Differential long-term stimulation of type I versus type III collagen after infrared irradiation

The effects of infrared radiation on the human skin

BACKGROUND

Infrared radiation (IR) is the portion of the electromagnetic spectrum between visible light (VL) and microwaves, with wavelengths between 700 nm and 1 mm. Humans are mainly exposed to ultraviolet (UV) radiation (UVR) and IR through the sun. Unlike UVR which is well known for its carcinogenic properties, the relationship between IR and skin health has not been as extensively studied; as such, we gather the available published evidence here to better elucidate this relationship.

METHODS

Several databases including Pubmed, Google Scholar, and Embase were searched for articles relating to infrared radiation and the skin. Articles were selected for their relevance and novelty.

RESULTS

Detrimental effects such as thermal burns, photocarcinogenesis, and photoaging have been reported, though evidence suggests that these may be due to the thermal effects produced secondary to IR exposure rather than the isolated effect of IR. There are currently no chemical or physical filters specifically available for protection against IR, and existing compounds are not known to have IR-filtering capacity. Interestingly, IR may have some photoprotective properties against the carcinogenic effects of UVR. Furthermore, IR has been used with encouraging results in skin rejuvenation, wound healing, and hair restoration when given at an appropriate therapeutic dose.

CONCLUSION

A better understanding of the current landscape of research surrounding IR can help illuminate its effects on the skin and highlight areas for further research. Here, we review relevant data on IR to assess its deleterious and beneficial effects on human skin, along with possible means for IR photoprotection.

Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study

Acellular matrices produced by tissue decellularisation are reported to have tissue integrative properties. We examined the potential for incorporating acellular matrix grafts during procedures where there is an inadequate natural tissue bed to support an enduring surgical repair. Hypospadias is a common congenital defect requiring surgery, but associated with long-term complications due to deficiencies in the quality and quantity of the host tissue bed at the repair site. Biomaterials were implanted as single on-lay grafts in a peri-urethral position in male pigs. Two acellular tissue matrices were compared: full-thickness porcine acellular bladder matrix (PABM) and commercially-sourced cross-linked acellular matrix from porcine dermis (Permacol™). Anatomical and immunohistological outcomes were assessed 3 months post-surgery. There were no complications and surgical sites underwent full cosmetic repair. PABM grafts were fully incorporated, whilst Permacol™ grafts remained palpable. Immunohistochemical analysis indicated a non-inflammatory, remodelling-type response to both biomaterials. PABM implants showed extensive stromal cell infiltration and neovascularisation, with a significantly higher density of cells (p < 0.001) than Permacol™, which showed poor cellularisation and partial encapsulation. This study supports the anti-inflammatory and tissue-integrative nature of non-crosslinked acellular matrices and provides proof-of-principle for incorporating acellular matrices during surgical procedures, such as in primary complex hypospadias repair.

Near-infrared-emitting nanoparticles activate collagen synthesis via TGFβ signaling

Research efforts towards developing near-infrared (NIR) therapeutics to activate the proliferation of human keratinocytes and collagen synthesis in the skin microenvironment have been minimal, and the subject has not been fully explored. Herein, we describe the novel synthesis Ag2S nanoparticles (NPs) by using a sonochemical method and reveal the effects of NIR irradiation on the enhancement of the production of collagen through NIR-emitting Ag2S NPs. We also synthesized Li-doped Ag2S NPs that exhibited significantly increased emission intensity because of their enhanced absorption ability in the UV-NIR region. Both Ag2S and Li-doped Ag2S NPs activated the proliferation of HaCaT (human keratinocyte) and HDF (human dermal fibroblast) cells with no effect on cell morphology. While Ag2S NPs upregulated TIMP1 by only twofold in HaCaT cells and TGF-β1 by only fourfold in HDF cells, Li-doped Ag2S NPs upregulated TGF-β1 by tenfold, TIMP1 by 26-fold, and COL1A1 by 18-fold in HaCaT cells and upregulated TGF-β1 by fivefold and COL1A1 by fourfold in HDF cells. Furthermore, Ag2S NPs activated TGF-β1 signaling by increasing the phosphorylation of Smad2 and Smad3. The degree of activation was notably higher in cells treated with Li-doped Ag2S NPs, mainly caused by the higher PL intensity from Li-doped Ag2S NPs. Ag2S NPs NIR activates cell proliferation and collagen synthesis in skin keratinocytes and HDF cells, which can be applied to clinical light therapy and the development of anti-wrinkle agents for cosmetics.

