Effects of low-level laser therapy, electroacupuncture, and radiofrequency on the pigmentation and skin tone of adult women
Identifieur interne : 000776 ( Pmc/Corpus ); précédent : 000775; suivant : 000777Effects of low-level laser therapy, electroacupuncture, and radiofrequency on the pigmentation and skin tone of adult women
Auteurs : Hee-Kyoung Kim ; Kyoung-Ok Min ; Jung-Hyun Choi ; Soon-Hee KimSource :
- Journal of Physical Therapy Science [ 0915-5287 ] ; 2016.
Abstract
[Purpose] In this study, the effects of low-level laser therapy (LLLT), electroacupuncture (EA), and radiofrequency (RF), which are used in physical therapy, on the pigmentation and skin tone of adult women’s faces were investigated to provide basic data for skin interventions. [Subjects and Methods] Thirty adult females were assigned to either an LLLT group (n=10), an EA group (n=10), or an RF group (n=10). The intervention was performed in two 15-minute sessions per week for six weeks. Subjects’ skin tone and pigmentation were observed before and after the intervention. [Results] The EA group showed significant reductions in pigmentation in the left and right eye rims, as well as in the left cheek. The RF group showed significant post-intervention reductions in pigmentation under the left eye, as well as in the left and right eye rims and the left cheek. The LLLT group showed significant increases in skin tone in the forehead and both eye rims. The RF group showed significant increases in skin tone under both eyes. [Conclusion] The application of LLLT, EA, and RF had positive effects on pigmentation and skin tone of adult women’s faces.
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DOI: 10.1589/jpts.28.1407
PubMed: 27313340
PubMed Central: 4905879
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effects of low-level laser therapy, electroacupuncture, and radiofrequency on
the pigmentation and skin tone of adult women</title><author><name sortKey="Kim, Hee Kyoung" sort="Kim, Hee Kyoung" uniqKey="Kim H" first="Hee-Kyoung" last="Kim">Hee-Kyoung Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Min, Kyoung Ok" sort="Min, Kyoung Ok" uniqKey="Min K" first="Kyoung-Ok" last="Min">Kyoung-Ok Min</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Choi, Jung Hyun" sort="Choi, Jung Hyun" uniqKey="Choi J" first="Jung-Hyun" last="Choi">Jung-Hyun Choi</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Soon Hee" sort="Kim, Soon Hee" uniqKey="Kim S" first="Soon-Hee" last="Kim">Soon-Hee Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27313340</idno><idno type="pmc">4905879</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905879</idno><idno type="RBID">PMC:4905879</idno><idno type="doi">10.1589/jpts.28.1407</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000776</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000776</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effects of low-level laser therapy, electroacupuncture, and radiofrequency on
the pigmentation and skin tone of adult women</title><author><name sortKey="Kim, Hee Kyoung" sort="Kim, Hee Kyoung" uniqKey="Kim H" first="Hee-Kyoung" last="Kim">Hee-Kyoung Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Min, Kyoung Ok" sort="Min, Kyoung Ok" uniqKey="Min K" first="Kyoung-Ok" last="Min">Kyoung-Ok Min</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Choi, Jung Hyun" sort="Choi, Jung Hyun" uniqKey="Choi J" first="Jung-Hyun" last="Choi">Jung-Hyun Choi</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author><author><name sortKey="Kim, Soon Hee" sort="Kim, Soon Hee" uniqKey="Kim S" first="Soon-Hee" last="Kim">Soon-Hee Kim</name><affiliation><nlm:aff>NONE</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Physical Therapy Science</title><idno type="ISSN">0915-5287</idno><idno type="eISSN">2187-5626</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>[Purpose] In this study, the effects of low-level laser therapy (LLLT),
electroacupuncture (EA), and radiofrequency (RF), which are used in physical therapy, on
the pigmentation and skin tone of adult women’s faces were investigated to provide basic
data for skin interventions. [Subjects and Methods] Thirty adult females were assigned to
either an LLLT group (n=10), an EA group (n=10), or an RF group (n=10). The intervention
was performed in two 15-minute sessions per week for six weeks. Subjects’ skin tone and
pigmentation were observed before and after the intervention. [Results] The EA group
showed significant reductions in pigmentation in the left and right eye rims, as well as
in the left cheek. The RF group showed significant post-intervention reductions in
pigmentation under the left eye, as well as in the left and right eye rims and the left
cheek. The LLLT group showed significant increases in skin tone in the forehead and both
eye rims. The RF group showed significant increases in skin tone under both eyes.
