WO2018172757A1

WO2018172757A1 - Phototherapy apparatus

Info

Publication number: WO2018172757A1
Application number: PCT/GB2018/050715
Authority: WO
Inventors: Gareth Jones; Huw ANTHONY
Original assignee: Aesthetic Technology Limited
Priority date: 2017-03-20
Filing date: 2018-03-20
Publication date: 2018-09-27
Also published as: GB2562459A; GB201704358D0

Abstract

The present invention relates to a phototherapy apparatus, to a method of combatting (eg treating or preventing) a skin disorder in a subject (eg a non-animal or animal (eg human) subject) or a cosmetic (eg aesthetic or restorative) method for a subject and to the use of the phototherapy apparatus in combatting a skin disorder in a subject or in a cosmetic method.

Description

PHOTOTHERAPY APPARATUS

Whilst exposure to light is commonly associated with skin ageing and damage, light also has many positive influences on the body. It helps to produce vitamin D and provides energy and serotonin and can also accelerate natural repair processes in skin. These benefits have been harnessed in a technique known as phototherapy.

Phototherapy is based on the principle that living cells are able to absorb and be influenced by light and the treatment has long been recognised for its regenerative and antiinflammatory properties. The treatment involves exposing the skin to low levels of beneficial light energy from the visible and infrared part of the light spectrum which energise cellular functions to stimulate various processes with therapeutic effects. Energised skin cells function better and regenerate faster which in turn leads to younger-looking, more healthy and radiant skin.

In a phototherapy device known as OMNILUX™ (GlobalMed Technologies), a relatively large area of skin is flooded indiscriminately with light of a specific wavelength to treat a particular skin condition. The efficacy of the treatment depends on the presence of certain target photoreceptor molecules in the area to be treated. If multiple wavelengths are required, they can only be delivered serially not concurrently. This limits the scope and efficacy of treatment and prolongs treatment time.

US-A-6896693 discloses a phototherapy device that is beneficial to the well-being of organisms such as animals (eg humans) and plants. The device lies against the skin or surface or at a distance up to several feet and is used for general relaxation and

detoxification, alleviating illness, disease, pain, inflammation or injury, stimulating or sedating the acupressure meridian system or rebalancing the electromagnetic energy-field surrounding an organism.

US-A-2009/0177190 discloses a method of reducing the appearance of melanin on the skin of a subject by exposure to red narrow-band radiation at a wavelength in the range 620 to 750 nm with a bandwidth up to 20 nm. The dose is effective to cause the appearance of melanin to diminish without causing photothermolysis.

US-A-2004/0068305 discloses a phototherapy device including an array of light sources arranged in a number of configurations so as to achieve substantially uniform distribution of light on a subject.

US-A-5766233 discloses devices for healing wounds and sores by phototherapy in which LEDs are held close to or in contact with the affected areas. LEDs emitting infrared and red light are included and can be pulsed in predetermined sequences for therapeutic purposes. A first series of pulse frequencies is 78±10 Hz, 702±20 Hz and 8.58 KHz±100 Hz. A drive means causes the light emitting element to emit a second series of pulse frequencies (15.6±3 Hz, 287±20 Hz, and 31.2±5 Hz) after a wound or sore has been treated with the first series of pulse frequencies from four to six times.

WO-A-2014/158783 discloses an apparatus for targeted UV phototherapy.

In some therapies, the number of beneficial photoreceptor molecules in the target area is maximized using creams or lotions to imbibe into the skin This is the case for example in the treatment of acne using aminolevulinic acid (ALA) to increase the level of photoporphyrins.

An increase in the photoreceptor density can also be achieved by generally pre-heating the skin using a conventional heater. The pre-heated skin is then exposed to light from a phototherapy device. The two-step procedure is inefficient, prolonged, costly and potentially more uncomfortable for the patient.

The present invention seeks to improve phototherapy by rapid localised heating of the skin to stimulate the axon reflex.

