Journal of the Korea Academia-Industrial cooperation Society Vol. 16, No. 5 pp. 3131-3138, 2015 http://dx.doi.org/10.5762/kais.2015.16.5.3131 ISSN 1975-4701 / eissn 2288-4688 광민감물질이배제된광선역학요법이여드름피부에미치는효과 박선남 1*, 김경연 2 1 호서대학교한방화장품학과, 2 신성대학교미용예술계열 Effects of Photodynamics Therapy on the Acne Skin without Light Sensitive Material Seon-Nam Park 1*, Kyung-Yun Kim 2 1 Department of Cosmetic Science, Hoseo University 2 Department of Beauty Art, Shinsung college 요약피부과에서는여드름피부관리시광민감물질인 5-aminolevulinic acid(ala) 를도포한후광선역학요법 (Photodynamic therapy, PDT) 을실시한다. 피부관리실에서는의약품사용은금지되어있다. 따라서이연구의목적은의약품인 ALA를도포하지않고광선역학요법을여드름피부관리프로그램에도입하여그효과를알아보았다. 연구방법은면포및경도여드름을가진여대생 24명을네그룹 (1군: 대조군, 2군 : 420 nm 파장의청색광조사, 3군 : 660 nm 의적색광조사, 4군 : 청색광과적색광을조사 ) 으로나누어 2, 3, 4군을 6주간주 1회가시광선을 20분씩조사한후, 대조군과비교하였다. 그결과가시광선이조사된그룹은홍반, 유분량, 구진, 농포의수가감소하였고, 모공의크기가축소되었으며수분량은증가하였다. 피부관리실의현재여드름관리와광선역학요법을병행한다면피부관리실의여드름프로그램에긍정적인효과를줄것이라기대된다. Abstract At a dermatology during the skin care, photodynamic therapy(pdt) is carried after 5-aminolevulinic acid(ala), light sensitive material, is applied. At a skin care shop, using drug is prohibited. Thus, the aim of this research was to see the effect of the acne skin by irradiating PDT to the skin without applying ALA. The research method was that 24 female undergraduates who had acne on their face at the level of mild or comedonal, and the participants were divided into four groups(group1: no treatment, group 2: 420 nm of blue visible light, group 3: 660 nm of red visible light and group 4: blue and red visible light). The participants of group 2, 3 and 4 were irradiated with visible light for 20 minutes per week for 6 weeks, and they were compared to group 1. As a result of the research, the number of erythema, sebum, papules and pustules of those who were irradiated with visible light decreased, and the pore size of those also decreased while the amount of moisture increased. If an skin care shop applies PDT to the existing acne skin care, that PDT will influence on the program of a skin care shop is expected. Key Words : Acne, ALA, Blue visible light, Photodynamic therapy, Red visible light 1. 서론 외모가경쟁력이라는유행어가생길만큼외모지상주의시대에살고있는현대여성은외모에관심을더가질수밖에없다 [1]. 신체이미지의외모평가가자기존중 감에영향을미치어자신의외모를긍정적으로평가하고만족할수록자신을존중하는것으로나타난다. 특히여드름과같은눈에직접보이는피부질환은다른질환과는달리외부로노출되고때로는직접만져질수도있으므로정신적인문제와삶의질에영향을미칠수있다 [2]. * Corresponding Author : Seon-Nam Park(Hoseo Univ.) Tel: +82-10-3401-1679 email: skinnancy@naver.com Received January 19, 2015 Revised (1st March 15, 2015, 2nd March 31, 2015) Accepted May 7, 2015 Published May 31, 2015 3131