Long-term objective assessments of skin rejuvenation using solar protection and solar repair shown through digital facial surface analysis and three-dimensional volumetric assessment

Background

Despite the knowledge that the vast majority of skin aging is caused by the sun, and the widespread prevalence of sunscreen usage, solar skin damage continues to occur due to the combined biological impact of ultraviolet, visible light and near-infrared radiation. Sunscreens have only proven effective at filtering ultraviolet light. They do not attenuate visible light or near-infrared.

Objective

To evaluate the effectiveness of a novel, solar-specific skincare approach embracing both comprehensive daily solar protection from ultraviolet through to near-infrared radiation and nightly solar repair.

Participants

Eighteen Japanese patients were enrolled in this study. Topical skincare products (The Essential Six, RATIONALE, Victoria, Australia), comprising solar protection preparations to be used in the morning and topical solar repair at night, were applied to the patients’ skin for 12 months. Patients refrained from using any other skincare formulations and did not undergo any form of medical esthetic treatment during the study.

Measurements

Digital facial skin and three-dimensional volumetric assessment were performed pre- and post-treatment, and patient assessments were recorded after 6 and 12 months post-treatment.

Results

Improvements in skin texture and luminosity as recorded via digital photography, significant amelioration of skin redness and pigmentation in facial surface analysis, and volumetric reduction in three-dimensional volumetric assessment were observed compared to the pre-treatment for all patients. Eighty-nine percent, and 94% of patients self-reported their approval of treatment outcomes after 6 and 12 months post-treatment, respectively. Minor complications, characterized by slight pain and itching were observed in 3 patients. These minor complications resolved spontaneously.

Conclusion

The results of this study indicate that the solar-specific skincare formulations focused on the daily comprehensive prevention of negative solar effects and nightly repair of photodamage provide a safe and highly effective pathway to skin preservation and rejuvenation.

Upregulated expression of La ribonucleoprotein domain family member 6 and collagen type I gene following water-filtered broad-spectrum near-infrared irradiation in a 3-dimensional human epidermal tissue culture model as revealed by microarray analysis

BACKGROUND/OBJECTIVES

Water-filtered broad-spectrum near-infrared irradiation can induce various biological effects, as our previous clinical, histological, and biochemical investigations have shown. However, few studies that examined the changes thus induced in gene expression. The aim was to investigate the changes in gene expression in a 3-dimensional reconstructed epidermal tissue culture exposed to water-filtered broad-spectrum near-infrared irradiation.

METHODS

DNA microarray and quantitative real-time polymerase chain reaction (PCR) analysis was used to assess gene expression levels in a 3-dimensional reconstructed epidermal model composed of normal human epidermal cells exposed to water-filtered broad-spectrum near-infrared irradiation. The water filter allowed 1000-1800 nm wavelengths and excluded 1400-1500 nm wavelengths, and cells were exposed to 5 or 10 rounds of near-infrared irradiation at 10 J/cm2 .

RESULTS

A DNA microarray with over 50 000 different probes showed 18 genes that were upregulated or downregulated by at least twofold after irradiation. Quantitative real-time PCR revealed that, relative to control cells, the gene encoding La ribonucleoprotein domain family member 6 (LARP6), which regulates collagen expression, was significantly and dose-dependently upregulated (P < 0.05) by water-filtered broad-spectrum near-infrared exposure. Gene encoding transcripts of collagen type I were significantly upregulated compared with controls (P < 0.05).

CONCLUSIONS

This study demonstrates the ability of water-filtered broad-spectrum near-infrared irradiation to stimulate the production of type I collagen.

Upregulated epidermal growth factor receptor expression following near-infrared irradiation simulating solar radiation in a three-dimensional reconstructed human corneal epithelial tissue culture model

Background and objective

Humans are increasingly exposed to near-infrared (NIR) radiation from both natural (eg, solar) and artificial (eg, electrical appliances) sources. Although the biological effects of sun and ultraviolet (UV) exposure have been extensively investigated, the biological effect of NIR radiation is still unclear. We previously reported that NIR as well as UV induces photoaging and standard UV-blocking materials, such as sunglasses, do not sufficiently block NIR. The objective of this study was to investigate changes in gene expression in three-dimensional reconstructed corneal epithelial tissue culture exposed to broad-spectrum NIR irradiation to simulate solar NIR radiation that reaches human tissues.

