Joint publication in Laser Partner and Laser World 
(www.laser.nu/lllt/lllt_editorial.htm)

Ladislav Hanousek, M.D., Hradec Kralove, CZ

pediatricka.ord.l.hanousek@worldonline.cz

 

Abstract

The author draws upon his five-year experience in the use of a biostimulation laser (685nm/20mW) in his private paediatrics surgery, describing the most frequent applications, and dealing with economical as well as with some psychological aspects of laser practice. He has achieved best results in therapy of herpes, aphtae, relapsing tonsillitis and superficial injuries, stressing significant limitation of scarring in the course of this treatment. Finally, the author summarizes necessary time of laser treatment of individual applications.

 

Introduction

It should be mentioned at the very beginning that this brief paper will not deal with surgical lasers which are used to destruction of tissue in a way of incission, vaporization, or coagulation. On the contrary, biostimulation lasers work with much less intensive radiation and therefore they are usually called biostimulation, therapeutic, non-invasive, or soft lasers. Their beam do not damage tissue, but it has, on the other hand, effects stimulating metabolism and microcirculation. The character of radiation results in safe use in medicine of adults as well as of children.

It is not absolutely necessary to study radiobiology very thoroughly in order to be able to work with a biostimulation laser. I would like to underline in my paper especially the fact that even a GP, occupying himself mostly with differential diagnostics and treatment of everyday children out-patients, can be satisfied by the using of  a laser, even though he does not get down to the very point of theoretical physical rules of laser radiation, unless he has the right tendency to do so. It is obviously necessary, as it will be mentioned later, to clarify the relations between beam intensity and wavelength of our device, however these are quantities with  which we had purchased the laser, and we only decide on how long pathological skin or mucouse will be irradiated in order to healing effect be achieved.

No matter how complex the effects of the laser on biological tissue are, I always keep explaining parents the effects of laser saying that by utilizing strictly polarized light with a strictly defined wavelength it is possible for us to make the light penetrate in subcutaneous structures and, together with the photons, bring additional energy into the tissue, where it can be consumed by mitochondrias to produce energy necessary for the healing processes. And no matter how simplified this explanation may appear, it can help to understand not only the parents of our patients the effects.

 

Therapy

I have been working with a 20 milliwatt, 685 nanometers laser probe (universal for treatment of skin as well as subcutaneous structures) for five years. During this time I have used the laser in approximately four hundred patients, 1 - 20 times in each. I have been treating some fifteen diagnoses, and I would like to mention the most effective laser applications hereunder.

• Herpes simplex

Healing herpes, even if succesful, might hardly appear an application which could bring you fame with the parents. Though it is true, to a certain extent, those who suffer from this disease and whom you were able to help will praise you long and everywhere, and their relatives will be visiting you with a kind face if you can spent four minutes a day irradiating their lips. It can only be confirmed what scientific literature declares, that even one irradiation speeds up healing significantly, and moreover, that if you irradiate a herpes in four consecutive days for four minutes it will never appear on this place again. If you start applications in the time of the first papulose eruptions you can be sure that you eliminate pain and that the period of cosmetic inpleasant manifestations of the crusts on the lips can be cut from two weeks to a few days. The same applies to herpes zoster where patient`s benefit is even more significant from the analgesic point of view.

• Wound healing

This is a field where you can become a bit famous. I succeeded in healing up (shining up, as my patients say) suppurating non healing wounds which even surgeons had been at a loss with. By improving perfusion in closest surroundings of the wound and with biostimulation effect of laser beam you can support formation of granulations since the very beginning of the therapy, as well as closing even deep wounds from hypodermis up to the surface of the skin. Varicose ulcers do not appear in paediatrics, but I am sure that some of your relatives will appreciate your hands if you use a laser to treat them. I am not exagerrating, I have got my personal experience.

