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Layla

Layla had been a long term (>1 year) patient of the dermatology service for the autoimmune skin disease Pemphigus Foliaceous, of which the hallmarks are marked pain and swelling due to blistering, vesiculation, and secondary infections of the skin. Layla was on a combination of several immunosuppressive medications and chronic antibiotics but had never been in remission since her disease was diagnosed one year prior. Newly diagnosed high blood pressure and incredible liver enzyme elevations (ALP >5000) had lead to discussions about euthanasia due to decreasing quality of life. The owner felt Layla did not seem comfortable or interested in her normal activities (eating, playing) as her illness progressed. Her skin lesions had begun on her face (predominantly nasal planum) and ears and had progressed to body-wide. The UTVMC Dermatology service said this was the most resistant case of P.F. they had ever seen.

Images 1-3. Spring 2012. Layla is pictured at the heart of her flourishing disease, with ulcerated and blistering lesions across her body and face. Note the abdominal silhouette secondary to liver enlargement from the hepatopathy induced by the suite of immunosuppressive medications being used in attempt to control her disease. Her ALP liver enzyme value approached 45x the upper end of normal when these images were taken.

Layla became a patient of the Integrative Medicine Service in Spring, 2012. The owner was largely considering euthanasia, but wanted to consider all options prior to that decision. A variety of options were discussed, and after meeting the service and Layla’s owner decided to put Layla on a homemade balanced diet and liver-protective supplements. Biweekly sessions were begun using 670 nm module on the Respond Systems Luminex Ultra laser.

The first 6 sessions consisted of 6 J/cm2, CW, on lesions of the body and face. When working around the face, protective eyewear appropriate for the laser wavelength were placed on Layla; during the treatment on regions other than the face, a black cloth was held lightly over Layla’s eyes to shield them.

After the first two sessions, Layla’s owner noted improved comfort when walking due to decreased foot swelling as well as decreased pruritis and scratching. It was noted that the blisters present healed faster after laser therapy, and secondary infections were largely eliminated (based on observation and skin cytology).

After the first month of biweekly sessions, Layla began coming in once weekly for laser therapy. A repeat of bloodwork showed her liver enzymes had decreased by 50%, and her palpable hepatomegaly was visibly decreasing.

Images 4-6. June, 2012 (three months after initiating laser therapy). Note marked decrease in blistering lesion occurrence on the body and face. Few lesions persist,…..

slow wean off of some of her immunosuppressive medications was begun, and a repeated decrease in her systolic/diastolic blood pressure allowed weaning off of her anti-hypertensive medication. Monthly laser sessions have been initiated at the three month period and Layla will continue to be monitored and her progress updated.

 This Luminex Ultra 670 nm red laser has lead to an increase in skin lesion healing, and an increase in comfort to the patient with no side effects as were observed with her other modalities of therapy. The Dermatology service is amazed that Layla is approaching remission while being able to decrease her immunosuppressive medications.

Laser Specifications:
Power Density : 500mW/cm2
Beam Area: 1 cm2
Energy: 6 Joules
Energy Density: J J/cm2
Treatment Time: 12 seconds
Laser Output Power: .5W

 

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