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Gupta et al. Plast Aesthet Res 2018;5:41 I http://dx.doi.org/10.20517/2347-9264.2018.51 Page 5 of 7

proliferation thus the rate of collagen production and wound contraction are increased. However evidence
for its beneficial effects in human wounds is lacking. By decreasing the healing time of open wounds, LLLT
may reduce the risk of infection and other complications. LLLT also has positive effect over post burn
[6]
hypertrophic scars .
LLLT has a photobiomodulation effect over tissue; it has photochemical and photomechanical components
[8]
and no photothermal effect . A variety of mechanisms of action are proposed:
(1) photonic energy is converted to chemical energy within the cell and ATP generated;
(2) enzymes in the mitochondria may be activated or deactivated;
(3) DNA replication increases;
(4) increased DNA leads to increased neurotransmission;
(5) a cascade of metabolic effects result in various physiological changes, which result in improved tissue
[4,8]
repair, faster resolution of the inflammatory response, and reduction in pain .
The role of LLLT for promoting wound healing has long been studied, still there is insufficient literature
to design a standard treatment protocol [9-11] . Using LLL as an adjunct to conventional treatment of second
degree superficial burns is expected to decrease the time of healing, rate of infection, pain and overall cost
of treatment. In our experience we have found acceptable healing of wounds in target areas in all twenty
patients. But the observations are not sufficient to conclude that wound healing rates were higher compared
to conventional treatment alone. Wound swab culture came positive in five wounds. No effect over infection
could be concluded with the observations.

In the diabetic foot LLLT has been shown to have effect on all stages of wound healing by increasing
fibroblasts and keratinocyte proliferation, collagen synthesis, neoangiogenesis, improve microcirculation,
stimulate granulation tissue formation, cell growth and wound contraction, anti-edema and anti-
[12]
inflammatory action .

[13]
Van Breugel and Bar has found that the laser can either stimulate or inhibit human fibroblasts in vitro,
depending on exposure time and power density used. Therefore the configuration of LLL used for treatment
is important. We have observed effects of LLLT with 100 mW power output and 125 second exposure time,
2
delivering energy density of 4 J/cm . Twice weekly therapy regime was followed. This is as per the settings
[6]
used by Gaida et al. .
Effect of LLLT also depends on the physiological state of the tissue at the time of therapy. This explains the
[14]
variability of the results reported in the literature. Karu stated that light stimulates cell proliferation if the
cells are growing poorly at the time of irradiation. Thus, if a cell is fully functional, there is nothing for laser
[14]
irradiation to stimulate, and therefore no therapeutic benefit will be observed .
[15]
LLLT is a safe and cost effective treatment modality . We have not found any laser related adverse effect in
[8]
any patient. Hawkins et al. state that in the clinical situation, LLLT is an accepted, efficient, noninvasive,
and painless method of treating edema, inflammation, and pain.

Statistical analysis could not be performed because of less number of cases. No objective evidence of pain
relief was recorded. Collagen dressing used along with LLLT is identified as a confounding factor. This study
was a pilot study and despite its shortcomings it has promising results and provides a basis for larger studies.

In conclusion, LLLT can be used as an adjunct to the conventional treatment of second degree superficial