Fundamental research on the action mechanism of the 800 nm semiconductor laser on skin blackheads and coarse pores.

The aim of the study was to determine the mechanism of action of the 800 nm semiconductor laser on skin blackheads and coarse pores. A total of 24 healthy purebred short-haired male guinea pigs, weighing 350-400 g, were selected and smeared with 0.5 ml coal tar suspension evenly by injector once daily. Treatment was continued for 14 days to form an experimental area of 8×3 cm on the back of the guinea pigs. The animals were divided into the following groups: Normal control group (NC), low-dose laser treatment group (L-LS), high-dose laser treatment group (H-LS), and Q-switched Nd:YAG treatment group (QC). Samples were extracted 1, 7 and 14 days after surgery and hematoxylin and eosin staining was used to identify the following: Epidermis, dermis, sebaceous gland change and hair follicle damage; the expression of proliferating cell nuclear antigen (PCNA) of sebaceous gland cells using immunohistochemistry; sebaceous gland cell apoptosis using TUNEL; and the protein expression of caspase-3, Bax and Bcl-2 using western blot analysis. With the extension of time, we observed inflammatory cell infiltration, an increase in hair follicle distortion and necrosis of the surrounding hair follicles. The expression levels of PCNA of the L-LS, H-LS and QC groups decreased with time. Regarding the respective time points, the NC group was highest, the L-LS and H-LS groups were next highest and the H-LS group was lowest. The difference was statistically significant (P<0.05). The apoptotic rate of the L-LS, H-LS and QC groups increased with time. With regard to the respective time points, the NC group was lowest, the L-LS and QC groups were next lowest and the H-LS group was highest. The difference was statistically significant (P<0.05). The protein expression of caspase-3, Bax and Bcl-2 of the L-LS, H-LS and QC groups increased with time. Regarding the respective time points, caspase-3 and Bax protein expression of the NC group was lowest, the L-LS and QC groups were next lowest and the H-LS group was highest. Bcl-2 protein expression of the NC group was highest, protein expression of the NC group was next highest and the H-LS group was lowest. The difference was statistically significant (P<0.05). In conclusion, the low-dose 800 nm semiconductor laser is an effective treatment on skin blackheads and coarse pores, and promotes hair follicle cell apoptosis without reducing the expression of PCNA.

Introduction

Blackhead analysis includes blackhead moles, keratosis pilaris, hair follicle ichthyosis, keratosis follicularis and trichostasis spinulosa (1). Pore analysis was divided into three kinds of pore structures: Sweat gland openings that are not visible to the naked eye; hair follicle sebaceous gland openings that are visible to the naked eye; and hair follicle sebaceous gland openings containing keratotic plug that are visible to the naked eye (2). The main reasons for skin blackheads and coarse pores were: Physique, heredity, age, gender, oily skin, hormones affecting skin roughness, collagen density, sebaceous gland distribution and secretion, light aging caused by ultraviolet rays, and poor face-cleaning habits (3). Blackheads and coarse pores can seriously impact facial beauty and reduce the self-confidence of patients (4).

The traditional treatments of acne include needle-lancing and topical drugs, such as retinoic acid and salicylic acid (5). However, conventional cleaning products are ineffective for certain blackheads. Evidence suggests that Q-switched Nd:YAG and lattice laser treatment for blackheads and coarse pores is effective, but the improvement was limited and the effect was not lasting and stable (6).

The aim of the present study was to determine the mechanism of action of the 800 nm semiconductor laser on skin blackheads and coarse pores. To the best of our knowledge, there is no similar experimental study examining this type of laser treatment to treat skin blackheads and coarse pores.

Materials and methods

Experimental animals

A total of 24 healthy purebred short-haired male guinea pigs, weighing 350–400 g, were selected for the present study. The animals were provided by the Shanghai Laboratory Animal Center (Shanghai, China), batch no. SYXK 2015–0016. The guinea pigs were fed routinely in an environment with temperatures of 20–25°C, relative humidity of 55–60%, and light and dark cycle of 12 h each. One week after adapting to the environment, the guinea pigs were coated with 0.5 ml of coal tar suspension (Chongqing Jinrong Chemical Co., Chongqing, China) evenly by injector once daily. Treatment was continued for 14 days to form an experimental area of 8×3 cm on the back of the guinea pigs (Fig. 1).