[Conclusion] The application of LLLT, EA, and RF had positive effects on pigmentation and
skin tone of adult women’s faces.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Puizina Ivi, N" uniqKey="Puizina Ivi N">N Puizina-Ivić</name></author><author><name sortKey="Miri, L" uniqKey="Miri L">L Mirić</name></author><author><name sortKey="Carija, A" uniqKey="Carija A">A Carija</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zelickson, Bd" uniqKey="Zelickson B">BD Zelickson</name></author><author><name sortKey="Kist, D" uniqKey="Kist D">D Kist</name></author><author><name sortKey="Bernstein, E" uniqKey="Bernstein E">E Bernstein</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kottner, J" uniqKey="Kottner J">J Kottner</name></author><author><name sortKey="Lichterfeld, A" uniqKey="Lichterfeld A">A Lichterfeld</name></author><author><name sortKey="Blume Peytavi, U" uniqKey="Blume Peytavi U">U 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Phys Ther Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Phys Ther Sci</journal-id><journal-id journal-id-type="publisher-id">JPTS</journal-id><journal-title-group><journal-title>Journal of Physical Therapy Science</journal-title></journal-title-group><issn pub-type="ppub">0915-5287</issn><issn pub-type="epub">2187-5626</issn><publisher><publisher-name>The Society of Physical Therapy Science</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27313340</article-id><article-id pub-id-type="pmc">4905879</article-id><article-id pub-id-type="publisher-id">jpts-2015-1023</article-id><article-id pub-id-type="doi">10.1589/jpts.28.1407</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Effects of low-level laser therapy, electroacupuncture, and radiofrequency on
the pigmentation and skin tone of adult women</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Hee-Kyoung</given-names></name><degrees>PhD, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Min</surname><given-names>Kyoung-Ok</given-names></name><degrees>PhD, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Choi</surname><given-names>Jung-Hyun</given-names></name><degrees>PhD, PT</degrees><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kim</surname><given-names>Soon-Hee</given-names></name><degrees>PhD, PT</degrees><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="cor1" ref-type="corresp"><sup>*</sup></xref></contrib><aff id="aff1"><label>1)</label> Department of Physical Therapy, Yongin University, Republic of Korea</aff><aff id="aff2"><label>2)</label> Department of Physical Therapy, Institute for Elderly Health and Welfare, Namseoul University, Republic of Korea</aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author. Soon-Hee Kim, Department of Physical Therapy, Yongin University: 470
Samga-dong, Cheoin-gu, Yongin, Republic of Korea. (E-mail: <email xlink:href="shkim2776@empas.com">shkim2776@empas.com</email>)</corresp></author-notes><pub-date pub-type="epub"><day>31</day><month>5</month><year>2016</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2016</year></pub-date><volume>28</volume><issue>5</issue><fpage>1407</fpage><lpage>1411</lpage><history><date date-type="received"><day>30</day><month>11</month><year>2015</year></date><date date-type="accepted"><day>19</day><month>1</month><year>2016</year></date></history><permissions><copyright-statement>2016©by the Society of Physical Therapy Science. Published by IPEC
Inc.</copyright-statement><copyright-year>2016</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd) License. </license-p></license></permissions><abstract><p>[Purpose] In this study, the effects of low-level laser therapy (LLLT),
electroacupuncture (EA), and radiofrequency (RF), which are used in physical therapy, on
the pigmentation and skin tone of adult women’s faces were investigated to provide basic
data for skin interventions. [Subjects and Methods] Thirty adult females were assigned to
either an LLLT group (n=10), an EA group (n=10), or an RF group (n=10). The intervention
was performed in two 15-minute sessions per week for six weeks. Subjects’ skin tone and
pigmentation were observed before and after the intervention. [Results] The EA group
showed significant reductions in pigmentation in the left and right eye rims, as well as
in the left cheek. The RF group showed significant post-intervention reductions in
pigmentation under the left eye, as well as in the left and right eye rims and the left
cheek. The LLLT group showed significant increases in skin tone in the forehead and both
eye rims. The RF group showed significant increases in skin tone under both eyes.