• Diminishing formation of scars after injuries

Using a laser in the treatment of dermatological injuries is very useful. I must mention here a short case history since I consider the case as one of my most successful ones in the course of my paediatrician`s practice: Four years ago parents of a three years old girl visited me. The girl stumbled on a pavement and unfortunately fell down with her head just in front of a foxhound tied at a shop entrance. The dog, startled, bit the girl in the face causing a lacerated V - shaped wound on her cheek with sides 1.4 cms in length. The wound had been treated by a surgeon with a sterile lining only, with the perspective of further surgery in the future. Our office treated the wound with strips, applying a 670nm/20mW laser probe from the first day. In general, Augmentin was medicated, and the dog was tested on lyssa (negative). We were irradiating the wound every day, individual sessions lasting 5 minutes. From the second day the wound started drying, it did not gather, and within a week the sides of the wound were healed together with a thin line of newly created tissue. As repeated irradiation is recommended in order to prevent cicatrization, we continued for one more week, thus 10 days in total. After a month another 5 sessions were added, 5 minutes each. The effect of laser therapy was bewildering. In a few months the wound became hardly visible, now it is possible to detect it only when closely examining the cheek. I am convinced that for the sake of such results it is worth to invest in a laser. The more I have been using laser in similar indications, the more it has been obvious that there are other rewards for the work than only economic profit.

• Tendonitis

Duration of healing of post-injury pain in tendons and joints can be shortened rather significantly by using a laser. Especially pain in lesser joints can be eliminated quickly. It was my first experience with this kind of treatment, shortly after the purchase of a laser, successful healing of tendonitis of my own thumb (a volleyball injury) tormenting me for a number of months despite of having tried other kinds of treatment. Since then I have been recommending a laser to treat finger distorsions and medium joints (TC and others), where 685 nm wavelength can still manage.

• Relapsing tonsillitis

This pathology is a very rewarding one for laser therapy. In contrast with antibiotics, which penetrate into scarry tissue of tonsils in case of chronic tonsillitis very hard, laser irradiates the whole of the tissue of the tonsil through with no problems, stimulating local immune mechanisms. Since I have started using laser no tonsillectomy had to be indicated as six irradiations of tonsils improves their selfdefence ability in such a way that any further streptococcal tonsillitis is rather rare to occur.

• Gingivitis and sensitive teeth necks

These are also diseases the therapy of which is effective, too. Pain usually drops after 2 - 3 irradiations, after 3 - 5 treatments bleeding manifestations disappear. Similar effect can be reached irradiating the gums after a tooth extraction.

• Aphtae and stomatitis aphtosa

Especially paediatricians know very well complications caused by stomatitis aphtosa in children. Therapy is nearly 100 per cent effective, and namely the analgesic effect of laser irradiation is soothing for the patients.

• Furunculi and other dermal inflammations, minor eczematic centres, psoriasis

Proven applications. Increase of perfusion as well as stimulation of celullar metabolism lead to quick decline of manifestations in affected tissue and to the healing even of major manifestations in a few days. However, opinions on effects of biostimulation lasers in therapy of psoriasis are not same. I myself do not have many cases of this diagnosis, but I can confirm that my surgery had been repeatedly visited by an adult female patient from a remote city only thanks to the fact that irradiation helped her significantly. The most prevailing opinion is that even a mere decrease of intensity of negative manifestations of this disease represents a substantial benefit for the patient.

• Burns

Therapy of burns has been proven on a rather major group of patients in my surgery, and it can be said that just the treatment applied  immediately after the injury leads to decrease of pain and to a quick recovery of burnt skin.

• Other pathologies

Scientific literature brings numerous articles objectively evaluating effects of laser nearly in all specialties of medicine. Thus positive effects are described in treatment of alopecia, bed sores, haematomas, keloid scars, striae, adnexitis, vulvitis, syndesmotic contractures, arthrosis, arthralgias, or vertebral pains. It is also well known that cosmeticians in beauty parlors use lasers (although their lasers are rather less efficient) for deep clensing of skin and for treatment of wrinkles through biostimulation of minor facial muscles. There is no reason to disbelieve that laser therapy can be effective in above indications, although I have not been using the laser very much in these cases, rather due to lack of time.