Figure 1.

Detailed treatment plan for experimental area of 8×3 cm on the back of the guinea pigs.

Experimental groups

The subjects were divided into the following groups: Normal control group (NC); low-dose laser treatment group (L-LS); high-dose laser treatment group (H-LS); and Q-switched Nd:YAG treatment group (QC).

Methods

A LightSheer Duet ET 800 nm semiconductor laser (Lumenis Ltd., Yokneam, Israel) treatment was applied with an energy density of 20–30 J/cm2 (L-LS group), 35–55 J/cm2 (H-LS group) and a Q-switched Nd:YAG mode. Spot testing was completed on an area of molding, with a pulse width of 0.5 msec and a spot size of 7 mm. A single spot was arranged to avoid repetition. During the treatment process, shading pockets were used to cover eyes, with cold compression applied for 30 min after treatment. A Nikon D800 SLR camera (Nikon, Tokyo, Japan) was used to capture images before and after treatments. Samples were taken at 1, 7 and 14 days after surgery. The applications of the experimental method are shown in Fig. 1.

Observation of epidermis, dermis, sebaceous gland changes, and hair follicle damage by hematoxylin and eosin (H&E) staining

A solution of 4% lidocaine was injected locally in the experimental area before skin-tissue cutting, iodine disinfection and oppression hemostasis was performed. A 4% paraformaldehyde fixation was used, along with phosphate-buffered saline (PBS) flushing, gradient alcohol dehydration, xylene transparence, paraffin wax soakage, embedding and a paraffin section device (Beijing Liuyi Instrument Factory, Beijing, China) to cut a 4-µm serial section. This was applied to plaster before drying and performing H&E staining (Thermo Fisher Scientific, Waltham, MA, USA). The sections were observed under a light microscope (Olympus Corp., Tokyo, Japan).

Detection of the expression of proliferating cell nuclear antigen (PCNA) of sebaceous gland cells by immunohistochemical methods

Conventional xylene, gradient alcohol dewaxing, PBS flushing, 50 µl peroxidase, room temperature blocking for 30 min, distilled water washing of 5 min × 3 times, and 0.125% fresh pancreatic enzyme dropping paraffin were all used as part of the testing. A constant temperature box (Sanyo Electric Co., Osaka, Japan) was set at 37°C for incubation for 20 min as 50-µl blocking serum of goat was added and incubated at room temperature for 1 h. Rabbit anti-PCNA monoclonal antibody (no. sc-7907) at a concentration of 1:2,000) and internal resistance rabbit anti-GAPDH monoclonal antibody (no. sc-25778) (both from Santa Cruz Biotechnology, Inc., Dallas, TX, USA) at a concentration of 1:1,000 and incubated at 4°C overnight. PBS cleaning 5 min × 3 times; 50 BB rat anti-rabbit bivalent antibody (Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd., Beijing, China) at a concentration of 1:500 was added. Biotin labeling was incubated at room temperature for 1 h with PBS rinsing for 5 min × 3 times, while 50 µl horseradish peroxidase (Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd.) was added and incubated at room temperature for 1 h with PBS cleaning for 5 min × 3 times. The samples were kept in the dark as 20 µl chromogenic solution (Beijing Zhongshan Golden Bridge Biotechnology Co., Ltd.) at a concentration of 1:50 was added. Hematoxylin redyeing, ethyl alcohol differentiation, gradient dehydration, xylene lucency and neutral gum seal sheets were utilized. The results were observed by a low-power lens.