Materials and methods

DNA microarray and quantitative real-time polymerase chain reaction analysis were used to assess gene expression levels in a three-dimensional reconstructed corneal epithelial model composed of normal human corneal epithelial cells exposed to water-filtered broad-spectrum NIR irradiation with a contact cooling (20°C). The water-filter allowed 1,000–1,800 nm wavelengths and excluded 1,400–1,500 nm wavelengths.

Results

A DNA microarray with >62,000 different probes showed 25 and 150 genes that were up- or downregulated by at least fourfold and twofold, respectively, after NIR irradiation. In particular, epidermal growth factor receptor (EGFR) was upregulated by 19.4-fold relative to control cells. Quantitative real-time polymerase chain reaction analysis revealed that two variants of EGFR in human corneal epithelial tissue were also significantly upregulated after five rounds of 10 J/cm² irradiation (P<0.05).

Conclusion

We found that NIR irradiation induced the upregulated expression of EGFR in human corneal cells. Since over half of the solar energy reaching the Earth is in the NIR region, which cannot be adequately blocked by eyewear and thus can induce eye damage with intensive or long-term exposure, protection from both UV and NIR radiation may prevent changes in gene expression and in turn eye damage.

Effect of infrared radiation A on photoaged hairless mice harboring eumelanin and pheomelanin in the epidermis

Infrared radiation A (IRA) is absorbed by melanin and generates heat. Therefore, the effect of IRA could be well analyzed using skin, which contains melanin in the epidermis. Hairless mice harboring epidermal melanocytes that produce eumelanin, pheomelanin, or non-melanin were generated by backcrossing K14-stem cell factor mice, recessive yellow mice, and then albino hairless mice. High-dose IRA was irradiated over 18 weeks after the establishment of photoaged mice by irradiation with ultraviolet B (UVB) three times a week for 14 weeks. Tumor formation was assessed every week. The formation of cyclobutane pyrimidine dimer and apoptotic cells by the irradiation of IRA and UVB was evaluated. Repetitive irradiation of IRA did not promote tumor formation in all types of mice. Pre-irradiation of IRA to UVB, but not post-irradiation, accelerated the elimination of cyclobutane pyrimidine dimers and enhanced apoptosis; these effects were most obvious in eumelanin-producing mice. Real-time polymerase chain reaction analysis showed downregulation of FLICE (cellular caspase 8)-like inhibitory protein and B-cell lymphoma-extra large and upregulation of Bcl-2-associated X protein by UVB, but further enhancement of these molecules by pre-irradiation of IRA was not observed. These results indicate that IRA does not confer the promotion of UVB-induced carcinogenesis in photoaged mice harboring epidermal melanocytes and that photochemical reaction between IRA and melanin might be involved in the induction of apoptosis and the elimination of cyclobutane pyrimidine dimers by UVB. The enhancement of apoptosis by pre-irradiation of IRA to UVB might be induced by mechanisms other than the modification of the mRNA expression of FLICE (cellular caspase 8)-like inhibitory protein, B-cell lymphoma-extra large, and Bcl-2-associated X.

Objective assessment of skin tightening in Asians using a water-filtered near-infrared (1,000-1,800 nm) device with contact-cooling and freezer-stored gel

BACKGROUND

Near-infrared has been shown to penetrate deeper than optical light sources independent of skin color, allowing safer treatment for the Asian skin type. Many studies have indicated the efficacy of various types of devices, but have not included a sufficiently objective evaluation. In this study, we used three-dimensional imaging for objective evaluation of facial skin tightening using a water-filtered near-infrared device.

METHODS

Twenty Japanese patients were treated with the water-filtered near-infrared (1,000-1,800 nm) device using a contact-cooling and nonfreezing gel stored in a freezer. Three-dimensional imaging was performed, and quantitative volume measurements were taken to evaluate the change in post-treatment volume. The patients then provided their subjective assessments.

