The Branch of medical science that studies and deals with the diagnosis, treatment as well as prevention of diseases of skin, hair, nails, oral cavity and genitals is known as dermatology. Photo dermatology is the light therapy used to treat different types of skin diseases using exposure of specific wavelength of light using like using lasers which unlike ordinary light can be directed in specific wave length and its electromagnetic spectrum belong to infrared, visible and ultraviolet section other example light emitting diodes, fluorescent lamps etc. Photo dermatology uses the incident radiation as a source which is targeted on the skin using skin optical devise and there is absorption of these radiations inside the skin under certain mechanisms used depending on several applications used for the treatment. Due to which there are photochemical reactions in the skin as an outcomes there are cellular changes and thus desired clinical response are obtained. The Skin is made up of three layers the epidermis, the dermis and the subcutis .The outer layer whose prime function is to act like a barrier, made up of special squamous epithelial tissue. The immediate next layer to epidermis is the dermis which lies as the deeper part contains fibroblasts doing the function of synthesis of elastin, glycosaminoglycans and collagen; mast cells; macrophages; lymphocytes. Generally, it implies that energy is applied to the skin when it is exposed to any radiation source. So as to get the desired therapeutic and biological effect on the skin.
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The ultimate source of energy and light is the sunlight but excessive exposure to sunlight is hazardous to biological system. For all the human beings the accurate amount of sunlight needed varies depending on the presence of pathological photosensitivity, genetic factor and individual skin phenotype. For most of the individual a fair amount of sunlight is necessary for the synthesis of vitamin D and normal physiological well being. Whereas, otherwise depending upon the skin type exposure to excessive sunlight may lead to immunosuppresion, photoagaing, photo carcinogenesis, whereas few dermatologic patients' sunlight can be very harmful in further deteriorating the skin condition and being a key pathogen in inculcating various dermatology related diseases. All medical light is generated
when electrical energy is converted into photon energy. To obtain the desired focus, specific optical fibers or fluorophores are used. To focus on the target area lenses, mirrors and fibers are used. In this way, there are various medical lights used in dermatology like fluorescent lamps, Lasers, intense pulsed light, incandescent light, arc lamps etc. For the application of all the photo dynamic therapy (PDT) proper consideration of appropriate drug and light parameters to be given are very important factors in its protocol. In PDT, light and oxygen are activated in the presence of sufficient quantity of photo sensitizer, on which the entire photo dynamic reaction are dependent. The prodrug used in the mechanism should have high capability to distinguish between the target tissue and the healthy tissue. In Topical photo dynamic therapy the drug used should be able to penetrate inside the skin to the target tissue at the required depth in sufficient quantity.
Similar to PDT other examples of photo dermatology procedure are like, deep penetrating light treatment (DPLT) using Light Emitting Diode is useful in the treatment of acne, wrinkle reduction, wound healing, and pain reduction. Ultra Violet (UV) radiation is also used for the treatment of eczema, rickets, and psoriasis however this is done under the clever supervision of the photo dermatologist as excessive exposure of UV radiation leads to erythema or more familiarly known as sunburns when there is acute effect of skin reddening due to sunlight. Comparatively, the individual with the darker skin are less prone than the individual with fairer skin to sunburns or erythema. Narrow band photo light therapy and PUVA are also some of the techniques used to treat various skin disorders.
Skin is a wonderful complex organ that performs very important functions that keeps the inside in and the outside out. As it protects against the damage from UV radiations, then the loss of essential body fluid is prevented, it guards against the entry of microorganisms and toxic environmental chemicals and protects us. Exhibits various immunological functions. It helps in the synthesis of vitamin D and regulates body temperature also it is important in sexual attraction and social interaction. It's easy to judge its importance due to the various functions it performs; however each individual has different skin types and accordingly the level of sensitivity varies. Due to which few people face different types of skin related diseases. Dermatology studies it and dermatologist have come up with very useful treatment of various diseases, few of which are treated in the combination of light and drug, antibiotics or medicated creams. Primarily, the diagnosis of dermatological diseases is done by using description and classification of skin disease.
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The steps in the process of identifying skin diseases consist of taking a history like duration and onset, nature of symptoms, fluctuation, significant allergies, diabetes and TB, past skin problem, family history, occupation and hobbies; then the patient is examined where the Site and/or distribution of the problem is checked then the characteristics of individual lesion is studied thirdly examination of secondary sites like if the nails are in psoriasis, the fingers and wrist in scabies the toe web fungal infections; is done finally the effective special techniques that can be used are thought of carefully; later whenever necessary investigations such as blood tests to test for the types of infections are done; For example, wood's light technique which is a nickel oxide-filtered ultraviolet light source used to highlight the features of the skin having organisms responsible for erythrasma coral-pink. Some pigmentry disorders as also traced using wood's light technique as it produces green fluorescence in the presence of certain organisms which cause scalp ring-worm; also as the part of detail investigation in some cases even skin biopsy is performed to confirm the clinical diagnosis before proceeding with the treatment .This is usually done by punch biopsy or the excisional/incional biopsy are done. Special investigation also includes patch tests, were contact allergies are suspected, once all the above procedures and required management are carried out then the treatment to the patient with respective type of skin disease is started.