Test sebaceous gland cell apoptosis using TUNEL

Under the condition of conventional dewaxing and rehydration, 20 mg/ml proteinase K (Chongqing Bofei Biochemical Products Co., Ltd., Chongqing, China) without DNase was incubated at 37°C for 20 min with PBS washing 5 min × 3 times. Hydrogen peroxide of 3% was placed at room temperature for 10 min with PBS washing 5 min × 3 times. TUNEL reaction mixture (Hoffmann-La Roche, Basel, Switzerland) was prepared and added to create a 50 cr TUNEL reaction mixture, followed by adjusting the thermostat to 37°C, and wet box reacting for 60 min with PBS washing 5 min × 3 times. POD transforming agent (50 µl) was added and incubated at 37°C in a wet box for 30 min with PBS washing for 5 min × 3 times. Hematoxylin redyeing, ethyl alcohol differentiation, gradient dehydration, xylene lucency and neutral gum seal sheet were utilized. The results were observed by a low-power lens.

Detection of protein expression of caspase-3, Bax and Bcl-2 by western blot analysis

For cell total protein extraction, cell lysis liquid P0013 (Beyotime Institute of Biotechnology, Jiangsu, China) at a final concentration of 1 mM was used and blended thoroughly. It was placed on ice and centrifuged at 10,000 for 20 min. The supernatant was the extraction of the total protein. For the protein concentration determination, a BCA protein concentration determination kit P0009 (enhancement mode) (Beyotime Institute of Biotechnology) was used to detect protein according to the manufacturer's instructions. For the protein sample handling, we used protein electrophoresis to calculate the volume. A corresponding 5X loading buffer with a final concentration of 1X loading buffer was added, and blending, heating, centrifugation and electrophoresiswere conducted. We utilized sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), transmembrane protein (wet), sealing and the incubation of the primary antibodies. To determine a pre-staining protein molecular mark, a PVDF membrane was cut according to a target protein molecular weight. This was placed in the antibody incubation box with the following: A 1X TBST washing, rabbit anti-caspase-3 monoclonal antibody, no. sc-98785 at a concentration of 1:2,000, and a rabbit anti-Bax monoclonal antibody, no. sc-25778 (both from Santa Cruz Biotechnology, Inc.) at a concentration of 1:1,000. Incubation of secondary antibody (the primary antibody was recycled with 1X TBST washing before 5 ml of skim milk at a 5% concentration and a corresponding species secondary antibody was added according to the proportion of 1:5,000–1:20,000), and exposed (chemiluminescence methI). The results were expressed by the gray value ratio of the band.

Statistical analysis

SPSS 20.0 software (IBM, Armonk, NY, USA) was used for statistical analysis. Measurement data were presented as mean ± standard deviation. Comparison between groups was performed using one-way ANOVA test followed by post hoc test (LSD). The comparison in one group introduced variance analysis to repeat measurement data. P<0.05 was considered to indicate a statistically significant difference.

Results

H&E staining results

Two to four cell layers of hair follicle epithelium were evident in the NC group. Its follicular infundibulum did not expand, while the hair follicle appeared quasicircular. The mesenchyme did not have infiltration of inflammatory cells. In the L-LS group, we observed hair follicle distortion and abundant infiltration of inflammatory cells at 1 day. Hair follicle retrogression and the separation between papilla and hair bulb were seen at 7 days. At 14 days, the hair follicle epithelium appeared thin, inflammatory cells were reduced and the hair follicle form returned to normal. In the H-LS group, abundant inflammatory necrosis under the hair follicle was visible, with the hair shaft being heated for 7 days. This reduced hair follicle amounts at 14 days. In the QC group, the infiltration of inflammatory cells was seen at 1 day, with hair follicle deformation at 7 days and partial hair follicle inflammatory necrosis at 14 days (Fig. 2).

Figure 2.

H&E staining (magnification, ×40; from top to bottom: NC, L-LS, H-LS and QC groups; from left to right: 1, 7 and 14 days). NC, normal control; L-LS, low-dose laser treatment; H-LS, high-dose laser treatment; QC, Q-switched Nd:YAG treatment; H&E, hematoxylin and eosin.