Thus viewed from a first aspect the present invention provides a phototherapy apparatus comprising:

one or more than one source of thermal irradiation capable of elevating the temperature within a treatment area of the skin of a subject in a manner sufficient to stimulate the axon reflex to initiate vasodilation;

one or more than one source of phototherapeutic irradiation having a peak wavelength such that the phototherapeutic irradiation is absorbed by a target

photoreceptor in the skin of the subject to activate a photoresponse;

a modular housing in which the one or more than one source of thermal irradiation and the one or more than one source of phototherapeutic irradiation are mounted in a manner such that selective illumination by the thermal irradiation or the phototherapeutic irradiation is localised to substantially the whole or a part of the treatment area of the skin of the subject; and

a controller for controlling selective illumination of the treatment area of the skin of the subject by the thermal irradiation or the phototherapeutic irradiation.

By initiating vasodilation in response to a rapid elevation in the temperature within the treatment area of the skin (ie the local skin temperature), the stimulation of the axon reflex causes a rapid increase in blood flow. The rapid increase in blood flow causes a similarly rapid increase in the concentration of target photoreceptors and oxygen in the treatment area of the skin which in turn enhances the efficacy of the phototherapeutic irradiation. The vasodilatory effect continues after thermal irradiation has ceased and the rapidity and sustainability of the vasodilatory effect promotes phototherapeutic efficacy before the onset of pain.

The photoresponse may be a photochemical or photobiological process. The one or more than one source of thermal irradiation is typically a single source of thermal irradiation.

Each of the one or more than one source of thermal irradiation may be selected

independently from the group consisting of lamps, lasers and LEDs. Each of the one or more than one source of phototherapeutic irradiation may be selected independently from the group consisting of lamps, lasers and LEDs.

Preferably the one or more than one source of thermal irradiation and the one or more than one source of phototherapeutic irradiation are mounted in the modular housing in a manner such that selective illumination by the thermal irradiation or the phototherapeutic irradiation is substantially uniform in the whole or the part of the treatment area of the skin of the subject.

The modular housing may be configured (eg shaped) to facilitate the localisation of selective illumination by the thermal irradiation or the phototherapeutic irradiation to substantially the whole or a part of the treatment area of the skin of the subject. For this purpose, the modular housing may be tiltable, swivelable, foldable or rotational.

The modular housing may be configured (eg shaped) to conform substantially to the configuration of the whole or the part of the treatment area of the skin of the subject. For example, the modular housing may be configured to conform substantially to a facial configuration.

The modular housing may comprise [eg consist of) one or more than one mod ule. Typically where there is more than one module, each module is substantially identical.

Preferably the modular housing com prises (eg consists of) more than one mod ule (eg a pair of modules or three modules), wherein the one or more than one source of thermal irradiation and the one or more than one source of phototherapeutic irradiation are mounted in the more than one module in a manner such that selective illumination by the thermal irradiation or the phototherapeutic irradiation is localised to su bstantially the whole or the part of the treatment area of the skin of the subject.

Preferably the modular housing comprises (eg consists of) more than one module (eg a pair of modules or three modules) mutually spaced apart and connected side-by-side.

Particularly preferably the more than one module (eg the pair of modules or the three modules) are mutually spaced apart and connected adjustably (preferably foldably) side-by- side.

Preferably the phototherapy apparatus further comprises an adjustment mechanism operatively mounted between each of the more than one module so as to permit the modular housing to be foldable (eg foldable between a substantially planar profile and a concave profile).

The modular housing may be coupled to a base (eg by a coupling arm). The coupling arm may be attached to the base in a manner such as to allow the modular housing to swivel. The coupling arm may include a hinge joint which allows the modular housing to move in a vertical plane. The coupling arm may attached to the rear of the modular housing in a manner such as to allow the modular housing to tilt.

The one or more than one source of thermal irradiation and the one or more than one source of phototherapeutic irradiation may be mounted in the modular housing in a manner such that selective illumination is by a beam of the thermal irradiation or the

phototherapeutic irradiation.

The beam may be focussed to a spot. Beam shaping elements (such as a focussing lens) may be used to achieve a beam or spot with a desirable size, profile or position.

A light diffusing window may be mounted in the modular housing {eg in each module). The light diffusing window may serve to increase the uniformity of the beam.

An alignment mechanism may be used to ensure that the modular housing is properly aligned over the treatment area of the skin of the subject.

The phototherapy apparatus may further comprise a cooling device for cooling the treatment area of the skin. The cooling device may be usefully deployed to permit higher doses of thermal irradiation to be applied.

