The subject of LED Phototherapy has its roots firmly planted in science. Since NASA first used LEDs (light emitting diodes) for experimental plant growth studies in space the technology was developed into medical treatments for everything from skin cancer, mouth ulcers, brain tumours and diabetic wound healing – the possibilities for Phototherapy seem endless. 

The PDT (Photodynamic Therapy) that has become the skin therapy we know today was originally developed by Paterson Institute for Cancer Research. 
Its optimised intensity and adjustable dose function have been used in the treatment of thousands of non-melanoma lesions with great success. 

It was during the research and development of this technology that improvement in skin texture, colour and increased collagen deposition was noted leading to the development of PDT for skin rejuvenation. 

Before 2003, lasers had been widely used for the purpose of resurfacing and subsequent collagen regeneration, wrinkle reduction and acne. These utilised light heat energy to produce the desired result and were high risk, causing hyperpigmentation for some patients, while some treatments required weeks of downtime and presented a risk of infection. 

Then in 2003 the first LED skin therapy device came to market in the form of Omnilux in 2003 and changed the face of skin rejuvenation. For the first time it became possible to improve photo ageing, scarring, general dyschromia of the skin and acne lesions without the use of lasers or UV light – making it safe for all skin types and with zero downtime. 

The aesthetic market is now flooded with LED devices from handheld devices containing a few LEDs to masks that sit directly on the face and to canopy type machines. The huge array of choice, and the many differing ways in which companies measure data often make it hard also to compare devices fairly. This, coupled with a lack of standards, makes it very difficult for a practitioner to decide on the right machine for them and their business. 

We use LED technology everywhere, from phones and computer screens to car headlights. These LEDs all emit different colours and wavelengths of light within the visible light spectrum. For the purposes of skin treatment we use wavelengths (measured in Nanometers) that enter the skin at different depths that make the therapy useful to treat a variety of skin conditions. 

Current data and clinical studies support evidence for the use of Red, Blue and Near-infrared, there is currently little, or no, evidence for Green, Yellow, Violet or any other colours. 

The use of Phototherapy today allows us to treat a wide variety of skin conditions from acne to psoriasis without heat or trauma making it an integral part of skin treatment for both therapists and medics.
However the aesthetic market is now flooded with LED devices from handheld devices containing a few LEDs to masks that sit directly on the face and to canopy type machines. 
The huge array of choice, and the many differing ways in which companies measure data often make it hard also to compare devices fairly. This, coupled with a lack of standards, makes it very difficult for a practitioner to decide on the right machine for them and their business. 

Not only can some of these devices be ineffective, they could also be potentially dangerous causing skin damage, so it is vitally important to research the device you are purchasing before parting with your money. Far too often machines are marketed via social media or within the Aesthetic industry that have little or no clinical data, all very confusing for the average person to understand. Some machines do not even conform to basic safety standards. 

A machine with a Medical CE certification will have a mandatory CE marking accompanied by a Notified Body number to show that it meets general safety and performance requirements. If a device doesn’t carry a Notified Body number then it doesn’t carry a Medical CE certification, it may however have a CE mark without a Notified Body number which is a basic safety mark.  From 1 July 2023 Medical machines sold in the UK will need a UKCA marking

Purchasing a device without understanding the technology can lead to poor choices in selection of equipment and potentially disastrous consequences, and little to no result for the client. As we strive to offer the best outcomes for our clients we must offer the very best technology that we can without compromising safety. Some insurance companies are now asking for proof of certification of equipment to ensure maximum safety standards. 

The most important thing to consider when purchasing any device is the results, first and foremost this is why we want to incorporate these types of machines into our businesses. Any medical device company making results based claims would have had to spend years and thousands of pounds to produce information to make results based claims and will be very proud of their data and will happily share it. 

Light emitting diodes are small lights that when an electric current is passed through it produce light. Electrons in the semiconductor recombine with electron holes resulting in the release of energy as a photon.  At the time of manufacture, and when in combination with varying materials, the light which is emitted can be fine-tuned at source to emit as a pre- selected peak wavelength. This results in a defined spectrum of light being emitted.

There are many types of LED’s available “off the shelf” that can be used for many types of products, many of which are the same used in TVs, lighting, computer screens etc. They use RGB LEDs, which means red, green and blue LEDs. RGB LED products combine these three colours to produce many hues of light and as we know light is measured in nanometers and are capable of producing many wavelengths. Machines using RGB LEDs for skin are generally quite cheap to produce and often used in machines that have single LEDs that change colour rather than using individual LEDs that emit a single colour and wavelength. 
RGB LEDs however cannot deliver the necessary energy required (measured in Joules) for the desired results and can vary by as much as +/-  20nm in wavelength. An inconsistent wavelength coupled with the variable energy RGB LEDs produce could potentially be hazardous or simply completely ineffective. In the case of blue light which is capable of entering the eye over a duration of time, this can be very harmful, especially without the right eye protection. 