RESULTS

Objective assessments of the treated cheek volume evaluated by a three-dimensional color schematic representation with quantitative volume measurements showed significant improvement 3 months after treatment. The mean volume reduction at the last post-treatment visit was 2.554 ± 0.999 mL. The post-treatment volume was significantly reduced compared with the pretreatment volume in all patients (P < 0.0001). Eighty-five percent of patients reported satisfaction with the improvement of skin laxity, and 80% of patients reported satisfaction with improvement of rhytids, such as the nasolabial folds. Side effects, such as epidermal burns and scar formation, were not observed throughout the study.

CONCLUSION

The advantages of this water-filtered near-infrared treatment are its high efficacy for skin tightening, associated with a minimal level of discomfort and minimal side effects. Together, these characteristics facilitate our ability to administer repeated treatments and provide alternative or adjunctive treatment for patients, with improved results. This study provides a qualitative and quantitative volumetric assessment, establishing the ability of this technology to reduce volume through noninvasive skin tightening.

Impact of near-infrared radiation in dermatology

Sunlight that reaches the human skin contains solar energy composed of 6.8% ultraviolet (UV), 38.9% visible light and 54.3% infrared radiation. In addition to natural near-infrared (NIR), human skin is increasingly exposed to artificial NIR from medical devices and electrical appliances. Thus, we are exposed to tremendous amounts of NIR. Many studies have proven the effects of UV exposure on human skin and skin cancers but have not investigated well the effects of NIR exposure. Furthermore, many of the previous NIR studies have used NIR resources without a water filter or a contact cooling. With these resources, a substantial amount of NIR energy is absorbed in the superficial layers and only limited NIR energy can be delivered to deeper tissues. Thus, they could not sufficiently evaluate the effects of incident solar NIR. In order to simulate solar NIR that reaches the skin, a water filter is essential because solar NIR is filtered by atmospheric water. In reality, NIR increases the surface temperature and induces thermal effects so a contact cooling is needed to pursue the properties of NIR. I clarify that NIR can penetrate the skin and non-thermally affect the subcutaneous tissues, including muscle and bone marrow, using a NIR resource with a water filter and a cooling system. I would like to emphasize the biological effects of NIR which have both merits and demerits. Appropriate NIR irradiation induces dermal heating thermally and non-thermally induces collagen and elastin stimulation, which results in skin tightening. NIR also induces non-thermal DNA damage of mitotic cells, which may have the potential application for treating cancer. However, as continuous NIR exposure may induce photoaging and potentially photocarcinogenesis, we should consider the effect of, not only UV, but also NIR and the necessity for protection against solar NIR. Here, this paper introduces the new aspects of the biological effects of NIR radiation.

Non-thermal DNA damage of cancer cells using near-infrared irradiation

Previously, we reported that near-infrared irradiation that simulates solar near-infrared irradiation with pre- and parallel-irradiational cooling can non-thermally induce cytocidal effects in cancer cells. To explore these effects, we assessed cell viability, DNA damage response pathways, and the percentage of mitotic cancer cells after near-infrared treatment. Further, we evaluated the anti-cancer effects of near-infrared irradiation compared with doxorubicin in xenografts in nude mice by measuring tumor volume and assessing protein phosphorylation by immunoblot analysis. The cell viability of A549 lung adenocarcinoma cells was significantly decreased after three rounds of near-infrared irradiation at 20 J/cm(2). Apoptotic cells were observed in near-infrared treated cells. Moreover, near-infrared treatment increased the phosphorylation of ataxia-telangiectasia mutated (ATM) at Ser(1981), H2AX at Ser(139), Chk1 at Ser(317), structural maintenance of chromosome (SMC) 1 at Ser(966), and p53 at Ser(15) in A549 cells compared with control. Notably, near-infrared treatment induced the formation of nucleic foci of γH2AX. The percentage of mitotic A549 cells, as measured by histone H3 phosphorylation, decreased significantly after three rounds of near-infrared irradiation at 20 J/cm(2). Both near-infrared and doxorubicin inhibited the tumor growth of MDA-MB435 melanoma cell xenografts in nude mice and increased the phosphorylation of p53 at Ser(15), Chk1 at Ser(317), SMC1 at Ser(966), and H2AX at Ser(139) compared with control mice. These results indicate that near-infrared irradiation can non-thermally induce cytocidal effects in cancer cells as a result of activation of the DNA damage response pathway. The near-infrared irradiation schedule used here reduces discomfort and side effects. Therefore, this strategy may have potential application in the treatment of cancer.

