Photobiomodulation (PBM) through lasers, also called Low-Level Laser Therapy (LLLT), is a rapidly growing treatment modality that finds its application in treating various musculoskeletal conditions and is noted for its analgesic and anti-inflammatory effects, including accelerated wound healing, tissue repair, and cellular growth. Lasers have been tested for their efficacy in the treatment of burns and burn scars with largely positive results. Laser Therapy may result in opening new doors to therapeutic treatment for injuries related to burns.
Laser Therapy and Burns
According to WHO, burn injuries are a huge healthcare burden as they affect around 6 million people worldwide each year and are the cause of 180,000 deaths annually. Moreover, non-fatal burns might result in scar formation and other serious deformities, which can lead to psychosocial damage. Various complexities arise with non-healing burn wounds, which have led the medical world to look for alternative treatments. In this context, LLLT has been shown to improve symptoms associated with burns, help restore functionality, and even minimize burns scars.[1] Studies have also shown that LLLT upregulates cellular metabolic processes and enhances the regenerative capacity of injured tissues.[2]
Why Do Lasers Work for Burn Injuries?
Photobiomodulation via Lasers has been found to be highly effective in treating injuries and wounds of various kinds. It is known to enhance wound repair, mitigate inflammation, restore cellular function, and reduce pain.[3] Studies have reported that the prime reason why Laser is effective for burns is that it upregulates the production of TGF-β1, a cellular protein that plays a key role in wound epithelization and promotion of cellular proliferation and migration.[4]
Photoactivation of TGF-β1 and Healing of Burns
TGF-β1, or transforming growth factor beta 1, is an protein that performs a series of important functions, including cell growth and proliferation. Physicochemical activation plays a key role in regulating TGF-β1’s pathophysiological activity since they are secreted as latent complexes.[5] Studies have demonstrated that low-level lasers can activate latent TGF-β1, which suggests that photoactivated TGF-β1 stimulates healing and improves wound contraction.[6] [7]
Why Laser Therapy?
The management of burn-related injuries and scars is typically carried out by surgical and pharmacological intervention, which may result in discomfort, pain, inflammation, and even dependence, in the case of medicines. LLLT is not only an FDA-cleared treatment for the management of pain and inflammation with substantial clinical evidence, but it is also a non-invasive, non-pharmacological, and side-effect-free treatment. Apart from its role in activating transforming growth factor beta-1, here are some of the other reasons why photobiomodulation works for burns and burn scars.
- PBM can signal transient myofibroblast transformation, which actively mediates burn wound healing.[8]
- Laser Therapy accelerates macrophage migration which plays a key role in wound clearance.[9] [10]
- PBM treatments downregulate inflammatory response in burn wounds.[11]
Research on the Efficacy of Lasers for Burns
Several studies have been conducted to determine the efficacy of lasers for burns and burn-related injuries.[12] [13] One such study involved 10 minute exposure to lasers on 3rd-degree burn wounds in rats.[14] As a result, various healing markers were observed, including attenuated inflammatory response, enhanced cellular proliferation, collagen accumulation, and wound contraction. Another study investigated the effects of Laser on the epidermal healing of burns.[15] After 7 days of treatment, the subjects (rats) showed a reduced inflammatory response, decreased dermal necrosis, and enhanced granulation tissue formation, resulting in accelerated burn wound repair.
Laser Therapy and Burn Scars
Burn-related injuries often result in the development of hypertrophic scars. These scars aren’t just a cosmetic concern, they can also result in pain and impaired mobility. In this case, LLLT has been tested due to its non-invasive, non-pharmacological nature to heal burn scars. Laser Therapy is shown to decrease scar thickness and pain, improve overall functionality, and enhance scar pigmentation.[16] One systematic review included fifty-one studies and trials that investigated the efficacy of Laser Therapy for burn scars.[17] The analysis showed that LLLT can improve the appearance of scars, including improved pigmentation and thickness.
The efficacy of Laser Therapy in the treatment of pain and wounds associated with burns has been documented in several clinical trials and research papers. The mechanism of action of PBM through Lasers is clear as it activates TGF-β1, reduces inflammation and pain, and enables tissue regeneration. Check out Berman Partners’ collection of FDA-cleared, customizable Laser Devices if you want to get your hands on a side effect-free, non-invasive, and non-pharmacological therapy. Our mission is to bring reliable Laser and Light Therapy products to healthcare practitioners and consumers. If you have any questions, don’t hesitate to contact us, and we would be more than happy to help.
References
[1] Silveira PC, Ferreira KB, da Rocha FR, Pieri BL, Pedroso GS, De Souza CT, Nesi RT, Pinho RA. Effect of Low-Power Laser (LPL) and Light-Emitting Diode (LED) on Inflammatory Response in Burn Wound Healing. Inflammation. 2016 Aug;39(4):1395-404. doi: 10.1007/s10753-016-0371-x. PMID: 27206919.
[2] Bihari, I. “The biostimulative effect of low level laser therapy of long-standing crural ulcers using helium neon laser, helium neon plus infrared lasers, and noncoherent light.” Laser therapy 1 (1989): 75-78.
[3] Chung H, Dai T, Sharma SK, Huang YY, Carroll JD, Hamblin MR. The nuts and bolts of low-level laser (light) therapy. Ann Biomed Eng. 2012 Feb;40(2):516-33. doi: 10.1007/s10439-011-0454-7. Epub 2011 Nov 2. PMID: 22045511; PMCID: PMC3288797.
