real amount of light reaching the neurons was calculated by taking into account the optical characteristics of the light source and of media in the light path. The knowledge of these parameters is essential to be able to compare results of the literature and a way to reduce inconsistencies. We found that 4 min irradiation of a mean irradiance of 11.3 mW/cm(2) (corresponding to an actual irradiance reaching the neurons of 83 mW/cm(2) ) induced a 1.6-fold neurite growth acceleration on non-injured neurons and on axotomized neurons. Although the axotomized neurons were naturally already in a rapid regeneration process, an enhancement was found to occur while irradiating with the LED light, which may be promising for therapy applications. Dorsal Root Ganglion neurons (A) without previous injury and (B) subjected to a conditioning injury.
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Sensitive skin is a relatively common dermatologic condition and no optimal treatments have been established so far. Low-level laser/light therapy (LLLT) has been used for its biostimulative effect in various clinical settings. The purpose of this study was to investigate whether low-level laser/light therapy can improve sensitive skin clinically and to evaluate the effects of LLLT on skin in vitro. Twenty-eight patients complaining of sensitive skin were treated with low-level polarized light, and clinical results were evaluated using subjective and objective method. To investigate possible working mechanism of LLLT on skin, cultured human keratinocytes pretreated with nontoxic concentration of sodium lauryl sulfate (SLS) were used. Cytokines released from irritated keratinocytes after LLLT were analyzed. All patients showed subjective and objective improvement after treatment. No adverse effects were reported. The average number of LLLT sessions required to achieve clinical improvement was 9.9, and cumulative dose of LLLT was 71.3 J/cm(2) on the average. Erythema index decreased significantly after LLLT treatment (p = 0.017). In vitro assay showed that LLLT significantly reduced the release of VEGF from SLS-pretreated keratinocytes (p = 0.021). Our results suggest that LLLT could be a useful and safe treatment modality for sensitive skin, and modification of inflammatory cytokines released from irritated keratinocytes may be considered as one of plausible mechanisms in sensitive skin treated with LLLT.