한국산학기술학회논문지제 16 권제 5 호, 2015 여드름의발생에는다양한요인들이영향을미치는데대표적인요소로는비정상적인모낭이상각화, 피지분비의증가, Propionibacterium acnes(p. acnes) 증식그로인한염증반응이주요발생원인이다 [3]. 이들원인을치료하기위한방법으로경구항생제, 외용약제도포, Peeling( 박피 ), 레이저를이용한방법등이있다 [4]. 그러나경구항생제는뛰어난치료효과를나타내지만피부와점막이건조해질수있고, 태아의기형을유발할수있다는단점이있으며 [5], 국소도포제는여드름의원인균인 P. acnes의내성을보인다고보고되었다 [6]. 또한박피의화학적처리나레이저등의처리에의한방법이있으나시술당시및시술후에통증을수반한다는단점을지니며, 모두전문적이고지속적인관리가필요하고, 정상생활로의회복기간을가져야한다 [7]. 이에따라부작용이적으면서동시에효과적인여드름치료방법이요구되고있다. Cunliffe에의해여름철에여드름이호전된다고밝혀진 [8] 후여러연구에서가시광선이여드름치료에효과적인것으로보고되었다 [9]. 면포에서농포에까지여러단계의다양한병변에서배양되는여드름병변에대표적인세균인 P. acnes는내인성포르피린인 protoporphyrin, uroporphyrin, proporphyrin을생성하는데, 이러한포르피린들은광감작물질로서빛을흡수하면 [10] 활성일중항산소를생산하여 P. acnes의세포벽을구성하는지질을파괴함으로써살균효과를나타낸다 [11]. Kennedy 등의연구에서는광민감물질인 ALA을국소도포한후, 광선을조사하는광선역학요법으로기저세포암을치료한결과 90% 이상이완전히호전되었고미용적효과가좋은것으로보고하였다 [12]. Mariwallas K & Rohrer TE에의하면 415 nm 의청색광은 P. acnes에대한살균효과가가장큰파장으로알려져있고 [10], 600~650 nm 의적색광은염증, 상처재생에효과적으로밝혀졌다 [13]. 이런한연구결과로최근피부과에서는여드름치료수단으로가시광선의사용이늘어나고있다. 현재국내외에서는 LED 치료기의연구개발이활발히진행중이며, Table 1은국내외 LED 치료기연구동향이다. 또한전문적인의사없이언제든지사용할수있다는점에서개인이직접광선 (LED) 을피부에조사하여여드름치료에사용할수있도록의료기기로허가되어진개인용광선조사기 (Bling Bling, 카이로스, Korea) 가판매중이다. 피부관리실에서는 식품의약안전청공고제2007-215호 에표시된의료기기의 등급중인체에직접접촉되지아니하고접촉되더라도위험성이거의없고, 인체에미치는영향이경미한의료기기에해당하는 1, 2 등급만사용이가능하다고한다. 이상과같이피부관리실에서의 LED 사용은극히바람직할것으로사료된다. 또한소비자측면에서피부관리실이용에따른소비자만족을개선하기위해서는다양한서비스의개발이필요하다 [14]. 이에본연구에서는광선역학요법 (Photodynamic therapy, PDT) 에사용하는 5-aminolevulinic acid(ala) 를사용하지않고여드름피부에 420 nm 파장의청색광과 660 nm 의적색광각각단독요법의관리와청색광, 적색광의병행요법의관리를시행하여세그룹간의효과를비교하여향후피부관리실에서여드름피부관리프로그램개발에유익한정보를제시하고자한다. Table 1. Domestic and international research trends. prodcut name Bio Light Bionain Nouvo Lightwave LEDSCR Omnilux manufactur features er (nation) -420 nm, 660 nm wave Beautytech -Medical instrument manufacturer and (Korea) distributor -LED SCREEN Type -420 nm, 515 nm, 635 nm wave UTI -acquirement of KFDA in 2007 (Korea) -domestic laser medical instrument distributer -410 nm, 480 nm, 630 nm -acquirement of KFDA in 2007 MItech -the highest recognition among the (Korea) domestic products -420 nm, 630 nm, 880 nm wave -acquirement of FDA in 2007-585 nm, 635 nm wave -acquirement of FDA and CE in 2009 -Laser medical instrument distributer -415 nm, 633 nm, 830 nm wave -acquirement FDA and CE in 2005 -acquirementt KFDA in 2007 -The most sold-out global product 2.1 연구대상및방법 2. 연구방법 Light-wave (U.S.) Quantel (France) Photo Therapeutic s Ltd. (U.K.) 본연구는 2014 년 4 월부터 2014 년 6 월까지 Table 1 의 Burton acne scale[15] 의 2~3단계의안면부여드름을가진 20대여대생총 24명을대상으로하였다. 연구시행 4주이전결과에영향을미칠수있는여드름치료약제 ( 국소및경구항생제, 레티노이드제, 아젤레익산, 3132