All LED devices must state associated warnings based upon its optical power, if your device doesn’t have any safety warnings related to eye hazard you can assume the device does not conform to safety standards or it conforms to the lowest measured optical output meaning it possibly may not be generating enough power to produce the energy required to see any significant results. 

For skin treatment using LED technology, light (photonic) energy is delivered into the target chromophore to produce cell activation. Standard LEDs deliver energy in a waveform and whilst they deliver energy,  the cells cannot absorb this light effectively and wasted photons can lead to increased skin heating. This could in turn aggravate inflammatory skin conditions such as acne and Rosacea. Some devices can become increasingly hot over time, resulting in reduced power and results so it is important to check if the device has some kind of cooling technology. 

The key to efficacy with light therapy is how much energy is absorbed by the skin. Therefore, the power of the LEDs used in a Phototherapy machine determines how close the device needs to be placed to achieve optimal results. But, because different manufacturers use different power LEDs, the distance each machine needs to sit next to the skin will vary between machines.

Single wavelength colour LEDs are specifically designed to deliver optimised intensities of light. The wavelengths need to be very specific in order to deliver results. Additionally, when the LEDs are packed closely together they allow the maximum light and proven dosages to be delivered to the treatment area. The amount of LEDs used in a device will also vary from machine to machine and some few LEDs some cluster LEDs. Typically it is thought more would be better but the uniform distribution of the optical power is the most important factor. 
The wavelengths used need to be very specific in order to deliver results. The most historically studied wavelengths of monochromatic light have over 40  peer-reviewed published studies that validate clinical claims and treatment protocols used for skin treatment. These are Blue 415nm, used for the treatment of acne vulgaris. Red light (633nm) for a variety of applications including skin rejuvenation, wrinkle reduction, acne (anti-inflammatory), dyschromia of the skin such as pigmentation and rosacea, and Photodynamic Therapy (PDT) for the treatment of certain non-melanoma skin cancers medically.  Red light has both a rejuvenating and anti-inflammatory effect on the skin. Proven to increase cellular energy (ATP) which in turn boosts cellular renewal. Near Infrared (830nm) is the most deeply penetrating wavelength, working indirectly through cell membrane absorption to stimulate complex cellular processes that result in increased collagen, elastin and growth factor production to treat the visible signs of photodamage and stimulate cellular repair mechanisms essential in the wound healing process. The quality of the emissions is vital to achieve peak performance and can vary with some devices. 
A wavelength that falls outside the most documented wavelengths may still get results but, missing the target chromophore within the cell, alongside the inconsistency of power could lead to photosensitivity reactions or when too much energy being produced actually prohibiting any cellular reaction or harmful reactions. 

Due diligence must be applied when considering which device to purchase for your business. It is our duty as professionals to consider all the information available in order to keep our clients and ourselves safe. Failure to do your research could end with serious consequences. We could also find the client sees no results from the treatment at all. 
How do I decide what LED Phototherapy device to buy?

Here are my top 5 things to look out for when purchasing a LED Phototherapy device.

1.    Clinical Evidence. Ask the distributor or manufacturer to provide you with white papers, independent clinical trials and photos of THEIR OWN device’s treatment results. Do not accept generic evidence papers that look the same as the machine you're looking at or that are from generic LED studies. PubMed is a free source of information and doing your research can pay dividends. 

2.    Ask what wavelengths are used? How can you deliver those in treatment? Can you combine wavelengths ie Red and Blue together without reducing efficacy. 

3.    What LEDs are used? Are the LED’s used single colour/ wavelength? If they are changing colour how does the device maintain optimal effectiveness for each wavelength? Do you have data to support this? 

4.    Certification. Do you have a medical CE certificate? Is it FDA approved? Does it conform with safety standards and comply with industry/ insurance standards?

5.    Where is the device manufactured and what markings are shown? Some imported devices carry CE marks that differ from the recognised Medical CE mark or the recognised regular European CE mark. For instance some machines imported from China carry a similar looking CE mark that simply means ‘Chinese Import’.  From 1 July 2023 a UK CA marking will be required in order to place a medical device on the market in Great Britain. Until that time, the European CE mark is acceptable.