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LED Consultation & Consent Form

LED is a procedure that is designed for skin rejuvenation, pain reduction and wound healing. Light photons are absorbed by the cells to create ATP (cellular energy).

 

Risks:

All forms of health treatment, including LED, carry some risks and limitations. Complications that may occur in professional LED are very infrequent and are usually minor in nature.

  • Epidermal Tone Change: During the treatment process, some patients who are darker skin can experience epidermal darkening by one shade. This is normal and generally mild and only last an hour or two. This is due to higher absorption capabilities of darker skin types.
  • Burn: This is generally due to the gel un-protected sun exposure in the last 2 weeks of the procedure or using AHA or BHA peels before the LED procedure on the same day.

Precautions and Contraindications for treatments

There are some instances in which the LED Light Therapy may prove unsuitable for an individual when taking certain drugs or medical conditions, this may mean that an individual is unsuitable for the treatment.

Precautions due to drug induced photosensitivity. Please indicate if you are or have taken any of the following medication

Antibiotics

Tetracyline group: Doxyclyline, Oxytetracycline etc
Quinolone group: Ciprofloxacin, Ofloxacin, Levofloxacin
Sulfonamides: sulfamethoxazole/trimethoprim
If yes, the treatment can be administered as long as the medication has not been taken in the last 5 days

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Naproxen, Celecoxib
If yes, the treatment can be administered as long as the medication has not been taken in the last 5 days

Diuretics

Furosemide, Bumetanide, Hydro-chlorothiazide
If yes, the treatment can be administered as long as the medication has not been taken in the last 5 days

Retinoids

Roaccutane/accutane
If yes, the treatment can be administered as long as the medication has not been taken in the last 5 days

HMG-CoA reductase inhibitors

Statins (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin)
If yes, the treatment can still be administered at the discretion of the patient as long as they report no increased sensitivity to sun since commencing statins

Epidermal growth factor receptor inhibitors (treatment for lung cancer)

Cetuximab, panitumumab, erlotinib, gefitinib, lapatinib, vandetanib
If yes, please consult your physician before commencing a course

Antifungals

Terbinafine, Itraconazole, Voriconazole, Griseofulvin (Grisovin)
If yes, the treatment can be administered as long as the medication has not been taken in the last 5 days

Anti-Arrhythmic drugs

Codarone, Aratac, chlorpromazine
If yes, it is at your discretion whether you commence a treatment.

Anti-arthritic

Ridaura, Gold 50
If yes, the treatment cannot be administered.

Anti-arthritic

Azathioprine
If yes, the treatment can be administered as long as the medication has not been taken in the last 5 days.

Anti-Cancer drugs

Ledertrexate/Methotrexate
If yes, the treatment can be administered as long as the medication has not been taken in the last 5 days.

Precautions and Contraindications for treatments There are some instances in which the treatment may prove unsuitable for an individual.

    • Are you Pregnant? Yes / No
    • Do you suffer from epilepsy or seizures triggered by light? Yes / No
    • Do you suffer from a photosensitive disorder? Yes / No

(A photosensitive disorder describes a condition which means that you are sensitive or react to normal amounts of light. Photosensitive disorders include Porphyria, Lupus erythematosus, photosensitive eczema and Albinism).

If you answered yes to any of these questions, then unfortunately you are not suitable

  • Do you suffer from light induced migraines? * Yes / No
  • Are you currently taking St John’s Wort or other herbal remedies? * Yes / No

If you answered yes to question 4 or 5, then it is at your discretion whether you commence a treatment.

*Although uncommon the light may induce a migraine attack.

*St John’s Wort taken in very large amounts (more than the RDA) may cause some people to be slightly more sensitive to light.


Consent:

I understand that the final result of my LED treatment cannot be guaranteed.
I understand that after the treatment, I will be required to refrain from un-protected sun exposure.
I have read all of the above and had all my questions satisfactorily answered. In signing this informed consent, I am stating I have read the informed consent information and I fully understand the possible risks, complications and benefits that can result from the LED system.

Note:

Do not sign this form until you have read and understood all of the above.

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