[Conclusion] The application of LLLT, EA, and RF had positive effects on pigmentation and
skin tone of adult women’s faces.</p></abstract><kwd-group><title>Key words</title><kwd>Low-level laser therapy</kwd><kwd>Electroacupuncture</kwd><kwd>Radiofrequency</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="s1"><title>INTRODUCTION</title><p>Studies related to anti-aging are currently being conducted actively around the world, and
the related markets are growing fast. In particular, many studies are being conducted on
delaying the skin aging process, as people have an increasing interest in changing their
external form as well as the functional aspects of their bodies to increase their
self-esteem<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>. Furthermore, with the
development of industry, interest in the effects of air contamination and environmental
pollution on the skin and the body is rising, which has led to rising interest in scientific
skin management and the introduction of various new skin care devices<xref rid="r2" ref-type="bibr">2</xref><sup>)</sup>.</p><p>Skin aging can be classified into two categories: intrinsic aging which develops naturally
with age, and aging caused by the external environment<xref rid="r3" ref-type="bibr">3</xref><sup>)</sup>. Intrinsic aging appears as wrinkles, sagging, and pigmentation,
whereas aging caused by the external environment, e.g. ultraviolet rays, wind, coldness,
dryness, and tobacco, appears as skin roughness, vasodilatation, actinic keratosis, and
solar lentigo, which are generated only in exposed regions<xref rid="r4" ref-type="bibr">4</xref><sup>)</sup>. In particular, skin photo-aging by UV rays leads to acute reactions
of erythema and edema, which increase the incidence of skin cancer and chronic reactions
such as skin pigmentation. Such pigmentation appears when melanin pigments are synthesized
excessively in melanin cells exposed to UV rays or when the physiological functions of the
skin deteriorate. When this happens, pigments are deposited in the horny cells of the
epidermis, which appear as melasma and freckles<xref rid="r5" ref-type="bibr">5</xref><sup>)</sup>. Various therapies to improve skin aging are being researched in
dermatology, and various laser treatments, chemical peels, surgical treatments, fillers, and
Botox are being used<xref rid="r6" ref-type="bibr">6</xref>,<xref rid="r7" ref-type="bibr">7</xref>,<xref rid="r8" ref-type="bibr">8</xref>,<xref rid="r9" ref-type="bibr">9</xref><sup>)</sup>.</p><p>The effects of low-level laser therapy (LLLT) include reduced inflammation, improved
lymphedema, relief of pain, and accelerated cell metabolism and cell division, which promote
skin regeneration and help facilitate wound healing. It is also effective in collagen
generation, acne treatment, wrinkle improvement, and skin laxity<xref rid="r10" ref-type="bibr">10</xref>,<xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r13" ref-type="bibr">13</xref>,<xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r16" ref-type="bibr">16</xref><sup>)</sup>. Electroacupuncture (EA) has been reported to accelerate
the healing of wound tissues, and to elicit anti-inflammation effects, wrinkle improvements,
and the reduction of face edema<xref rid="r17" ref-type="bibr">17</xref>,<xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r19" ref-type="bibr">19</xref><sup>)</sup>.