In a preferred embodiment, the one or more than one source of thermal irradiation is one or more than one plurality of thermal LEDs.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is one or more than one plurality of phototherapeutic LEDs.

Typically each of the one or more than one plurality of thermal LEDs and each of the one or more than one plurality of phototherapeutic LEDs may be individually mounted on a board or panel.

The one or more than one plurality of thermal LEDs and the one or more than one plurality of phototherapeutic LEDs mounted in the modular housing may be clustered. Each cluster may contain only thermal LEDs or only phototherapeutic LEDs. Each cluster may contain thermal LEDs and phototherapeutic LEDs which may be randomly or regularly distributed. The cluster may be a linear, staggered {eg herringbone or honeycomb), square, triangular, rectangular, hexagonal or circular pattern.

In an embodiment, the thermal LEDs and phototherapeutic LEDs are distributed in square clusters.

The plurality of thermal LEDs and the one or more than one plurality of phototherapeutic LEDs may be mounted in the modular housing in an array. Preferably the array is a plurality of discrete clusters (as described hereinbefore). The array may be a regular pattern. The array may be a linear, staggered {eg herringbone or honeycomb), square, triangular, rectangular, hexagonal or circular pattern.

In an embodiment, the thermal LEDs and phototherapeutic LEDs are distributed in a square array. Typically the bandwidth of the phototherapeutic irradiation is lOOnm or less.

Preferably the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength which is blue-violet (eg in the range 380 to 450nm). Particularly preferably the source of phototherapeutic irradiation has a peak wavelength which is in the range 390 to 430nm. More preferably the source of phototherapeutic irradiation has a peak wavelength which is in the range 400 to 430nm (eg about 415nm).

Preferably the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength which is red (eg in the range 600 to 700nm). Particularly preferably the source of phototherapeutic irradiation has a peak wavelength which is in the range 610 to 660nm. More preferably the source of phototherapeutic irradiation has a peak wavelength which is in the range 623 to 643nm (eg about 633nm).

Preferably the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength which is near-IR {eg in the range 750 to 900nm ). Particularly preferably the source of phototherapeutic irradiation has a peak wavelength which is in the range 750 to 850nm. Particularly preferably the source of phototherapeutic irradiation has a peak wavelength which is in the range 800 to 900nm. More preferably the source of phototherapeutic irradiation has a peak wavelength which is in the range 800 to 860nm (eg about 830nm).

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength of about 415nm.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength of about 633nm.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength of about 830nm.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength of about 670nm.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength of about 780nm.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a source of phototherapeutic irradiation having a peak wavelength of about 880nm. In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a first source of phototherapeutic irradiation having a peak wavelength of about 415nm and a second source of phototherapeutic irradiation having a peak wavelength of about 633nm.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a first source of phototherapeutic irradiation having a peak wavelength of about 633nm and a second source of phototherapeutic irradiation having a peak wavelength of about 830nm. These wavelengths are useful for skin rejuvenation, wound healing and pain relief, for treating rosacea, hyperpigmentation or bruising or for stimulating hair growth.

In a preferred embodiment, the one or more than one source of phototherapeutic irradiation is (or includes) a first source of phototherapeutic irradiation having a peak wavelength of about 415nm, a second source of phototherapeutic irradiation having a peak wavelength of about 633nm and a third source of phototherapeutic irradiation having a peak wavelength of about 830nm. These wavelengths are useful for treating acne, psoriasis, eczema, dermatitis and anti-bacterial wounds.

Preferably each of the one or more than one source of thermal irradiation is capable of elevating the temperature within the treatment area of the skin of the subject above the core temperature of the subject.

Typically each of the one or more than one source of thermal irradiation has a peak wavelength such that the thermal irradiation penetrates deep into tissue. Each of the one or more than one source of thermal irradiation may have a peak wavelength such that the thermal irradiation penetrates into the epidermis, dermis or hypodermis. Preferably each of the one or more than one source of thermal irradiation has a peak wavelength such that the thermal irradiation penetrates sub-cutaneously.

Each of the one or more than one source of thermal irradiation may have a peak wavelength which is substantially coincident with the absorption profile of water.

Each of the one or more than one source of thermal irradiation may have a peak wavelength which is substantially non-coincident with the absorption profile of haemoglobin.

