Low-level laser therapy of leg ulcer in sickle cell anemia

DOI: 10.5581/1516-8484.20120018 Chronic leg ulceration affects about 1% of the population at some point in their lives. Additionally, leg ulcers are one of the sequels of sickle cell disease with physiological and psychosocial consequences.(1) Treatment aims at improving the quality of life of patients and effectively healing the lesion. Adherence to treatment is not always effective, especially considering the profession of individuals with sickle cell anemia and the time required for therapy. The results of current therapeutic conduct appear to be unsatisfactory even though much has been published on a wide range of therapies.(2) Cutaneous lesions represent a dilemma and instigate clinical interest because of the high morbidity associated with changes in the normal healing process. An adequate choice of therapy and effort of the medical team can make the healing process quicker and reduce possible complications.(3) Among currently available methods, low-level laser therapy (LLLT) is an important, safe and practical tool. In vitro and in vivo studies have demonstrated that LLLT is an effective method to modulate tissue repair, thus significantly contributing to a faster and better organized healing process.(1,3) Here we describe the results of a therapeutic intervention in a 35-year-old female sickle cell anemia patient with recurring leg ulcers who was prevented from maintaining employment and appropriate social activities due to the disease. She had been diagnosed at 8 years old; she is homozygous for the Bantu haplotype. Between 16 and 18 years old, the patient was repeatedly hospitalized for infections, leg ulcers, generalized pain and anemia. Leg ulcers were a recurring problem which affected dayto-day activities. The patient participated in the "ulcer healing group" of Hospital de Base in São José do Rio Preto, São Paulo State, Brazil and the leg ulcers were treated. At an initial evaluation the patient had an active leg ulcer of the lower third of left leg above the medial malleolus. She also had whitish areas in the third anteromedial distal region of the left leg and on the dorsum of the foot, showing that several ulcers had healed. A macroscopic evaluation identified the presence of hyperpigmentation and the temperature in the region was elevated. Treatment using LLLT was proposed to accelerate the healing of the ulcer. The device used was a He-Ne Laser (Plasmax IV KLD Biosystems Inc.) with a wavelength of 632.8 nm and red (visible), 5mW peak emission, 10 60 mJ energy with an application area of 0.02 100 cm2 and automatic dosimeter. The application mode consisted of point action of 30 mJ for 9 seconds in order to accelerate local cell stimulation for healing. Points at 5 10 mm intervals on the edges of the ulcer were marked and laser therapy was applied. Moreover, with the aim of increasing circulation, 50 mJ were applied for 15 seconds in the region above the ulcer. A total of five treatment sessions were used twice weekly for 10 to 15 minutes each with progressive reduction as the ulcer healed. with high mortality.(6) On treating with chemotherapy, oncologists tend to regard pancytopenia as related to hematologic toxicities and thus insufficient testing, such as bone marrow aspiration or biopsy, is carried out. We suggest that every clinician should be aware of the possibility of HPS in cancer patients or poor outcomes may result. In conclusion, cancer patients with cachexia syndrome might be at risk for HPS because of the release of high levels of cytokines such as IL-6 or TNF-α. We suggest that clinicians should keep HPS in mind when treating cancer patients.