Immunohistochemistry

The expression levels of PCNA of the L-LS, H-LS and QC groups were reduced with time. At the respective time points, the NC group was highest, L-LS group and H-LS group were next highest and the H-LSIup was lowest. The difference was statistically significant (P<0.05) (Table I and Fig. 3).

Table I.

Comparison of expression levels of PCNA (%).

Groups	1 day	7 days	14 days
NC	32.6±5.5	33.5±5.4	32.7±5.3
L-LS	25.5±6.3	23.2±6.2	21.7±6.0
H-LS	11.2±4.7	8.6±4.2	6.3±4.3
QC	15.4±4.5	14.3±4.6	12.8±4.8
F-value	12.304	13.655	15.234
P-value	<0.001	<0.001	<0.001

PCNA, proliferating cell nuclear antigen; NC, normal control; L-LS, low-dose laser treatment; H-LS, high-dose laser treatment; QC, Q-switched Nd:YAG treatment.

Figure 3.

Immumohistochemical staining (magnification, ×200; from top to bottom: NC, L-LS, H-LS and QC group; from left to right: 1, 7 and 14 days). NC, normal control; L-LS, low-dose laser treatment; H-LS, high-dose laser treatment; QC, Q-switched Nd:YAG treatment.

TUNEL method result

The apoptotic rate of the L-LS, H-LS and QC groups increased with time extension. At the different time points, NC group was lowest, the L-LS group and QC group was next and the H-LS group was highest, with the difference being statistically significant (P<0.05) (Table II and Fig. 4).

Table II.

Comparison of apoptotic rate.

Groups	1 day	7 days	14 days
NC	0.5±0.1	0.4±0.1	0.6±0.2
L-LS	6.7±1.2	7.6±1.3	8.2±1.5
H-LS	13.6±3.4	15.8±3.5	17.2±3.6
QC	8.2±2.0	9.3±2.2	10.2±2.3
F-value	10.235	11.527	14.520
P-value	<0.001	<0.001	<0.001

NC, normal control; L-LS, low-dose laser treatment; H-LS, high-dose laser treatment; QC, Q-switched Nd:YAG treatment.

Figure 4.

TUNEL method staining (magnification, ×100; from top to bottom: NC, L-LS, H-LS and QC group; from left to right: 1, 7 and 14 days). NC, normal control; L-LS, low-dose laser treatment; H-LS, high-dose laser treatment; QC, Q-switched Nd:YAG treatment.

Western blot analysis

The protein expression level of caspase-3, Bax and Bcl-2 of the L-LS, H-LS and QC groups increased with time. At the respective time points, caspase-3 and Bax protein expression in the NC group was lowest, the L-LS and QC groups were next lowest and the H-LS group was highest. Bcl-2 protein expression in the NC group was highest, the protein expression in the NC group was next highest and the H-LS group was lowest. The difference was statistically significant (P<0.05) (Table III and Fig. 5).

Table III.

Protein expression level of caspase-3, Bax and Bcl-2.

Groups	Caspase-3			Bax			Bcl-2
	1 day	7 days	14 days	1 day	7 days	14 days	1 day	7 days	14 days
NC	0.21±0.06	0.22±0.05	0.20±0.07	0.15±0.04	0.16±0.03	0.14±0.05	0.23±0.08	0.24±0.06	0.23±0.07
L-LS	0.42±0.10	0.46±0.12	0.50±0.14	0.36±0.10	0.40±0.13	0.43±0.11	0.16±0.07	0.18±0.06	0.20±0.09
H-LS	0.47±0.13	0.50±0.16	0.55±0.18	0.42±0.14	0.46±0.13	0.49±0.16	0.10±0.03	0.12±0.04	0.14±0.04
QC	0.44±0.20	0.48±0.21	0.52±0.24	0.40±0.21	0.43±0.22	0.45±0.23	0.14±0.05	0.16±0.06	0.18±0.05
F-value	8.632	9.203	9.624	9.032	9.421	9.637	9.562	9.624	9.758
P-value	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

NC, normal control; L-LS, low-dose laser treatment; H-LS, high-dose laser treatment; QC, Q-switched Nd:YAG treatment.