광민감물질이배제된광선역학요법이여드름피부에미치는효과 부신피질호르몬등 ) 를사용한자는연구에서제외하였으며, 딥클렌징이끝난후눈의안전을위해보호안경을씌어주고세그룹에게각각주 1회 20분씩 6주간가시광선을조사하였다. 실험은 Fig. 1과같은순서로동시간대동일인에의해조사및측정하였다 Table 2. Grading criteria of acne severity. Grade Severity Types of lesions Grade 0 Total absence of lesions Grade 1 Subclinical acne Few comedones only visible by close examination Grade 2 Comedonal acne Comedones and mild inflammation Grade 3 Mild acne Inflamed papules and erythema Grade 4 Moderate acne Many inflamed papules and pustules Grade 5 Severe nodular Deep nodules with inflamed acne papules and pustules Grade 6 Severe cystic acne Many nodule cystic lesions with scarring 2.2 연구재료및도구본연구에사용된실험재료는 DR.&CO의클렌징로션, Oil free 스킨, 단백질분해효소파파인이포함된딥클렌징파우더, 아이스모델링마스크 ( 닥터앤코, 대덕랩코, Korea) 을사용하였고, 실험에사용한기기는비침습적측정장비 (Beauty on Macro, Beautech, Korea) 를이용하여측정하였다 [16]. 가시광선치료기 (LED) 는 420 nm와 660 nm 파장을내는광선조사기 (Bio Light, Beautech, Korea) 를사용하였다. 2.3 측정도구 2.3.1 육안평가실험시작전, 실험 2주, 실험 4주및종료일에임상사진촬영을시행하였고, 세명의피부미용전공박사가임상사진을보고여드름병변의면포, 구진의수를세어기록하였다. Group 1: Normal (No treatment (n=6) Deep Modeling mask Selecting and Instructing Participants 24 undergraduates of the twenties Investing Before carrying out the experiment Measuring the skin condition and conducting the survey Group 2: Blue (420 nm, Blue LED light) (n=6) Deep Blue LED light (20 minute) Modeling mask Group 3: Red (660 nm, Red LED light) (n=6) Deep Red LED light (20 minute) Modeling mask Measuring the skin after 2, 4, 6weeks Data Analysis Fig. 1. Experimental design. Group 4: Violet (Blue LED ight+ Red LED light) (n=6) Deep Blue LED ight (10 minute) +Red LED light (10 minute) Modeling mask 2.3.2 피부측정기평가 Rogiers의국제적으로표준화된피부측정방법인 EEMCO(European Group on Efficacy Measurement of Cosmetics and Other Topical Product) 의측정가이드라인에맞추어측정조건을온도 20 22, 습도 40 60% 의환경에측정전 30분간피검자를실내에적응하도록하고동일한장소에서동일한측정기기와검사자에의해측정이이루어졌다. 측정값은 3회측정후평균값으로나타내었다 [17]. 피부측정은실험전, 실험 2주, 실험 4주, 실험종료일총 4회에걸쳐실시하였고, 안면피부에나타난유분, 수분, 모공크기, 각질량, 홍반변화에대해측정하였다. 2.4 통계방법분석된자료의통계처리는 statistica program의 Breakdown & one-way ANOVA로통계처리하였고, Ducan's multiple range test에의하여통계학적인유의성을판정하였다. 3. 결과및고찰 3.1 육안평가 3.1.1 구진수의변화 3133
한국산학기술학회논문지제 16 권제 5 호, 2015 Fig. 2와같이구진의평균개수는가시광선을조사하지않은 Normal 군을제외하고세군모두에서관리 6주후에통계적으로유의한호전결과를보였으며, Red 군에서는 4주후부터유의한결과가나타났다 ( * p<0.05). Aimbire 등의연구에서상처에저용량의적색광을조사하면 tumor necrosis factor-α의농도가감소하여항염증작용을한다고보고되었으며 [18], Lee 등의연구결과또한적색광관리 4주후에구진의수가의미있게감소하여 [19] 본연구와같은결과가나타나구진에는 Blue 광선보다 Red 광선이효과적이라고사료된다. Fig. 3. The change of the number of pustules at 0 week, 2 week, 4 week and 6 week after treatment. Normal: No light treatment group, Blue: 420 nm blue light treatment group, Red: 660 nm red light treatment group, Violet: Blue and Red treatment group. The values with an asterisk differ from the normal group by one-way ANOVA (*p<0.05, ***p<0.001). Fig. 2. The change of the number of papules at 0 week, 2 week, 4 week and 6 week after treatment. Normal: No light treatment group, Blue: 420 nm blue light treatment group, Red: 660 nm red light treatment group, Violet: Blue and Red differ from the normal group by one-way ANOVA (*p<0.05, **p<0.01, ***p<0.001). 