Radiofrequency (RF) has been reported to be effective at reducing of wrinkles and in the
treatment of acne scars by increasing blood circulation and promoting collagen generation,
as well as reducing abdominal obesity<xref rid="r11" ref-type="bibr">11</xref>, <xref rid="r20" ref-type="bibr">20</xref>,<xref rid="r21" ref-type="bibr">21</xref>,<xref rid="r22" ref-type="bibr">22</xref><sup>)</sup>.</p><p>This study was conducted to observe the effects of LLLT, EA, and RF, which are used in
physical therapy, on the pigmentation and skin tone of adult women’s faces to provide basic
data on skin interventions.</p></sec><sec sec-type="methods" id="s2"><title>SUBJECTS AND METHODS</title><p>The subjects of this study were 30 adult women between 30 and 55 years of age who visited M
Dermatology Hospital in Yongin, Gyeonggi-do, South Korea and who voluntarily agreed to
participate after listening to an explanation of the purpose of this study. The subjects
were assigned to a LLLT group, (n=10), an EA group (n=10), and an RF group (n=10). The
intervention was performed in two 15-minute sessions per week for six weeks. Their skin tone
and pigmentation were observed pre and post intervention. Inter-group homogeneity testing
for general characteristics before treatment revealed no significant differences. Written
informed consent was obtained from each subject. The Ethics Committee of Namseoul
University, South Korea approved the study. The IRB approval number is
Research-104147-201504-HR-003. The characteristics of the subjects are shown in <xref rid="tbl_001" ref-type="table">Table 1</xref><table-wrap id="tbl_001" orientation="portrait" position="float"><label>Table 1.</label><caption><title>General characteristics</title></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1">Variables</th><th align="center" rowspan="1" colspan="1">LLLT (n=10)</th><th align="center" rowspan="1" colspan="1">EA (n=10)</th><th align="center" rowspan="1" colspan="1">RF (n=10)</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age (yrs)</td><td align="center" rowspan="1" colspan="1">42.8 ± 4.9</td><td align="center" rowspan="1" colspan="1">43.4 ± 7.1</td><td align="center" rowspan="1" colspan="1">42.9 ± 3.7</td></tr><tr><td align="left" rowspan="1" colspan="1">Height (cm)</td><td align="center" rowspan="1" colspan="1">163.0 ± 7.9</td><td align="center" rowspan="1" colspan="1">158.0 ± 4.3</td><td align="center" rowspan="1" colspan="1">159.8 ± 4.3</td></tr><tr><td align="left" rowspan="1" colspan="1">Weight (kg)</td><td align="center" rowspan="1" colspan="1">56.7 ± 7.5</td><td align="center" rowspan="1" colspan="1">58.8 ± 7.2</td><td align="center" rowspan="1" colspan="1">52.4 ± 6.1</td></tr></tbody></table><table-wrap-foot><p>Values are shown as the mean ± SD. LLLT: low-level laser therapy group, RF:
radiofrequency group, EA: electroacupuncture group</p></table-wrap-foot></table-wrap>.</p><p>For the LLLT group, RedPulsar (SOMETECH Inc., Korea), which is a diode laser, was used the
treatment sessions. It is a class IIIb laser with a wavelength of 635 nm, and power output
of 10 mW<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup>. For the RF group, PRIX III
(SHENB Co., Ltd, Korea) was used at a frequency of 1 MHz (RF energy, maximum
450 W/cm<sup>2</sup>) the treatment sessions<xref rid="r24" ref-type="bibr">24</xref><sup>)</sup>. For the EA group, disposable stainless steel acupuncture with a
size of 0.20 × 15 mm was used. For the EA stimulator, an OTS H-306 (HANIL TM Co., Ltd.,
Korea) was used with operating conditions of a frequency of 3 Hz, 5 seconds of on time, and
2 seconds of off time. EA was performed at a clinical practice by a therapist with 10 years
experience. The intensity of the EA was increased until the subject felt simulation and a
little muscular contraction and was then maintained<xref rid="r19" ref-type="bibr">19</xref><sup>)</sup>.</p><p>For the skin measurement, JANUS (PSI Co., Ltd., Korea) was used. After the face was fixed
at a certain position and external light sources were blocked, the facial skin conditions
under irradiation by white light, polarized light and UV light were captured with a Canon
DSLR camera with 10-million pixelresolution. For the measurement of pigmentation and skin
tone, the measurement areas were set and measured ratios of each variable. To minimize the
measurement errors, the same rater performed measurements from the beginning to the end in
similar indoor environments (room temperature 20–21 °C and humidity 50–60%).</p><p>All data were coded and analyzed using the statistical analysis program SPSS (ver.18). To
determine the post-intervention changes in pigmentation and skin tone in each group, a test
of normality was conducted. If subjects passed the test, a paired samples t-test was
conducted; otherwise, the Wilcoxon rank-sum test was performed. To determine the inter-group
differences in pigmentation and skin tone, one-way ANOVA was used when the data satisfied
normality; otherwise, the significance of differnces was verified by the Kruskal-Wallis
test. Significance was accepted for values of p<0.05.</p></sec><sec sec-type="results" id="s3"><title>RESULTS</title><p>The LLLT group showed no significant changes in post-intervention pigmentation (p>0.05).
