Low-level Light Therapy for Treatment of Diabetic Foot Ulcer: A Review of Clinical Experiences

July 2016 | Volume 15 | Issue 7 | Original Article | 843 | Copyright © 2016

Catherine N. Tchanque-Fossuo MD MS,a,b,* Derek Ho BS,a,b,* Sara E. Dahle DPM MPH,b,c Eugene Koo MS,a R. Rivkah Isseroff MD,a,b and Jared Jagdeo MD MSa,b,d

aDermatology Service, Sacramento VA Medical Center, Mather, CA
bDepartment of Dermatology, University of California Davis, Sacramento, CA
cDepartment of Surgery, Podiatry Section, Sacramento VA Medical Center, Mather, CA
dDepartment of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
*These authors contributed equally to the preparation of this manuscript.

Abstract

BACKGROUND: Diabetic foot ulcers (DFU) represent a significant complication of diabetes mellitus (DM). DFU affect one in four patients with DM and treatments of DFU are limited and challenging. The management of DFU remains a significant healthcare and socioeconomic burden ($245 billion). There is a wide range of advanced therapies for DFU, but these are costly and have demonstrated only minimal efficacy in limited published studies. An emerging treatment modality to improve DFU and optimize wound healing is the use of low-level light therapy (LLLT). LLLT involves the use of light in the form of low-level or low-power laser or light emitting diodes to alter biochemical pathways, which may result in changes to cell shape, cell migration, and cell signaling.
OBJECTIVE: To review published clinical experiences (case series and case reports) using LLLT for treatment of DFU, and provide evidence-based recommendations and future directions on the potential of LLLT as a therapeutic modality for DFU.
METHODS AND MATERIALS: On January 16, 2016 we searched the published literature using databases: PubMed, EMBASE, CINAHL, and Web of Science with key terms: “diabetic foot” AND (“low level laser therapy” OR “low level light therapy” OR “LLLT” OR “light emitting diode” OR “phototherapy” OR “laser”).
RESULTS: After screening of titles, abstracts and/or full-text, 7 original articles were suitable in our review. Our review contains 5 case series and 2 case reports that evaluated LLLT for treatment of DFU, and all reviewed studies have shown positive improvement of DFU using LLLT with no adverse events, albeit with limitations that may be minimized with future RCTs.
CONCLUSIONS: LLLT is an emerging and promising treatment modality to current alternatives that are costly and have shown limited success. Based upon the published evidence, we envision additional research may allow for stronger recommendation with LLLT for treatment of DFU.

J Drugs Dermatol. 2016;15(7):843-848.

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INTRODUCTION

Diabetic foot ulcers (DFU) represent a significant complication of diabetes mellitus (DM).1,2 DFU affect one in four patients with DM and treatments of DFU are limited and challenging.1,2 Patients with DFU are at increased risk for complications such as infections and limb loss.3,4 Of note, the majority of non-traumatic lower extremity amputations are preceded by a DFU, which significantly impact the patients’ quality of life and result in higher mortality rate reaching that of cancer.4-8 As a result, the management of DFU remains a significant healthcare and socioeconomic burden as immense expenditures (upwards of $245 billion) are attributed to medical costs, loss of work, productivity, and decreased quality of life.5,9

Advanced therapies5 for the treatment of DFU include wound dressings, vacuum assisted devices10, hyperbaric oxygen,11 growth factors,12,13 bioengineered skin devices,10 and electrical stimulation.14 However, these advanced therapies are costly and have demonstrated only minimal efficacy in limited published studies, thus limiting recommendation and use.

An emerging treatment modality to improve DFU and optimize wound healing is the use of low-level light therapy (LLLT). LLLT originates in 1967 from the pioneering work of Mester, who discovered that low-level ruby laser radiation (1 J/cm2) applied on the shaved dorsum of mice did not result in cancer but rather hair growth.15-17 Mester advanced his research clinically on patients with cutaneous ulcerations and reported rapid healing of human skin ulcers following exposure with LLLT.18-20 Currently, LLLT has clinical applications in the field of dermatology, oncology, surgery, dentistry, acupuncture, and veterinary medicine with therapeutic outcome such as for treatment of nerve21,22 and muscle disorders,21 joint and back pain management,23-25 and chronic wound healing.26-28

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