Non-thermal DNA damage of cancer cells using near-infrared irradiation

Previously, we reported that near-infrared irradiation that simulates solar near-infrared irradiation with pre- and parallel-irradiational cooling can non-thermally induce cytocidal effects in cancer cells. To explore these effects, we assessed cell viability, DNA damage response pathways, and the percentage of mitotic cancer cells after near-infrared treatment. Further, we evaluated the anti-cancer effects of near-infrared irradiation compared with doxorubicin in xenografts in nude mice by measuring tumor volume and assessing protein phosphorylation by immunoblot analysis. The cell viability of A549 lung adenocarcinoma cells was significantly decreased after three rounds of near-infrared irradiation at 20 J/cm(2). Apoptotic cells were observed in near-infrared treated cells. Moreover, near-infrared treatment increased the phosphorylation of ataxia-telangiectasia mutated (ATM) at Ser(1981), H2AX at Ser(139), Chk1 at Ser(317), structural maintenance of chromosome (SMC) 1 at Ser(966), and p53 at Ser(15) in A549 cells compared with control. Notably, near-infrared treatment induced the formation of nucleic foci of γH2AX. The percentage of mitotic A549 cells, as measured by histone H3 phosphorylation, decreased significantly after three rounds of near-infrared irradiation at 20 J/cm(2). Both near-infrared and doxorubicin inhibited the tumor growth of MDA-MB435 melanoma cell xenografts in nude mice and increased the phosphorylation of p53 at Ser(15), Chk1 at Ser(317), SMC1 at Ser(966), and H2AX at Ser(139) compared with control mice. These results indicate that near-infrared irradiation can non-thermally induce cytocidal effects in cancer cells as a result of activation of the DNA damage response pathway. The near-infrared irradiation schedule used here reduces discomfort and side effects. Therefore, this strategy may have potential application in the treatment of cancer.

Objective assessment of skin rejuvenation using near-infrared 1064-nm neodymium: YAG laser in Asians

BACKGROUND

We reported previously that near-infrared (NIR) irradiation provides long-lasting stimulation of elastin, and is efficient for skin rejuvenation. Many studies have indicated the efficacy of various types of laser, but did not include sufficiently objective evaluation. Therefore, we evaluated the efficacy of NIR laser treatment not only subjectively but also objectively.

METHODS

Fifty Japanese patients were treated with a NIR 1064-nm neodymium: YAG laser. Objective computer assessments were performed by Canfield VISIA Complexion Analysis for improvement of dilated pores, skin texture, and wrinkles. The volunteers then provided subjective assessments. Histological evaluations of elastin were performed by Victoria blue staining up to 90 days post-treatment in four Japanese volunteers.

RESULTS

Mean pretreatment percentiles of dilated pores, skin texture, and wrinkles were 51.08 ± 24.82, 54.7 ± 26.33, and 58.02 ± 28.61, respectively. Mean post-treatment percentiles of dilated pores, skin texture, and wrinkles were 53.58 ± 23.89, 58.58 ± 24.44, and 62.2 ± 25.39, respectively. All objective computer assessments evaluated by percentiles in dilated pores, skin texture, and wrinkles showed significant improvement after NIR laser treatment. Ninety-six percent, 100%, and 98% of volunteers reported satisfaction with the improvement of dilated pores, skin texture, and wrinkles, respectively. NIR laser treatment appeared to increase the amount of elastin at day 30, which then decreased slightly but was still elevated at day 90 compared with nonirradiated controls on day 0. Thickening of the epidermis was detected on day 30, and epidermal smoothness persisted for up to 90 days. No treatment-related adverse events were observed.

CONCLUSIONS

NIR irradiation increased elastin in the dermis, and achieved skin rejuvenation. The results indicated that NIR irradiation provides safe and effective long-term stimulation of elastin, which is beneficial for improving dilated pores, skin texture, and wrinkles.