3.1.3 임상관찰 Fig. 4는피부관리와함께 420 nm 청색광을 6주동안주 1회 20분을조사하며관찰한사진이다. 이마의면포성여드름이관리전에비해관리후많이호전되었다. Fig. 5는피부관리와함께 660 nm 적색광을조사한사진으로볼주변에전반적으로홍반과염증이있던부위가조사후많이사라진것을확인할수있었다. 3.1.2 농포수의변화농포의평균개수는 4군모두관리후에감소하였으며, 420 nm의가시광선을조사한 Blue 군은관리전 4.6±0.54개에서관리 6주후 1.8±0.44개로유의하게 ( *** p<0.001) 농포의수가감소하였고, 660 nm의 Red 가시광선은 4.2±0.44개에서관리 6주후 2.4±0.54개로유의하게 ( * p<0.05) 농포가감소하였다. Blue와 Red 가시광선을함께조사한군은농포의수는감소하였으나통계적으로유의한변화는보이지않았다. Na와 Suh의 8주간의적색광조사연구결과비교시잦은조사횟수및높은누적용량이의미있는여드름의호전을보였다 [20]. Blue와 Red 가시광선을각 10분씩조사한 Violet 군또한조사시간을늘리면유의한결과가있으리라생각된다. <0 week> <2 week> <4 week> <6 week> Fig. 4. The clinical results before and after 420 nm visible light irradiation. 3134
광민감물질이배제된광선역학요법이여드름피부에미치는효과 <0 week> <2 week> Each point represents mean±sd for 6 peoples. Normal: No light treatment group, Blue: 420 nm blue light treatment group, Red: 660 nm red light treatment group, Violet: Blue and Red differ from the normal control group by one-way ANOVA and Duncan s multiple range tests(**p<0.01 ***p<0.001). <4 week> <6 week> Fig. 5. The clinical results before and after 660 nm visible light irradiation. 3.2 피부측정기를사용한평가 3.2.1 유분량변화비교 피부유분량측정에서여드름피부대상자들의평균유분량변화는관리 0주에비해모두감소하였으며관리 2주후부터는가시광선을조사한세군모두유의한감소를보였다 (**p<0.01 ***p<0.001). 가시광선을조사하지않은 Normal 군또한관리전에비해관리후유분량의감소로보여지는결과로효소를활용한딥클렌징이유분량감소에영향을미치나통계적으로유의한감소를위해서는가시광선의조사가효과적이라고판단된다. Hongcharu 등과 Jeon 등의광선역학요법연구에서피지분비량의감소를보고하였고, 피부조직검사에서피지선이위축됨을확인하였다 [21, 22]. 결과를종합해볼때, 피부관리실에서지성피부관리및여드름피부관리에보조수단으로서가시광선의활용이효과적이라판단된다. 3.2.2 수분량변화비교 Medrado 등의연구에의하면적색광조사시콜라겐합성증가, 근육섬유모세포의증식으로상처치유에도효과가있다고보고되었으며 [23], Young 등과 Corazza 등은적색파장대는진피세포에효과적인파장으로섬유모세포를활성화시켜콜라겐합성을증가시킨다고밝혔다 [24, 25]. 본연구의수분변화량측정결과적색광을단독조사한군과적색광과청색광을함께조사한군에서모두유의하게수분량이증가하였다 (**p<0.01 ***p<0.001). 이러한결과를미루어볼때적색광의콜라겐합성을촉진하여수분량이증가한것이라판단되며, 또한여드름관리시발생할수있는수분부족현상에적색광을이용한관리는수분량증가에도움이되리라판단된다. Fig. 7. Comparison of moisture value before and after skin management for four groups. Unit: pixel. Each point represents mean±sd for 6 peoples. Normal: No light treatment group, Blue: 42 0nm blue light treatment group, Red: 660 nm red light treatment group, Violet: Blue and Red differ from the normal control group by one-way ANOVA and Duncan s multiple range tests(**p<0.01 ***p<0.001). Fig. 6. Comparison of sebum value before and after skin management for four groups. Unit: pixel. 3.2.3 모공크기변화비교모공사이즈의변화를측정한결과가시광선을조사한세군에서관리 4주후부터유의하게모공의수치가 3135