There are different types of skin diseases found due to various types of bacterial, viral, fungal, Ectoparasite infections. Others such as Acne, Acneiform Eruption and Rosacea, Eczema, Pruritus, Psoriasis, Benign and Malignant Skin tumors, Naevi; different types of disorders of the Hair, Nails, Inherited, Pigmentry, vascular, connective tissue, Bullous, Papulosqamous and Miscellaneous Erythematous disorders; cutaneous drug reactions light-induced skin diseases. Photo dermatology terms it as light sensitive disorders. Even the treatment in most places is first examined and classified on phototesting, which is the complex technique available only at few places nationally, as sunlight caused skin diseases like actinic prurigo, cuteneous porphyria, xeroderma pigmentosum, polymorphic light eruption; and the other class in which other range of light therapy are used to treat patients with psoriasis, polymorphic light eruption, eczema, vitiligo with ultraviolet light. And under investigation and examination the ABCDE technique is used to determine the lesion, where A= Asymmetry; B= Border irregularity; C= Color variation; D=Diameter (>6mm); E= Elevation. And according to the World Health Organization the most dangerous long-term effect on the skin of UV radiation is found to be Skin cancer, due to the development of melanoma. And the HARMM technique is used to associated to Malignant Melanoma, where H= History of previous melanoma; A=Age>50; R=Regular dermatologist absent; M= Mole changing; M=Male gender.
Human skin is a sensitive organ. And light is nothing but a photon and when we term any light source ,like laser or fluorescent we are actually describing the method in which light source is produced. Skin does not care how the light was produced but it treats all light as photon energy delivered to it with certain quality and quantity which determines the light sources emission spectra. The surface of the skin is two dimensional. This makes it mandatory to measure the radiation or the light falling on the skin in terms of power density or energy per unit area. When the light falls on the skin there are photo biological reactions due to diverse light-dependent reactions. Once following the steps of examination of the individual skin types, and from the reaction it can be traced if particular light with certain wavelength and quality can be used in the treatment of the skin or is the result that is causing certain skin disease. In Most of the treatment procedures in Photo dermatology, different laser which is light source with specific wavelength usually with application of some base is used. These are the mixtures of various components, fundamentally formulated to provide freedom from microbial contamination in the skin and enhance stability. Now this Base includes ointments, gels, pastes, lotions, creams, oily creams. The preference of any particular type of base required is mainly determined by the type of skin problem along with careful consideration of any other type of side effects due to the use of that respective type of base. For example as ointment or an oily cream are more suitable than using a lotion as an appropriate base for the treatment of ichthyotic skin. This is basically known as topical medication. Whereas most of the non-topical medication is done taking pills into the mouth at particular time of the day. In Photo dermatology technique using Laser which is the Light Amplification by the Stimulated emission of radiation is implemented most of the time which in itself defines its technology. As they act as the source of high intensity light that can be accurately focused into right spots which are high in energy with having properties which are coherent, collimated and monochromatic. Laser Treatment is basically used to destroy the diseased tissue with the heat so it's a kind of burning process so sometime few effects like brown or white marks which may be permanent, rarely scarring may occur, reactivation of infection like herpes simplex, redness, bruising or temporary pain may occur. So for treating different types of skin diseases laser having different light sources such as CO2, argon, Krypton, yellow light lasers, red light lasers, Quality-Switched or QS ruby, Pulsed dye laser (PDL), copper vapour, copper bromide etc are used so in this way the laser types are named after the type of material used whose atoms are excited to produce that energy in the form of Laser. Usually the clinical application of the laser type is determined considering factors such as the wavelength, targeted tissue absorption of that light source and pulsed duration.
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A variety of vascular lesions including superficial vascular malformations are successfully treated with the lasers. However non-laser devises which are intense pulsed light is also used to treat vascular lesions. High energy, melanin specific quality switched laser can successfully remove various pigmented lesions. Also it is found that in reducing acne, sun damaged skin, facial wrinkles pulsed CO2 laser have been successful.
In many Hospitals today like Ninewells hospital, Dundee, U.K, with the broad study dermatologist have tried to make their best possible efforts to produce remote size laser treatment equipment which is portable. They are very easy and simple to be used by any patients as due to the application of suitable ointment for example like levulan, kerastick topical solution is applied so that it is absorbed by the targeted cells so the absorption of the desired laser light to treat the skin disease is the process as once the effect of the ointment is completed due to the application of laser the suitable targeted skin layer may produce a glow or fluoresces in the dark as one of the indication of the effectiveness of the entire portable device. As this technique is used by the patients who unlike have to visit to the dermatologist repeatedly for the treatment , in this case there is suitable type of ointment provided which is to be applied to the right spot in right quantity and the is a small equipment with the laser source to placed using strap which is to be tied up in the limbs, however though portable these smaller version equipments are restricted in their usage only to the limited portions of the body ,However these are useful to in the ways of avoided repeated visits to the dermatology , also the patient can easily move and perform their work.