Each of the one or more than one source of thermal irradiation may have a peak wavelength which is substantially non-coincident with the absorption profile of melanin.

Preferably each of the one or more than one source of thermal irradiation has a peak wavelength which is not absorbed by a target photoreceptor in the skin of the subject to activate a photoresponse.

Preferably each of the one or more than one source of thermal irradiation has a peak wavelength which is substantially non-coincident with the peak wavelength of each of the one or more than one source of phototherapeutic irradiation. By introducing localised heating in a manner which does not interfere with photochemical or photobiological processes, the apparatus is able to provide a precise treatment protocol which is well tolerated and targeted.

In a preferred embodiment, the one or more than one source of thermal irradiation is (or includes) a first source of thermal irradiation having a peak wavelength which is near-IR {eg 800nm or more). This allows the thermal irradiation to penetrate into fatty tissues in the dermis and subcutaneous layers where it causes the local skin temperature to increase rapidly without interfering with other photobiological processes.

In a preferred embodiment, the one or more than one source of thermal irradiation is (or includes) a first source of thermal irradiation having a peak wavelength which is in the range 900 to 1150nm. Particularly preferably the first source of thermal irradiation has a peak wavelength which is in the range 950 to llOOnm. Particularly preferably the first source of thermal irradiation has a peak wavelength which is in the range 1000 to 1150nm (eg 1064nm).

In a preferred embodiment, the one or more than one source of thermal irradiation is (or includes) a first source of thermal irradiation having a peak wavelength which is in the range 1150nm to 1600nm. Particularly preferably the first source of thermal irradiation has a peak wavelength which is in the range 1150 to 1400nm. Particularly preferably the first source of thermal irradiation has a peak wavelength which is in the range 1250 to 1500nm {eg 1250nm).

Each of the one or more than one source of thermal irradiation may be capable of elevating the temperature within the treatment area of the skin of the su bject by less than 15°C, preferably less than 10°C {eg by 3 to 7 °C).

Each of the one or more than one source of thermal irradiation may be capable of elevating the temperature within the treatment area of the skin of the subject to 48°C or less, preferably 42°C or less {eg to a temperature in the range 39.5 to 40 °C).

Each of the one or more than one source of thermal irradiation may be capable of elevating the temperature within the treatment area of the skin of the subject at a rate of 2°C per minute or more.

The skin of the subject may be skin on the chest, back, trunk, arm, leg, scalp, face or lumbar region. The phototherapy apparatus of the invention may be used for therapeutic or cosmetic (eg aesthetic or restorative) purposes. For example, the phototherapy apparatus may be used to combat {eg treat or prevent) skin disorders such as acne, rosacea, eczema, hyperpigmentation, vascular lesions, wrinkles, psoriasis, alopecia and atopic dermatitis. For example, the phototherapy apparatus may be used for skin rejuvenation or wound healing. For example, the phototherapy apparatus may be used for stimulating hair growth.

The whole or the part of the treatment area of the skin of the subject may be selectively illuminated by the thermal irradiation and the phototherapeutic irradiation in a

physiologically tolerable dose. Where necessary, this may be assisted by localised cooling. The parameters which contribute to a physiologically tolerable dose may be controlled by the controller to maximise efficacy, minimize treatment time and reduce patient discomfort.

The controller may be adapted to switch on and off independently the one or more than one source of thermal irradiation and the one or more than one source of phototherapeutic irradiation. The controller may control the duration of thermal irradiation and

phototherapeutic irradiation.

The controller may be adapted to permit irradiation in a continuous or pulsed mode. In the pulsed mode, the controller may control the pulse width (timing) and pulse frequency. The pulse frequency is typically < 0.1 Hz.

The controller may control irradiance of the thermal irradiation and the phototherapeutic irradiation.

Viewed from a further aspect the present invention provides a method of combatting (eg treating or preventing) a skin disorder in a subject or a cosmetic [eg aesthetic or restorative) method for a subject which comprises:

arranging the modular housing of a phototherapy apparatus as hereinbefore defined at an effective distance from or in contact with a treatment area of the skin of the subject; illuminating the whole or a part of the treatment area of the skin of the subject with a physiologically tolerable dose of thermal irradiation sufficient to elevate the temperature within the treatment area of the skin whereby to stimulate the axon reflex to initiate vasodilation; and

illuminating the whole or the part of the treatment area of the skin with one or more physiologically tolerable doses of phototherapeutic irradiation, wherein the or each dose of phototherapeutic irradiation is from selected ones of the one or more than one source of phototherapeutic irradiation.