The EA group showed significant decreases in pigmentation in the left and right eye rims
(p<0.05), as well as in left the cheek (p<0.05). The RF group showed significant
decreases in pigmentation under the left eye (p<0.05), as well as in the left and right
eye rims and the left cheek (p<0.05). The inter-group differences in the pigmentation
changes were significant for the nose and left eye rim (p<0.05) (<xref rid="tbl_002" ref-type="table">Table 2</xref><table-wrap id="tbl_002" orientation="portrait" position="float"><label>Table 2.</label><caption><title>Comparison of the intra-group and inter-group changes in pigmentation among the
LLLT, EA, and RF groups</title></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="2" align="left" rowspan="1">Pigmentation</th><th align="center" rowspan="1" colspan="1">Intervention</th><th align="center" rowspan="1" colspan="1">Pre</th><th align="center" rowspan="1" colspan="1">Post</th></tr></thead><tbody><tr><td align="left" rowspan="3" colspan="2"><sup>a</sup>Forehead</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">12.8 ± 7.0</td><td align="center" rowspan="1" colspan="1">12.9 ± 7.1</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">16.2 ± 5.3</td><td align="center" rowspan="1" colspan="1">15.3 ± 5.4</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">12.9 ± 7.6</td><td align="center" rowspan="1" colspan="1">13.3 ± 7.3</td></tr><tr><td align="left" rowspan="3" colspan="2"><sup>b</sup>Nose<sup>1,3<2</sup></td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">19.2 ± 8.0</td><td align="center" rowspan="1" colspan="1">18.7 ± 7.5</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">23.8 ± 7.1</td><td align="center" rowspan="1" colspan="1">23.0 ± 6.8</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">20.1 ± 9.6</td><td align="center" rowspan="1" colspan="1">20.5 ± 9.4</td></tr><tr><td align="left" rowspan="6" colspan="1"><sup>a</sup>Under eyes</td><td align="left" rowspan="3" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">26.2 ± 7.5</td><td align="center" rowspan="1" colspan="1">25.0 ± 7.2</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">24.4 ± 7.0</td><td align="center" rowspan="1" colspan="1">23.3 ± 5.7</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">23.3 ± 10.5</td><td align="center" rowspan="1" colspan="1">21.8 ± 9.3</td></tr><tr><td align="left" rowspan="3" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">24.4 ± 7.7</td><td align="center" rowspan="1" colspan="1">22.6 ± 7.1</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">27.8 ± 8.3</td><td align="center" rowspan="1" colspan="1">25.1 ± 8.0</td></tr><tr><td align="center" rowspan="1" colspan="1">RF<sup>*</sup></td><td align="center" rowspan="1" colspan="1">23.6 ± 12.7</td><td align="center" rowspan="1" colspan="1">22.1 ± 12.7</td></tr><tr><td align="left" rowspan="6" colspan="1"><sup>a</sup>Eye rims</td><td align="left" rowspan="3" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">26.1 ± 8.7</td><td align="center" rowspan="1" colspan="1">25.8 ± 8.6</td></tr><tr><td align="center" rowspan="1" colspan="1">EA<sup>*</sup></td><td align="center" rowspan="1" colspan="1">25.8 ± 7.7</td><td align="center" rowspan="1" colspan="1">22.1 ± 7.6</td></tr><tr><td align="center" rowspan="1" colspan="1">RF<sup>*</sup></td><td align="center" rowspan="1" colspan="1">24.8 ± 8.9</td><td align="center" rowspan="1" colspan="1">23.4 ± 9.1</td></tr><tr><td align="left" rowspan="3" colspan="1">Left<sup>2,3<1</sup></td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">26.0 ± 10.3</td><td align="center" rowspan="1" colspan="1">25.9 ± 9.2</td></tr><tr><td align="center" rowspan="1" colspan="1">EA<sup>*</sup></td><td align="center" rowspan="1" colspan="1">26.2 ± 6.4</td><td align="center" rowspan="1" colspan="1">22.2 ± 6.3</td></tr><tr><td align="center" rowspan="1" colspan="1">RF<sup>*</sup></td><td align="center" rowspan="1" colspan="1">27.5 ± 5.6</td><td align="center" rowspan="1" colspan="1">24.5 ± 6.3</td></tr><tr><td align="left" rowspan="6" colspan="1"><sup>a</sup>Cheeks</td><td align="left" rowspan="3" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">28.5 ± 10.6</td><td align="center" rowspan="1" colspan="1">28.4 ± 10.3</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">26.6 ± 6.6</td><td align="center" rowspan="1" colspan="1">25.6 ± 6.1</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">25.7 ± 10.7</td><td align="center" rowspan="1" colspan="1">27.4 ± 10.8</td></tr><tr><td align="left" rowspan="3" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">26.7 ± 10.7</td><td align="center" rowspan="1" colspan="1">26.7 ± 10.2</td></tr><tr><td align="center" rowspan="1" colspan="1">EA<sup>*</sup></td><td align="center" rowspan="1" colspan="1">27.9 ± 8.3</td><td align="center" rowspan="1" colspan="1">25.7 ± 8.1</td></tr><tr><td align="center" rowspan="1" colspan="1">RF<sup>*</sup></td><td align="center" rowspan="1" colspan="1">27.2 ± 11.3</td><td align="center" rowspan="1" colspan="1">25.8 ± 10.7</td></tr></tbody></table><table-wrap-foot><p>Values are shown as the mean ± SD. *Significant difference between (p<0.05) the
pre- and post-tests within each group: <sup>a</sup>Paired samples t-test,
<sup>b</sup>Wilcoxon rank-sum test. LLLT: low-level laser therapy, EA:
electroacupuncture, RF: radiofrequency, 1: LLLT, 2: EA, 3: RF</p></table-wrap-foot></table-wrap>).</p><p>The LLLT group showed significant increases in skin tone in the forehead and both eye rims
post intervention. (p<0.05). The EA group did not show any significant changes in skin
tone (p<0.05). The RF group showed significant increases in skin tone under the left and
right under eyes (p<0.05). The inter-group differences in the skin tone changes were
insignificant (p>0.05) (<xref rid="tbl_003" ref-type="table">Table 3</xref><table-wrap id="tbl_003" orientation="portrait" position="float"><label>Table 3.</label><caption><title>Comparison of the intra-group and inter-group changes in skin tone among the
LLLT, EA, and RF groups</title></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="2" align="center" rowspan="1">Skin tone</th><th align="center" rowspan="1" colspan="1">Intervention</th><th align="center" rowspan="1" colspan="1">Pre</th><th align="center" rowspan="1" colspan="1">Post</th></tr></thead><tbody><tr><td align="left" rowspan="3" colspan="2"><sup>a</sup>Forehead</td><td align="center" rowspan="1" colspan="1">LLLT<sup>*</sup></td><td align="center" rowspan="1" colspan="1">57.2 ± 2.6</td><td align="center" rowspan="1" colspan="1">60.2 ± 2.0<sup>*</sup></td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">55.9 ± 3.0</td><td align="center" rowspan="1" colspan="1">55.9 ± 3.2</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">56.9 ± 3.6</td><td align="center" rowspan="1" colspan="1">55.6 ± 3.8</td></tr><tr><td align="left" rowspan="3" colspan="2"><sup>b</sup>Nose</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">52.8 ± 2.8</td><td align="center" rowspan="1" colspan="1">52.7 ± 2.5</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">51.8 ± 2.0</td><td align="center" rowspan="1" colspan="1">51.4 ± 2.9</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">52.6 ± 3.3</td><td align="center" rowspan="1" colspan="1">55.6 ± 3.8</td></tr><tr><td align="left" rowspan="6" colspan="1"><sup>a</sup>Under eyes</td><td align="left" rowspan="3" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">46.2 ± 3.8</td><td align="center" rowspan="1" colspan="1">47.1 ± 3.9</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">47.8 ± 2.8</td><td align="center" rowspan="1" colspan="1">47.9 ± 3.1</td></tr><tr><td align="center" rowspan="1" colspan="1">RF<sup>*</sup></td><td align="left" rowspan="1" colspan="1">47.0 ± 3.0</td><td align="left" rowspan="1" colspan="1">48.3 ± 3.9</td></tr><tr><td align="left" rowspan="3" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">47.2 ± 3.8</td><td align="center" rowspan="1" colspan="1">48.1 ± 3.6</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">48.3 ± 3.0</td><td align="center" rowspan="1" colspan="1">48.4 ± 3.4</td></tr><tr><td align="center" rowspan="1" colspan="1">RF<sup>*</sup></td><td align="center" rowspan="1" colspan="1">47.6 ± 3.2</td><td align="center" rowspan="1" colspan="1">49.0 ± 3.5</td></tr><tr><td align="left" rowspan="6" colspan="1"><sup>a</sup>Eye rims</td><td align="left" rowspan="3" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">LLLT<sup>*</sup></td><td align="center" rowspan="1" colspan="1">48.7 ± 5.2</td><td align="center" rowspan="1" colspan="1">51.1 ± 5.3</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">49.5 ± 3.7</td><td align="center" rowspan="1" colspan="1">50.1 ± 3.9</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">50.8 ± 3.3</td><td align="center" rowspan="1" colspan="1">51.8 ± 3.5</td></tr><tr><td align="left" rowspan="3" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">LLLT<sup>*</sup></td><td align="center" rowspan="1" colspan="1">49.9 ± 4.6</td><td align="center" rowspan="1" colspan="1">51.5 ± 4.9</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">50.2 ± 3.6</td><td align="center" rowspan="1" colspan="1">50.4 ± 4.1</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">50.6 ± 3.7</td><td align="center" rowspan="1" colspan="1">51.7 ± 4.0</td></tr><tr><td align="left" rowspan="6" colspan="1"><sup>a</sup>Cheeks</td><td align="left" rowspan="3" colspan="1">Right</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">50.0 ± 3.6</td><td align="center" rowspan="1" colspan="1">50.2 ± 3.2</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">49.7 ± 2.2</td><td align="center" rowspan="1" colspan="1">48.9 ± 3.5</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">50.0 ± 3.3</td><td align="center" rowspan="1" colspan="1">50.5 ± 4.1</td></tr><tr><td align="left" rowspan="3" colspan="1">Left</td><td align="center" rowspan="1" colspan="1">LLLT</td><td align="center" rowspan="1" colspan="1">51.7 ± 3.9</td><td align="center" rowspan="1" colspan="1">51.8 ± 3.9</td></tr><tr><td align="center" rowspan="1" colspan="1">EA</td><td align="center" rowspan="1" colspan="1">50.70 ± 2.7</td><td align="center" rowspan="1" colspan="1">50.2 ± 3.5</td></tr><tr><td align="center" rowspan="1" colspan="1">RF</td><td align="center" rowspan="1" colspan="1">51.3 ± 3.5</td><td align="center" rowspan="1" colspan="1">51.6 ± 4.03</td></tr></tbody></table><table-wrap-foot><p>Values are shown as the mean ± SD. *Significant difference between (p<0.05) the
pre- and post-tests within each group: <sup>a</sup>Paired samples t-test,
<sup>b</sup>Wilcoxon rank-sum test. LLLT: low-level laser therapy, EA:
electroacupuncture, RF: radiofrequency, 1: LLLT, 2: EA, 3: RF</p></table-wrap-foot></table-wrap>).</p></sec><sec sec-type="discussion" id="s4"><title>DISCUSSION</title><p>Aging refers to the physiological phenomenon in which structural and functional changes
naturally appear in entities over time. In particular, human skin is an organ that shows
clear changes with age. Skin aging can be classified into two categories: intrinsic aging
caused by genetic programming and aging caused by external environmental conditions, e.g.
exposure to UV rays, wind, heat, and tobacco<xref rid="r3" ref-type="bibr">3</xref>, <xref rid="r25" ref-type="bibr">25</xref><sup>)</sup>. The categories of skin aging appear in
various forms depending on the region and psychological stress. To overcome this process,
various efforts to delay the progress of skin aging are being made worldwide, and
anti-aging-related markets are growing rapidly<xref rid="r1" ref-type="bibr">1</xref><sup>)</sup>. In this study, the effects of LLLT, EA, and RF on the pigmentation
and skin tone of adult women’s faces were investigated.</p><p>Lee et al.<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup> found that the melanin
level significantly decreased after the irradiation by blue o red LED light (p<0.05).