[4] Ramirez, Horacio, Shailee B. Patel, and Irena Pastar. “The role of TGFβ signaling in wound epithelialization.” Advances in wound care 3.7 (2014): 482-491.
[5] Aluwihare P, Mu Z, Zhao Z, Yu D, Weinreb PH, Horan GS, Violette SM, Munger JS. Mice that lack activity of alphavbeta6- and alphavbeta8-integrins reproduce the abnormalities of Tgfb1- and Tgfb3-null mice. J Cell Sci. 2009 Jan 15;122(Pt 2):227-32. doi: 10.1242/jcs.035246. PMID: 19118215; PMCID: PMC2714418.
[6] Arany PR, Nayak RS, Hallikerimath S, Limaye AM, Kale AD, Kondaiah P. Activation of latent TGF-beta1 by low-power laser in vitro correlates with increased TGF-beta1 levels in laser-enhanced oral wound healing. Wound Repair Regen. 2007 Nov-Dec;15(6):866-74. doi: 10.1111/j.1524-475X.2007.00306.x. PMID: 18028135.
[7] Arany PR, Cho A, Hunt TD, Sidhu G, Shin K, Hahm E, Huang GX, Weaver J, Chen AC, Padwa BL, Hamblin MR, Barcellos-Hoff MH, Kulkarni AB, J Mooney D. Photoactivation of endogenous latent transforming growth factor-β1 directs dental stem cell differentiation for regeneration. Sci Transl Med. 2014 May 28;6(238):238ra69. doi: 10.1126/scitranslmed.3008234. PMID: 24871130; PMCID: PMC4113395.
[8] Pourreau-Schneider N, Ahmed A, Soudry M, Jacquemier J, Kopp F, Franquin JC, Martin PM. Helium-neon laser treatment transforms fibroblasts into myofibroblasts. Am J Pathol. 1990 Jul;137(1):171-8. PMID: 2372040; PMCID: PMC1877706.
[9] Koh TJ, DiPietro LA. Inflammation and wound healing: the role of the macrophage. Expert Rev Mol Med. 2011 Jul 11;13:e23. doi: 10.1017/S1462399411001943. PMID: 21740602; PMCID: PMC3596046.
[10] Khan I, Rahman SU, Tang E, Engel K, Hall B, Kulkarni AB, Arany PR. Accelerated burn wound healing with photobiomodulation therapy involves activation of endogenous latent TGF-β1. Sci Rep. 2021 Jun 28;11(1):13371. doi: 10.1038/s41598-021-92650-w. Erratum in: Sci Rep. 2021 Aug 31;11(1):17706. PMID: 34183697; PMCID: PMC8238984.
[11] Hamblin MR. Mechanisms and applications of the anti-inflammatory effects of photobiomodulation. AIMS Biophys. 2017;4(3):337-361. doi: 10.3934/biophy.2017.3.337. Epub 2017 May 19. PMID: 28748217; PMCID: PMC5523874.
[12] Yadav A, Verma S, Keshri GK, Gupta A. Role of 904 nm superpulsed laser-mediated photobiomodulation on nitroxidative stress and redox homeostasis in burn wound healing. Photodermatol Photoimmunol Photomed. 2020 May;36(3):208-218. doi: 10.1111/phpp.12538. Epub 2020 Feb 18. PMID: 32027411.
[13] Yadav A, Gupta A, Keshri GK, Verma S, Sharma SK, Singh SB. Photobiomodulatory effects of superpulsed 904nm laser therapy on bioenergetics status in burn wound healing. J Photochem Photobiol B. 2016 Sep;162:77-85. doi: 10.1016/j.jphotobiol.2016.06.031. Epub 2016 Jun 23. PMID: 27344636.
[14] Gaurav K. Keshri, Gaurav Kumar, Manish Sharma, Kiran Bora, Bhuvnesh Kumar, Asheesh Gupta,
Photobiomodulation effects of pulsed-NIR laser (810 nm) and LED (808 ± 3 nm) with identical treatment regimen on burn wound healing: A quantitative label-free global proteomic approach, Journal of Photochemistry and Photobiology, Volume 6, 2021. https://doi.org/10.1016/j.jpap.2021.100024.
[15] Silveira PC, Ferreira KB, da Rocha FR, Pieri BL, Pedroso GS, De Souza CT, Nesi RT, Pinho RA. Effect of Low-Power Laser (LPL) and Light-Emitting Diode (LED) on Inflammatory Response in Burn Wound Healing. Inflammation. 2016 Aug;39(4):1395-404. doi: 10.1007/s10753-016-0371-x. PMID: 27206919.
[16] Fu X, Dong J, Wang S, Yan M, Yao M. Advances in the treatment of traumatic scars with laser, intense pulsed light, radiofrequency, and ultrasound. Burns Trauma. 2019 Jan 29;7:1. doi: 10.1186/s41038-018-0141-0. PMID: 30723753; PMCID: PMC6350396.
[17] Willows BM, Ilyas M, Sharma A. Laser in the management of burn scars. Burns. 2017 Nov;43(7):1379-1389. doi: 10.1016/j.burns.2017.07.001. Epub 2017 Aug 4. PMID: 28784339.
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