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Pointing light at soft tissue: clinical applications 71

• Lesions will likely heal with less scarring; scars con- and palmar/plantar surfaces, and if the patient allows
tribute to susceptibility to future infections. you, separate the digits to improve interdigital skin
• Self-trauma will decrease with the relief of pain, exposure to laser. Remember to try to keep the beam
inflammation, and pruritus. perpendicular to the skin surface. Your treatment area
• The enhanced perfusion you can achieve with LT has to be calculated for both the dorsal and the palmar/
is actually well sought after in some deeply seated plantar surfaces, and it is usually a good idea to include
bacterial infections, where even pentoxifylline is all the area up to the carpus/tarsus.
considered. We always need to be aware of the patient’s eye
safety, and treating the front paws can put the beam and
A couple of clinical papers have been published the head in positions where eye exposure is relatively
addressing LT in canine pododermatitis. One of them easy, especially when the palmar surface is treated or in
describes how LT with daily treatments for five con- very nervous animals.
secutive days was effective in treating sterile pyogranu-
lomatous pododermatitis in a case–control study in five 7.5 Ear disease
dogs. [218] Some cases will not respond so dramatically,
but in my experience LT will allow you to decrease the 7.5.1 Otitis
use of glucocorticoids in such cases.
Another paper reports how a regime of three treat- LT can help acute and chronic cases of external otitis.
ments per week for 2 weeks plus two treatments per It is not uncommon to find patients respond to LT after
2
week for the next 2 weeks, using 4 J/cm , was not a challenging and frustrating series of other more con-
effective in decreasing two scores in atopic dermatitis ventional treatments. Nevertheless, proliferative otitis
dogs: localized canine atopic dermatitis severity score is more refractory (depending on the case you will have
(LCADSS) and owner localized pruritic visual analog to consider surgery and LT postoperatively), and some
score (LPVAS). [219] Interestingly, in this study one cases need a maintenance treatment regime to prevent
paw was treated with LT and another paw in the same relapse, or a new course of treatment with seasonal
patient was used as a control. The study had to con- worsening, most commonly in the spring time.
clude LT was not effective because there was no differ- Other segments of the ear can potentially benefit
ence between the paws … but both treated and control from LT; an experimental animal model showed LT
paws did improve. could help the tympanic membrane heal faster, while
If tissues are very inflamed, start treating with 2–4 J/ decreasing inflammation and preventing excessive
cm and low power density, even if it takes longer, on fibrosis. [220] LT may also be useful in the recovery of
2
at least 3 consecutive days. If the inflammation is less hearing and cochlear hair cells after different types of
2
severe, you can start with 4–8 J/cm and more focused damage, such as gentamicin-induced ototoxicity [221]
energy every 48 h – gradually increase if you don’t get and noise-induced hearing loss. [222] Ex-vivo dosimetry
a response, though. Treat both the dorsal (Fig. 7.9) measures show how penetration into the cochlea is

(a) (b)
Figure 7.10 (a, b) Interdigital treatment from the dorsal and cranial directions, opening the interdigital spaces.

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