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Dermatology and Wound Healing
Published on
April 17, 2025

International evidence-based consensus on the clinical application of photobiomodulation

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An international panel of 21 experts used the Delphi method to reach a consensus on the clinical use of photobiomodulation in adults. This document is an expert consensus based on a systematic review of the literature, not a quantified measure of effect.

What this study measured

In June 2022, the authors conducted a systematic review in Embase and MEDLINE to compile publications on photobiomodulation. An international multidisciplinary panel of 21 experts, selected based on their published work, then developed recommendations based on this review.

This paper is not a meta-analysis: it does not calculate any effect sizes and does not aggregate individual patient data. It is a formalized consensus among experts.

Key Findings

Unanimous consensus was reached after two rounds of the Delphi method, two meetings, and an iterative review by all panelists.

  • 21 multidisciplinary experts on the international panel.
  • Two rounds of Delphi surveys and two consensus meetings, until unanimous agreement is reached.
  • A systematic literature search conducted in June 2022 in Embase and MEDLINE.
  • The panel considers photobiomodulation to be safe for adult patients.
  • According to the panel, red-light photobiomodulation does not cause DNA damage.
  • Six indications identified as effective treatment options: peripheral neuropathy, androgenetic alopecia, wounds of various etiologies, pressure ulcers, pain attributed to diabetic foot ulcers, and acute radiation dermatitis.

The summary does not provide any percentages, mean differences, or confidence intervals. Nor does it include any specific values for dose, wavelength, or number of sessions.

How photobiomodulation works for this indication

The mechanism proposed in the literature remains hypothetical. Red and near-infrared light is thought to be absorbed by cytochrome c oxidase, the final complex in the mitochondrial respiratory chain, thereby increasing the production of ATP available to the cell. Other mechanisms have been suggested, including modulation of oxidative stress and effects on local blood flow and inflammatory mediators. These explanations are presented as hypotheses and have not been demonstrated by this consensus.

Limits You Should Know

The first limitation stems from the very nature of the document. An expert consensus ranks lower than a meta-analysis of randomized trials in the hierarchy of evidence, as it reflects a structured collective opinion rather than a statistical calculation. Furthermore, the literature review was completed in June 2022; studies published since then have not been included.

No numerical results are provided in the summary, which makes it impossible to assess the extent of the expected benefits on an indication-by-indication basis. However, this does not invalidate the unmentioned indications: the panel did not rule on them, which constitutes silence rather than a negative finding. Finally, the panelists themselves call for further research.

What This Means in Practice

This text provides a reference framework for healthcare professionals considering photobiomodulation. It identifies which indications, in the view of an international panel, have a sufficient evidence base, and highlights the favorable safety profile in adults. It does not establish any specific, quantifiable protocols and does not replace medical advice. Photobiomodulation is presented here as an option, never as a substitute for prescribed treatment.

Frequently Asked Questions

Is photobiomodulation dangerous to the skin or to DNA?

The panel concludes that photobiomodulation is a safe treatment modality for adult patients and that red-light photobiomodulation does not cause DNA damage. This conclusion applies to low-power devices and does not apply to ablative or photothermal lasers. No quantified incidence rates of adverse effects are provided in the abstract.

What recommendations does this consensus include?

Six conditions are cited as effective indications: peripheral neuropathy, androgenetic alopecia, wounds of various etiologies, pressure ulcers, pain attributed to diabetic foot ulcers, and acute radiation dermatitis. This list reflects what the panel deemed to be sufficiently documented as of June 2022. It does not exclude other uses, on which the panel simply did not reach a conclusion.

Is an expert consensus as good as a meta-analysis?

No, they are two different things. A meta-analysis statistically combines the results of trials to produce a numerical estimate of the effect, along with a confidence interval. A consensus formalizes the agreement among experts based on a review of the literature, which is useful for guiding practice but does not replace a measure of effect.

Reference

Maghfour J, Mineroff J, Ozog DM, Jagdeo J, Lim HW, et al. Evidence-based consensus on the clinical application of photobiomodulation. Journal of the American Academy of Dermatology, 2025;93(2):429-443. PMID 40253006. DOI 10.1016/j.jaad.2025.04.031. https://pubmed.ncbi.nlm.nih.gov/40253006/

This summary is provided for informational purposes only and does not constitute medical advice. Photobiomodulation is not a substitute for prescribed treatment. Consult a healthcare professional.