 

My experience in the most frequent applications of laser is given in the following table. Time duration of irradiation is marked in minutes with regard to the laser with 20 mW output, applications once a day, spot size 1 sq. cm, all age groups.

Diagnosis	Irradiation in minutes	Number of sessions
Herpes simplex	4	4
Wound healing	2	2 - 15
Tendonitis	4	5 - 10
Relapsing tonsillitis	1	6
Gingivitis and sensitive teeth necks	4	8
Aphtae and stomatitis aphtosa	2	4
Furunculi, dermal inflammations, minor eczematic centre	4	2 - 6
Psoriasis	4	5 - 10
Burns	2	2 - 5
Post injury arthralgias (minor joints incl. TC)	4	5 - 10

 

Practical considerations

It may not be quite easy to make up one`s mind and to purchase a laser. The costs of the purchase are not negligible, and one is not always willing to believe data in literature speaking about its effects and benefits for our patients. And as we do not posess a laser, we cannot test these effects, and the vicious circle is closed. Even if the motivation for purchase with the aim of increasing our therapeutic prestige can be strong enough, but it may not be strong enough on its own. Therefore it might be useful to consider whether a laser cannot be utilized for treatment of our own health problems. This had also been my case when buying my first laser. I had suffered from repeated herpes and relapsing dermatitis on my foot, and the idea to help myself made me to take the (risky) step and to buy a laser. And now, years after, I can seriously state that practical effects of laser therapy have surpassed all my expectations. Apart from herpes it was ulcus cruris and wound healing, where laser therapy really boosts up the therapy,  to name just the best results.

At first it is necessary to think over very carefully what kind of a laser with what kind of a laser probe to buy, so that we can use the laser for treatment of the widest spectrum of diagnoses. There are two basic types of therapy lasers, those irradiating in the red area of the spectrum (used mainly for superficial applications), and infrared lasers (used for irradiation of deeply located structures and for treatment of painful conditions). The type of the probe must be chosen accordingly. As far as therapeutic point of view is concerned, there are two main characteristics of laser probes: output and wavelength.

Output of a laser probe is given in milliwatts (mW) and the probes can be got in versions between 3 - 40 mW, for special lasers even with higher output powers. For paediatrics I would recommend a laser with sufficient output, so that the time of irradiation not be long and not impede us in our work, or the nurse who usually carries out the irradiation. However, I do not think it is necessary to force ourselves to purchase probes with extraordinarily high output as these are usually very expensive. Furthermore, duration of therapy could be very short and for the patients it might seem to be little effective from the psychological point of view. Considering optimum time being 4 - 5 minutes for most of above listed therapies, this can be obtained with a 15 - 25 mW probe.

The wavelength determines how deep the laser beam penetrates under the skin surface and therefore which structures we intend to treat mainly. In general, wavelengths about 600 nm are the best effective for superficial treatments, whilst wavelengths 800 - 900 nm penetrate as far as several centimeters into tissue, affecting well tendons, fasciae or joints. Probes with 670 nm wavelength are considered universal, and they can well be used for skin and subcutaneous affections, reaching also minor joints incl. TC. I cosider them optimum for majority of applications in the course of a normal use in a paediatrics surgery. In the event that we deal also with therapy of, for example, children athletes, two different laser probes, a red one and an infrared one (which we will appreciate with our age increasing), can be recommended.

 

Economical considerations

I have already mentioned the evaluations of the risk, that we would not make the adequate use of the device, seeming too high before the purchase. The Czech health insurance does not cover laser therapy and therefore patients have to pay for it. In general, it is not possible to become rich through laser therapy but, on the other hand, laser is a steady resource of little amounts covering incidental expences of our surgery, apart from its therapeutic effect.

 

Conclusions

My article is an information paper based on everyday practice. It has no advertising character and has not been influenced by nothing and by nobody. It represents a summary of my experience gained in the course of using a laser during the last five years. One gets accustomed to using a PC, finding out that it is a benefit. Similarly, in the case of a therapeutic laser you will soon come to the conclusion that you would not want to work without it, since there are applications where a laser has not got sufficiently effective therapeutic alternative.