The physiologically tolerable dose of thermal irradiation and the one or more physiologically tolerable doses of phototherapeutic irradiation may be delivered contin uously,

discontinuously, sequentially, serially, concurrently, simultaneously or in intervals.

The duration of thermal irradiation is dependent on the treatment type but is typically in the range 10 seconds to 15 minutes, preferably 1 to 10 minutes, more preferably 2 to 5 minutes.

The duration of phototherapeutic irradiation is dependent on the treatment type but is typically in the range 10 seconds to 15 minutes, preferably 1 to 10 minutes, more preferably 2 to 5 minutes.

The total duration of the phototherapeutic irradiation may be 10 to 30 minutes.

The total duration of thermal irradiation and phototherapeutic irradiation may be in the range 1 microsecond to one hour. The irradiance of the phototherapeutic irradiation is typically 200mW/cm², preferably 80mW/cm².

Viewed from a yet further aspect the present invention provides the use of a phototherapy apparatus as hereinbefore defined in combatting {eg treating or preventing) a skin disorder in a subject or in a cosmetic {eg aesthetic or restorative) method for a subject.

Preferably the use is in combatting acne, rosacea, eczema, hyperpigmentation, vascular lesions, wrinkles, psoriasis, alopecia or atopic dermatitis or for skin rejuvenation, wound healing or stimulating hair growth.

The present invention will now be described in a non-limitative sense with reference to the accompanying Figures in which:

Figure 1 illustrates a phototherapy apparatus according to an embodiment of the present invention from the front;

Figure 2 illustrates the phototherapy apparatus of Figure 1 from the rear;

Figure 3 is a schematic representation of a panel of four types of LED in an array in the modular housing of the phototherapy apparatus of Figure 1;

Figure 4 is a side schematic view of the beam profile of the phototherapy apparatus of Figure 1;

Figures 5a and b are schematic illustrations of a method of using the phototherapy apparatus of Figure 1; and

Figure 6 is a schematic representation of a panel of three types of LED in an array.

Figure 1 illustrates a phototherapy apparatus 1 according to an embodiment of the present invention from the front. The phototherapy apparatus 1 comprises a modular housing 2 with three modules 2a, 2b, 2c mutually spaced apart and connected side-by-side. Between each of the modules 2a and 2b and the modules 2b and 2c is an adjuster 4 which permits the modular housing 2 to be foldable between a substantially planar profile (as shown) and a concave profile.

In each module 2a, 2b, 2c is mounted a panel 30 of four types of LED in a sq uare array. The panel 30 is shown schematically in Figure 3 where the four types of LED are denoted as H, R, B and NIR. The LEDs in the square array are disposed regularly in square clusters with one of H, R, B and N IR respectively at the vertices. In this embodiment, the peak wavelengths of H, R, B and NIR are 1064nm, 633nm, 415nm and 830nm respectively. These are useful wavelengths for skin rejuvenation.

Each module 2a, 2b, 2c includes internal LED driver electronics and cooling slots 7 to the rear (see Figure 2). Each module 2a, 2b, 2c has a light diffusing window 3 to the front. The modular housing 2 is equipped with a pair of handles 18, 18b at the peripheral edge of the outermost modules 2a, 2c to assist in effective positioning. The modular housing 2 serves to create a beam with a uniform illumination profile on the skin 40 as shown schematically in Figure 4. The modular housing 2 is adjustably mounted on a base 20 by a coupling arm 6. The coupling arm 6 is attached to the base 20 by a pivot joint 9 which allows the modular housing 2 to swivel. The coupling arm 6 includes a hinge joint 25 which allows the modular housing 2 to move in a vertical plane. The coupling arm 6 is attached to the rear of the module 2b by a hinge joint 26 which allows the modular housing 2 to tilt.

The base 20 incorporates a digital display (eg LCD or OLED) 8 for the user to operate an internal controller and power supply system 5. Each of H, R, B and NIR may be switched on or off independently. Appropriate software allows the user to select relevant parameters such as pulse width (timing), pulse frequency and irradiance for each of H, R, B and N IR independently.

