Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2017-021419 on 31 May 2018. Downloaded from Efficacy of phototherapy to treat facial ageing when using a red versus an amber LED: a protocol for a randomised controlled trial Lidiane Rocha Mota,1 Lara Jansiski Motta,1 Ivone da Silva Duarte,2 Anna Carolina Ratto Tempestini Horliana,1 Daniela de Fátima Teixeira da Silva,1 Christiane Pavani1 To cite: Rocha Mota L, ABSTRACT Strengths and limitations of this study Motta LJ, Duarte IdS, et al. Introduction The skin undergoes morphological and Efficacy of phototherapy to physiological changes with the advancing age of an ► Each woman participating in this study will be eval- treat facial ageing when using individual. These changes may be caused by intrinsic and a red versus an amber LED: uated before and after the treatment, and the reduc- extrinsic factors that contribute to cellular ageing and a protocol for a randomised tion in wrinkles will be measured. consequent skin ageing. The term photoageing is used controlled trial. BMJ Open ► There is no control or placebo group and all of the to characterise the ageing of the skin caused by solar 2018;8:e021419. doi:10.1136/ participants will be treated; in this sense, each par- radiation. Clinically, the skin becomes more flaccid, thicker bmjopen-2017-021419 ticipant is in both the treatment group and the con- and hyperpigmented, while there is an early appearance trol group. ► Prepublication history for of wrinkles and other skin changes, such as skin cancer. this paper is available online. ► This split-face study will eliminate the individu- Nowadays, there are numerous treatments for ageing skin, To view these files, please visit al factors of each participant that affect treatment and one of them is with the use of phototherapy, which the journal online (http:// dx. doi. outcomes. uses light-emitting diodes (LEDs). The objective of this org/ 10. 1136/ bmjopen- 2017- ► The VisioFace equipment will standardise the pa- study will be to evaluate the percentages of reduction in 021419). rameters in acquiring photographs, such as light the volume of periocular wrinkles when treated with red exposure, and it will minimise bias. Received 27 December 2017 and amber LEDs. ► The habits of the participants may affect the results, Revised 19 April 2018 Methods and analysis All of the participants will http://bmjopen.bmj.com/ as a consequence of their diet, their use of cosmet- Accepted 24 April 2018 receive photobiomodulation to treat their periocular ics and their exposure to the sun. wrinkles. They will be using red and amber LEDs, with one colour being used on each hemiface. The facial side to be treated with each colour will be randomised. After an interval of 180 days, the participants will receive a of an organism, presenting roles such as cross-treatment. The primary variable of the study is the defence, thermoregulation and sensory volume of periocular wrinkles (crow’s feet), which will awareness. Maintenance of healthy skin and be measured by a VisioFace equipment. The secondary 1 variables are elasticity (measured by Cutometer) and integrity is extremely important. Exposure on September 27, 2021 by guest. Protected copyright. hydration (measured by Corneometer). Quality of life and to the sun speeds up the intrinsic ageing of self-assessment of the participants will be measured the skin, due to the formation of free radi- using the adapted Melasma Quality of Life scale - Brazilian cals and reactive oxygen species, as a result of 1 Portuguese adaption (MelasQoL-BP) and Skindex-29 ultraviolet (UV) radiation. Once UVA radi- questionnaires. All of the variables will be measured before ation penetrates deeper into the dermis, the and after a group of 10 sessions. resulting oxidative stress causes damage to Ethics and dissemination This protocol was approved the elastin fibres and collagen. In addition, by the Research Ethics Committee of the Nove de Julho there may occur a decrement in physiological University (acceptance number: 2.550.732). This trial antioxidant reserves and/or in the protective 1 has been registered in the Registro Brasileiro de Ensaios Biophotonics Applied to Health capacity of the skin.2 The changes that are Clínicos (Brazilian Clinical Trials Registry) (REBEC number: Sciences Postgraduate Program, caused by ageing modify the physical proper- Universidade Nove de Julho RBR-6YFCBM). This study is not recruiting yet. (UNINOVE), Sao Paulo, Brazil Trial registration number RBR6YFCBM; Pre-results. ties of the skin, leaving visible signs such as 2Coordenação da Medicina, epidermal hyperplasia, irregular pigmenta- Faculdade de Pato Branco, tion, telangiectasia, sagging tissues, a reduc- Paraná, Paraná, Brazil tion of collagen and elastin fibres, as well as a Correspondence to INTRODUCTION decrement in the natural moisturising factor. Dr Christiane Pavani; The skin covers the body and has essential These changes result in the appearance of chrispavani@ gmail. com functions in maintaining