한국산학기술학회논문지제 16 권제 5 호, 2015 감소하였다. Gold는광선역학요법은피지선에손상을일으켜피지생성을억제하고 [26], Young 등은대식세포에의한다양한사이토카인의생성으로피부상처치유에효과적이라고보고된결과를 [24] 종합적으로살펴보면가시광선조사는모공수렴에효과적으로사료된다. Each point represents mean±sd for 6 peoples. Normal: No light treatment group, Blue: 420 nm blue light treatment group, Red: 660 nm red light treatment group, Violet: Blue and Red differ from the normal control group by one-way ANOVA and Duncan s multiple range tests(***p<0.001). Fig. 8. Comparison of pore value before and after skin management for four groups. Unit: pixel. Each point represents mean±sd for 6 peoples. Normal: No light treatment group, Blue: 420 nm blue light treatment group, Red: 660 nm red light treatment group, Violet: Blue and Red differ from the normal control group by one-way ANOVA and Duncan s multiple range tests(*p<0.05, **p<0.01 ***p<0.001). 3.2.5 홍반변화비교적색광의경우포르피린을활성화시키는효과는청색광보다떨어지나상대적으로깊은투과도를지녀청색광이도달하지못하는여드름병변에도효과가있으며 [9], 대식세포는사이토카인의분비를촉진함으로써항염증작용을나타낸다 [24]. 또한종양괴사인자- 알파 (turom nerosis factor-a) 의농도가감소하여홍반완화에효과가있다고보고된다 [18]. 본연구결과또한적색광을조사한실험군에서홍반의수치가유의하게감소됨을확인하였다. 홍반감소를위한피부관리에는적색광조사가효과적이라사료된다. 3.2.4 각질량변화비교 Gold는광선요법은털집의과다각질화를억제한다고보고하였고 [26], Takahashi 등은사람의정상각질형성세포에서광선요법이세포자멸사를유도하여과다각질화를감소시키는결론이다 [27]. 본연구결과에는 420nm의청색가시광선조사 4주후에각질량이유의있게감소하는결과를보였다. 이는짧은파장으로피부내로의투과는제한되지만광역학반응에서빛의흡수가가장활발한파장대이므로 [12] 각질량감소에매우효과적이라고사료된다. Fig. 10. Comparison of erythema value before and after skin management for four groups. Unit: pixel. Each point represents mean±sd for 6 peoples. Normal: No light treatment group, Blue: 420 nm blue light treatment group, Red: 660 nm red light treatment group, Violet: Blue and Red treatment group. The values with an asterisk differ from the normal control group by one-way ANOVA and Duncan s multiple range tests(**p<0.01). 4. 결론 Fig. 9. Comparison of keratin value before and after skin management for four groups. Unit: pixel. 피부관리실에서의가시광선을활용한여드름관리프로그램개발을위하여본연구에서는병원에서가시광선조사시사용되는 ALA 광민감물질을도포하지않은 3136
광민감물질이배제된광선역학요법이여드름피부에미치는효과 상태로가시광선의효능을알아보고자청색광 (420 nm, 20분 ), 적색광 ( 660 nm, 20분 ), 청색광 10분조사후적색광 10분을조사한각세군을가시광선을조사하지않은군과각각비교실험한결과구진의감소는 660 nm 의적색광을조사한군에서실험 4주후부터유의한결과가 (*p<0.05) 나타났고, 농포는청색광과적색광을단독조사한두군에서 6주후유의한감소가나타났다 (*p<0.05 ***p<0.001). 수분량은적색광이단독 20분조사된군과 10분조사된두군에서유의하게증가하였고 (**p<0.01 ***p<0.001), 가시광선을조사한모든군에서유분량과모공의크기가유의하게감소하였다 (*p<0.05, **p<0.01 ***p<0.001). 각질량은 420 nm의청색광에서 4주후부터유의한감소가나타났고 (***p<0.001), 홍반량은 660 nm의적색광을 20분단독조사한군에서 6주후에유의한결과가나타났다 (**p<0.01). 따라서본연구에서는가시광선이피부유분량, 모공, 각질량감소효과및홍반완화, 수분량지수개선에효과가있었으며이로인해전체적인여드름개선효과를확인할수있었다. 이러한결과를미루어볼때가시광선을활용한관리가현재피부관리실의여드름관리와병행함으로써우수한효능의프로그램으로발전할것을기대한다. References [1] Haekyung Lee. Effects of Sociocultural Attitude toward Appearance, Body Image, and Self-Esteem on Appearance Management in Middle and High School Girls. Journal of the Korea Academia-Industrial cooperation Society, 15(2) 914-922, 2014. DOI: http://dx.doi.org/10.5762/kais.2014.15.2.914 [2] Haekyung Lee. Predictors of Wish to Undergo Cosmetic Surgery according to Experience of Cosmetic Surgery in Female College Students. Journal