The controller and power supply system 5 permits the user to select complex treatment regimens and two examples are shown schematically in Figures 5a and 5b. Sequential doses of irradiation from one or more of H, B, R and NIR are represented as blocks. The treatment regime shown in Figure 5a is one in which sequential doses from one or more of H, B, R and NIR are interrupted by intervals of non-illumination. The treatment regime shown in Figure 5b is one in which sequential doses from one or more of H, B, R and N IR are continuous.

The level of irradiance for each of H, B, R and NIR can be selected to be up to 200mW/cm². The dose of thermal irradiation from H may be selected to raise the local skin temperature by up to 15°C within a period of less than 5 minutes.

The treatment regimen for skin rejuvenation is generally delivered to the patient over 10 to 30 minutes and is well tolerated.

A different panel 60 is shown schematically in Figure 6 where three types of LED in a square array are denoted as H, R and NIR. The LEDs in the square array are disposed in parallel linear rows of H, R and NIR. In this embodiment, the peak wavelengths of H, R and NIR are 1064nm, 633nm and 830nm respectively.

Claims

1. A phototherapy apparatus comprising: one or more than one source of thermal irradiation capable of elevating the temperature within a treatment area of the skin of a subject in a manner sufficient to stimulate the axon reflex to initiate vasodilation;

photoreceptor in the skin of the subject to activate a photoresponse;

2. A phototherapy apparatus as claimed in claim 1 wherein the modular housing comprises more than one module mutually spaced apart and connected foldably side-by- side.

3. A phototherapy apparatus as claimed in claim 2 further comprising an adjustment mechanism operatively mounted between each of the more than one module so as to permit the modular housing to be foldable between a substantially planar profile and a concave profile.

4. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of thermal irradiation is one or more than one plurality of thermal LEDs.

5. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of phototherapeutic irradiation is one or more than one plurality of phototherapeutic LEDs.

6. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of thermal irradiation is one or more than one plurality of thermal LEDs and the one or more than one source of phototherapeutic irradiation is one or more than one plurality of phototherapeutic LEDs, wherein the thermal LEDs and the

phototherapeutic LEDs are clustered in square clusters.

7. A phototherapy apparatus as claimed in claim 6 wherein the thermal LEDs and the phototherapeutic LEDs are distributed in a square array.

8. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of phototherapeutic irradiation is (or includes) a source of

phototherapeutic irradiation having a peak wavelength which is blue-violet.

9. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of phototherapeutic irradiation is (or includes) a source of

phototherapeutic irradiation having a peak wavelength which is red.

10. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of phototherapeutic irradiation is (or includes) a source of

phototherapeutic irradiation having a peak wavelength which is near-IR.

11. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of thermal irradiation is (or includes) a source of thermal irradiation having a peak wavelength which is substantially non-coincident with the peak wavelength of the one or more than one source of phototherapeutic irradiation.

12. A phototherapy apparatus as claimed in any preceding claim wherein the one or more than one source of phototherapeutic irradiation is (or includes) a first source of phototherapeutic irradiation having a peak wavelength of about 415nm, a second source of phototherapeutic irradiation having a peak wavelength of about 633nm and a third source of phototherapeutic irradiation having a peak wavelength of about 830nm.

13. A method of combatting a skin disorder in a subject or a cosmetic method for a subject which comprises:

arranging the modular housing of a phototherapy apparatus as defined in any preceding claim at an effective distance from or in contact with a treatment area of the skin of the subject;

illuminating the whole or a part of the treatment area of the skin of the subject with a physiologically tolerable dose of thermal irradiation sufficient to elevate the temperature within the treatment area of the skin whereby to stimulate the axon reflex to initiate vasodilation; and

14 The use of a phototherapy apparatus as claimed in any of claims 1 to 12 in combatting a skin disorder in a subject or in a cosmetic method for a subject.

15. Use of a phototherapy apparatus as claimed in claim 14 in combatting acne, rosacea, eczema, hyperpigmentation, vascular lesions, wrinkles, psoriasis, alopecia or atopic dermatitis or for skin rejuvenation, wound healing or stimulating hair growth.