Weiss et al.<xref rid="r12" ref-type="bibr">12</xref><sup>)</sup> also found that erythema
and pigmentation decreased in 90% of subjects. In their study, however, even though the
values decreased, the differences were not significant. In an EA experiment with diabetic
mice by Zhai et al.<xref rid="r26" ref-type="bibr">26</xref><sup>)</sup>, both the erythema
index and melanin index of the back skin decreased significantly. In a study by Budamakuntla
et al.<xref rid="r27" ref-type="bibr">27</xref><sup>)</sup>, the Melasma Area Severity Index
(MASI) significantly decreased after microneeding, which was identical to the finding of
this study.</p><p>Kim et al.<xref rid="r28" ref-type="bibr">28</xref><sup>)</sup> reported that after the
application of fractional RF, the melanin index and erythema index improved significantly.
In the present study, pigmentation significantly decreased under the left eye, and in the
right eye rim, the left eye rim, and the right cheek. Budamakuntla et al.<xref rid="r27" ref-type="bibr">27</xref><sup>)</sup> which compared a Tranexamic acid
microinjection group and a Tranexamic acid with microneedling group, and found the MASI of
the microneedling group significantly decreased from 9.11 ± 4.09 to 5.06 ± 2.14
post-treatment (p<0.001), but the intergroup differences were not significant. Choi et
al.<xref rid="r24" ref-type="bibr">24</xref><sup>)</sup> compared RF and ultrasound and
reported, the RF group showed a significant reduction in pigmentation compared to the
ultrasound group. In a study by Park et al.<xref rid="r29" ref-type="bibr">29</xref><sup>)</sup>, the pigmentation of subjects who received microneedle therapy
system (MTS) treatment significantly decreased compared to those receiving RF. In the
present study, the EA group showed better effects in terms of nose pigmentation, and the EA
and RF groups showed better results the left eye rim than the LLLT group.</p><p>Lee et al. reported that 14 out of 24 patients experienced an increase in skin tone after
being irradiated by red LED light<xref rid="r23" ref-type="bibr">23</xref><sup>)</sup>.
Similarly, in the present study, the skin tone of the LLLT group significantly increased in
the forehead, the right eye rim, and the left eye rim.</p><p>Fitzpatrick et al.<xref rid="r20" ref-type="bibr">20</xref><sup>)</sup> reported improved
skin tone after the application of RF. In the present study, the RF group showed significant
increases in skin tone under the left and right eyes. According to Tobin and Paus, skin tone
is generated by a mixture of melanin, hemoglobin, and carotene, with melanin having the
greatest effect. In the present study, the skin tone improved as a result of reduced
pigmentation<xref rid="r30" ref-type="bibr">30</xref><sup>)</sup>.</p><p>Barrett<xref rid="r19" ref-type="bibr">19</xref><sup>)</sup> also reported that skin tone
improved after the application of EA, and Fabbrocini et al.<xref rid="r31" ref-type="bibr">31</xref><sup>)</sup> reported that skin tone significantly increased in 17.4% of a group
who received skin needling and depigmenting serum treatment and in 11.2% of a group who
received depigmenting serum treatment only. In the present study, the EA group did not show
significant changes in skin tone post intervention. The reason for this seems to be the
differences between previous studies and the present study in terms of the electrical
variables of the EA and in the application of serum, which can affect skin tone. Therefore,
future studies need to take this into consideration.</p><p>This study had a few limitations. First, the number of subjects was small and only included
adult women between 30 and 55 years of age. Therefore, the findings of this study cannot be
generalized. Second, this study was conducted for a short period of only six weeks and the
long-term effects were not evaluated. In the future, adult women of a broader age group
should be studied, and long-term effects of more than six months should be verified.</p></sec></body><back><ref-list><title>REFERENCES</title><ref id="r1"><label>1</label><mixed-citation publication-type="journal"><person-group><name><surname>Puizina-Ivić</surname><given-names>N</given-names></name><name><surname>Mirić</surname><given-names>L</given-names></name><name><surname>Carija</surname><given-names>A</given-names></name><etal>et al.</etal></person-group>: <article-title>Modern approach to topical treatment of aging
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