of the Korea Academia-Industrial cooperation Society, 14(1) 285-293, 2013. DOI: http://dx.doi.org/10.5762/kais.2013.14.1.285 [3] Cordain L, Lindeberg S, Hurtado M, Hill K, Eaton SB, Brand-Miller J. Acne vulgaris : A disease of wester civilization. Arch Dermatol., 138(12) 1584-1590, 2002. DOI: http://dx.doi.org/10.1001/archderm.138.12.1584 [4] Jungeun Lee. A study on Facial Acne management by LED of visible ray wavelength : Focusing on the twenties. Chungand University Master Thesis, 2007. [5] Webster GF, Grabger EM. Antibiotic treatment for acne vulgaris. Semin. Cutan. Med. Surg., 27(3) 183-187, 2008. DOI: http://dx.doi.org/10.1016/j.sder.2008.07.001 [6] Eady EA, Gloor M and Leyden JJ. Propionibacterium acnes resistance: A World Wide Problem, Dermatol., 206(1) 54-6, 2003. DOI: http://dx.doi.org/10.1159/000067822 [7] EunJin Jung. study on the medical esthetic conditioning,customer satisfaction and reformation plan. Chungand University Master Thesis, 2007. [8] Cunliffe WJ, Goulden V. Phototherapy and acne vulgaris. Br J Dermatol, 142(5) 855-856, 2000. DOI: http://dx.doi.org/10.1046/j.1365-2133.2000.03528.x [9] Sigurdsson V, Knulst AC, Van Weelden H. Phototheropy of acne vulgaris with visible light. Dermatology, 194(3) 256-260, 1997. DOI: http://dx.doi.org/10.1159/000246114 [10] Mariwallas K, Rohrer TE. Use of lasers and light-based therapies for treatment of acne vulgaris. Lasers Surg Med, 37(5) 333-342, 2005. DOI: http://dx.doi.org/10.1002/lsm.20276 [11] Goldberg DJ, Russell BA. Combination blue(415nm) and red (633 nm) LED phototherapy in the treatment of mild to severe acne vulgaris. J Cosment Laser ther, 8(2) 71-75, 2006. DOI: http://dx.doi.org/10.1080/14764170600735912 [12] Kennedy JC, Pottier RH, Pross DC. Photodynamic therapy with endogenous protoporphyrin Ⅸ: basic principles and present clinical experience. J Photochem Photobiol B, 6(1) 143-148, 1990. [13] HyunSook Jung. The effect of permeation of vitamin C iontophoresis on the improvement of acne and acne scar after medical treatment. Konkuk University Master Thesis, 2006. [14] Jeong-Suk Lee, Kyung-Min Ahn. Korean Skin Care on Japanese Tourist's Satisfaction and Revisit. Journal of the Korea Academia-Industrial Cooperation Society, 12(11) 4756-4763, 2011. DOI: http://dx.doi.org/10.5762/kais.2011.12.11.4756 [15] Elman M. Lebzelter J. Light therapy in the treatment of acne vulgaris. Dermatol Surg. 30(2) 139-146, 2004. DOI: http://dx.doi.org/10.1111/j.1524-4725.2004.30053.x [16] Seonnam Park. Treatment Effects of MTS and Iontophoresis on the Improvement of Skin Status in Twenties` Female College Students. KSIC, 9(3) 213-219, 2013. 3137
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