The duration of treatment and the type of laser vary as in case of skin treatment of acne non-ablative laser are used as compared to ablative types as they are far more gentle. This can take about 20 minutes depending upon the area and the type of skin having acne. In this process as the laser hits the skin the patients feels the stinging effect sensation on the skin. So in order to reduce or dull this sensation on the skin mostly pre-treatment anesthetic ointment are applied. Also the prescription of ointment is considered as a combination therapy and these ointments have retinoid a synthetic derivative of vitamin A or it may include antibiotics. So as to really notice the difference in the patients' skin, few sessions are needed. And the cost of treatment will be substantial considering the expertise of the respective dermatologist specialized in laser for treating several skin diseases. As usually in most of the photo dermatology with few sessions there are many skin disease which have shown successful outcomes as they completely disappeared with proper care and precautions.
All types of laser leave some post treatment effects. So in photo dermatology using Laser treatment post operative care is very important to be handled with proper measures. As in case of, after the application of 585-nm pulsed dye laser in the treatment of vascular lesion it is observed to have purpuria accompanied by hyperameria; in tissue cell extra fluid accommodation; reddening of skin due to widening of tiny blood vessels close to the surface of the skin due to the use of krypton, copper vapour, argon dye lasers. So in these cases after the application of laser treatment as a restorative measure would combine methods like using ointments of topical antibiotics for about 10 days; using only soothing, gentle soap like cetaphil or citricx correction cream wash daily on healing spot; and also try to guard skin against the sunlight. Similarly after the laser treatment pigmented lesions may turn purpuric or ash-white even in this case similar restorative methods are to be followed along with usage of sunscreen and bandages so as to protect the treated area against sunlight. The laser treatment performed for the treatment of hypertropic scars, lentigines, tattoos the targeted skin areas are highly sensitive so in such cases a restorative measures would include using ice very hour to avoid any swelling; avoid sports like swimming or other contact sport up to the complete healing time; it is usually prescribed to use the sunscreen of minimum SPF of 15 to prevent sunburns; in case of short term irritation it is advised to apply acetaminophen; avoid aspirin based drug during the complete healing process; using bactroban ointment, polysporin on the corrected spots. Cutaneous Laser treatment include many restorative measures like avoiding application of topical antibiotics, personal care products or any cosmetics as it may lead to allergies or irritation on the corrected spots; regularly taking the prescribed doses; taking antibiotics like streptococcus and staphylococcus, using non-narcotic pain relievers and using anti-inflammatory medications like acetaminophen; avoiding exposure to sunlight by using sunscreen or banucci sun block masks; In order to speed up the healing process using curative ointments regularly like catrix-10, aquaphor regularly to ensure hydration of corrected area. And after these restorative measures usually most of the patients are advised for the follow-up visit to the respective dermatologist for complete care of the treated area and to avoid any side effects.
All Laser treatment has usually the same set of side-effects. Side effects are encountered more frequently in association with topical steroid use. Side effects only occur due to heat, spreading beyond the targeted spots towards the nearby tissues. However selective photothermolysis, which are some of the current techniques which are capable of accurately targeting the desired spots. Compared to pulsed lasers, continuous wave lasers target less accurately which generally causes side effects. Depending upon the skin types and steroids used usually, side effects resulting from percutenous absorption can be classified as local, seen at the area of the application of steroids, systemic. Whereas under laser irradiation for vascular specific treatment the most common side effect due to crusting is hyperpigmentation. Epidermal melanin absorbing laser source causes hypopigmentation where pulsed laser is used and there is increased melanin absorption, but these are less common. Due to these skin texture changes. Skin pigmentation is the most common side effect seen in the pigment specific laser treatments, where continuous wave pulse is used.
Photo dermatology along with several uses in treating various skin types. Is also considered best in terms for those individuals who wish to avoid messy body lotion and are tired of taking regular pills as medication .For example with the approval of FDA Blue-light therapy works best for acne. As Blue light has narrow-band, high intensity. It helps in killing the acne producing bacteria propionibacterium acnes and also were other acne treating therapies have failed such as in acne vulgaris using Blue light therapy. This is given to the patients in regular sessions. There are mild effects such as dryness, pigment changes and swelling of treated areas. Other includes using repeated sessions of UVB photo therapy which is a whole body irradiation where the patient stands, undressed in special cabinet designed which helps to give short wave ultraviolet radiation mostly narrow band Ultraviolet B with 311nm is provided and psoriasis, vitiligo, T-cell lymphoma, itch,prurigo is best treated with this. However with prescribed care these can be handled. All the Technicians, nurses and Doctors using Photo therapy have to be well trained in the administration of photo therapy and the diagnosis of photodermatoses.