Figure 5.

Protein expression level of caspase-3, Bax and Bcl-2 as detected by western blot analysis.

Discussion

The 800 nm semiconductor laser can be used in the treatment of vascular diseases, such as nevus flammeus, and for non-vascular diseases, such as virus infection, sebaceous gland hyperplasia and stretch marks (7,8). Evidence has confirmed that it has an effect on immunity activation, acne formation reduction and hair follicle wall maturity intervention (9). The semiconductor laser takes advantage of many types of biological effects on skin hair follicle tissue, such as thermal effects, pressure effects, photochemical effects, light stimulation and electromagnetic fields, leading to the release of cytokines and the production of collagen (10). From animal models, it has been found that semiconductor lasers can significantly reduce the number of facial acne propionic acid bacillus, with grease secretion decreasing significantly. Additionally, the cytokines IL-1α receptor, TNF-α, melanocortin receptor 1 and TGF-β1 can be reduced in tissues, so as to achieve the effect of treating diseases (11).

A recent study also confirmed that semiconductor lasers can induce the apoptosis of the hair follicles, which may be associated with the therapeutic effect of the lasers (12). PCNA is the core element of the eukaryotes replication complex, a driving factor in DNA polymerase δ, which can bind with different replication-associated proteins and coordinate the DNA replication process (13). As a factor of function conversion, PCNA is involved in important cell events, such as DNA damage repair, cell cycle control and apoptosis by different control methods to interact with many cytokines (14). It is known that apoptosis may have three main signal transduction pathways: Death receptor pathways of apoptosis, mitochondrial pathways, and control pathways on which the p53 gene depends. The p53 gene is a type of tumor-inhibiting protein that is expressed by the control-associated gene to induce apoptosis (15). The tumor-inhibiting factor in G1 contains the PIP box, which can promote apoptosis by interacting with p53. Experimental results showed that ultraviolet rays can promote the combination of ING1 and PCNA, and that ultraviolet ray damage cell may be removed by apoptosis (15). Caspase-3 is a factor in performing apoptosis, which can cause a cascade amplification effect of downstream enzymes once triggered. Its excitation can lead apoptosis to an apoptosis stage that is related to nuclear change and is the most important downstream effect of protease (16). For the two signal transduction pathways of conventional evolution in apoptosis, the component ratio of Bcl-2 family members is the key factor of apoptosis regulation, especially the Bcl-2/Bax ratio in the ‘molecular switch’ that can trigger apoptosis (17). Bax and Bcl-2 regulate apoptosis by forming homodimer or heterodimer, when Bax forms homodimer to induce apoptosis, Bax and Bcl-2 may form a heterodimer to inhibit apoptosis.

From the present study, we found that the expression levels of PCNA of the L-LS, H-LS and QC groups reduced with time. At the respective time points, the NC group was highest, the L-LS and H-LS groups were next highest and the H-LS group was lowest. The difference was statistically significant (P<0.05). It suggested that low-dose laser treatment causes less damage to the number of PCNA, which is beneficial in the recovery of hair follicle regeneration capacity (18). The apoptotic rate of the L-LS, H-LS and QC groups increased with time. At the respective time points, the NC group was lowest, the L-LS and QC groups were next lowest and the H-LS group was highest. The difference was statistically significant (P<0.05). It suggested that low-dose laser treatment can promote the apoptosis of hair follicle cells to some extent (19). The protein expression of caspase-3, Bax and Bcl-2 in the L-LS, H-LS and QC groups increased with time. At the respective time points, caspase-3 and Bax protein expression in the NC group was lowest, the L-LS and QC groups were next lowest and the H-LS group was highest. Bcl-2 protein expression in the NC group was highest, protein expression in the NC group was in next highest and the H-LS group was lowest. The difference was statistically significant (P<0.05).

In conclusion, the low-dose 800 nm semiconductor laser is an effective treatment on skin blackheads and coarse pores. It promotes hair follicle cell apoptosis without reducing the expression of PCNA.