the homeostasis expression lines and creases.3 4 Rocha Mota L, et al. BMJ Open 2018;8:e021419. doi:10.1136/bmjopen-2017-021419 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2017-021419 on 31 May 2018. Downloaded from Recent data from the Brazilian Institute of Geography which are all of extreme importance in the maintenance and Statistics (IBGE) have shown that the average life of the epidermis. Both of these wavelengths are absorbed expectancy of the Brazilian population has increased by cytochrome c oxidase; however, it is considered that the from 66 years in 1991 to 75 years in 2016. This is similar red light penetrates deeper into the skin than the amber to the increase that has been verified on worldwide popu- light due to the presence of melanin.24–26 Given this back- lation. The challenge faced by science in the last few years ground, this work will aim to evaluate the percentages has been the development of procedures and technolo- of reduction in the volume of periocular wrinkles when gies that aim to delay the signs of ageing and increase treated with red and amber LEDs. the quality of life of elderly people, by achieving a healthy skin.5 Nowadays, the procedures in use aim to promote a cosmetic benefit and an improvement in the quality of METHODS AND ANALYSIS the skin, increasing self-esteem, with a reduction in skin Study design infections. As a result, these procedures can contribute This will be a controlled, randomised, double-blind, split- to a longer and healthier life. Among the technologies face, cross-over and unicentric clinical trial. This protocol being used to promote skin repair are dermocosmetics, as has been written based on the guidelines of the Standard well as equipment such as radiofrequency, phototherapy Protocol Items: Recommendations for Interventional (intense pulsed light, laser and light-emitting diodes Trials (SPIRIT). The study will be performed in the 6–9 (LEDs)) and microneedles. ambulatory of the Nove de Julho University (UNINOVE), Phototherapy is a non-invasive procedure that has been São Paulo, Brazil. Dissemination and registration for 10 11 used for tissue repair and healing. The treatment participation in the study will be conducted through is based on the use of a light-emitting device, and the the UNINOVE website, and the recruited participants resulting photons are absorbed by the biological tissues, will mainly be residents of the city of São Paulo. The promoting photochemical, photophysical and photobi- participants will be informed about the research, proce- ological actions. Phototherapy is not ablative, nor does dures, risks and benefits, and they will sign the informed it promote thermal effects, since the devices that are consent form. Only those participants who have read and used in phototherapy are low-powered lasers and LEDs; have agreed to sign the informed consent form will be that is, there is no cutaneous damage and no need for included in the study. The study will last for 2 years, with 12 any recovery time. The LED devices are produced in a a start date of May 2018. The study is not recruiting yet. wide range of wavelengths, from UV through the visible After recruitment, the researcher will check if the to infrared spectrum (247–1300 nm). When compared patient meets the inclusion/exclusion criteria based on with laser, the LED devices have lower cost and have anamnesis and skin evaluation. Anamnesis is an interview being used in instruments that can illuminate larger performed by the health professional to know patients’ http://bmjopen.bmj.com/ surfaces. Studies have shown that LEDs can be used in medical and aesthetics treatment history, as well as daily 10 13 14 therapeutic procedures with excellent results. The personal and social habits, which may have an influence use of LEDs in clinical practice has increased significantly, on treatment outcome. Regarding the daily personal and and their main use has been in wound healing, tissue social habits, anamnesis will include information on sun repair and rejuvenation since they do not cause trauma exposure, smoking and drinking frequency, sleep quality, 15 or tissue destruction. Some findings have suggested dietary habits, water intake, professional aesthetics treat- that if suitable parameters are used, the light acts on skin ment on the face and homecare cosmetics use. Anam- regeneration by modulating cellular activity and collagen nesis was not validated since it is not an instrument to on September 27, 2021 by guest. Protected copyright. expression, with a decrease in matrix metalloprotein- measure patient outcome.27 Skin evaluation, which will 16 ases. Usually, the wavelengths are chosen by the func- be performed by a medical doctor (IdSD), includes skin tion that is needed for the purpose of the therapy. The phototype and degree of severity of the wrinkles. Patients wavelengths in the blue range (400–470 nm) are mainly will receive information on the importance of the use of 17 used in the treatment of acne.