Aging facial skin: infrared broad band light technologies

The application of infrared broadband light is the more recent addition of nonsurgical laser and light-based treatment for skin laxity and rhytids. Infrared broadband light, when used with the mobile technique, offers a painless, safe, nonsurgical alternative treatment option for treatment of skin laxity on the face and neck. Multiple clinical studies have demonstrated improvements in skin laxity correlated histologically with neocollagenesis and neoelastogenesis over a 6-12 month period. The consistency of clinical improvement in skin laxity supports the use of this approach for moderate skin laxity.

Long-term histological comparison between near-infrared irradiated skin and scar tissues

Background and objective:

Our previous histological studies indicated that near-infrared (NIR) irradiation stimulates collagen proliferation in rat and human skin for 3 months. High collagen density in the dermis and smoothing of the epidermis were observed in irradiated rat skin, and appeared to last up to 6 months. Epidermal smoothness in irradiated rat skin seems to resemble scarring. Here, we performed a long-term histological comparison between NIR (1100 to 1800 nm) irradiated skin and scar tissues.

Materials and methods:

Rat skin was irradiated using a NIR device. Scar tissues were harvested from wounded areas and were compared with irradiated skin. Histological changes up to 180 days post-treatment were evaluated with hematoxylin and eosin, Azan-Mallory staining, and collagen type I and III staining.

Results:

In nonirradiated control skin, the dermis showed a low density of type I and III collagen, the surface of the epidermis was rough, and no significant changes were observed over time. In irradiated skin, both type I and III collagen increased significantly, and persisted up to 180 days. The density of type I collagen was significantly higher than that of type III collagen, whereas type I and III collagen of the control group did not differ significantly. Epidermis was thickened for 30 days, and epidermal smoothness persisted up to 180 days. In scar tissues, the density of type III collagen was higher than that of type I collagen. The number of fibroblasts remained high and the glial fibrils were dense until 180 days after injury compared with irradiated skin. Significant increases in both type I and III collagen and epidermal flattering persisted until 180 days.

Conclusions:

NIR irradiation induced high collagen density in the dermis, resulting in long-term epidermal smoothness without scar formation. Results indicated that NIR irradiation provides safe, consistent, and long-term effects of skin rejuvenation.

Non-thermal cytocidal effect of infrared irradiation on cultured cancer cells using specialized device

As infrared penetrates the skin, thermal effects of infrared irradiation on cancer cells have been investigated in the field of hyperthermia. We evaluated non-thermal effects of infrared irradiation using a specialized device (1100-18000 nm with filtering of wavelengths between 1400 and 1500 nm and contact cooling) on cancer cells. In in vitro study, five kinds of cultured cancer cell lines (MCF7 breast cancer, HeLa uterine cervical cancer, NUGC-4 gastric cancer, B16F0 melanoma, and MDA-MB435 melanoma) were irradiated using the infrared device, and then the cell proliferation activity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS) assay. Proliferation of all the cancer cell lines was significantly suppressed by infrared irradiation. Total infrared output appeared to be correlated with cell survival. Increased temperature during infrared irradiation appeared not to play a role in cell survival. The maximum temperature elevation in the wells after each shot in the 20 and 40 J/cm(2) culture was 3.8 degrees C and 6.9 degrees C, respectively. In addition, we have shown that infrared irradiation significantly inhibited the tumor growth of MCF7 breast cancer transplanted in severe combined immunodeficiency mice and MDA-MB435 melanoma transplanted in nude mice in vivo. Significant differences between control and irradiated groups were observed in tumor volume and frequencies of TUNEL-positive and Ki-67-positive cells. These results indicate that infrared, independent of thermal energy, can induce cell killing of cancer cells. As this infrared irradiation schedule reduces discomfort and side effects, reaches the deep subcutaneous tissues, and facilitates repeated irradiations, it may have potential as an application for treating various forms of cancer.

The other end of the rainbow: infrared and skin

Although infrared radiation (IRR) is ubiquitous in the terrestrial milieu, its effects on human skin have until now been largely ignored. Recent studies suggest an important role for infrared A (IRA) radiation (760-1440 nm) in dermal inflammation, photoaging, and photocarcinogenesis. In this issue, Calles et al. identify and analyze the IRA-induced transcriptome in human dermal fibroblasts. Their work paves the way for new research directions in IRA photobiology and raises important clinical questions regarding photoprotection and IRR-based dermatotherapy.