Non-healing ulcers in diabetic patients: case series.

02 February 2022

Authors: Maria Stella Aliqò, Luigi Favuzza, Laura Priola, Salvatore Corrao.

Year: 2021

Title: Clinical application of photobiomodulation with blue light on non-healing ulcers in diabatic patients: a case series study.

Publication: Wounds International https://bit.ly/3GlcHh7


To assess the efficacy of Blue Light (EmoLED) irradiation on lower limbs recalcitrant ulcers, not responding to the standard of care, in patients with diabetes.



  • Patients with diabetes and ulcers in the lower limbs that were not responding to standard of care were enrolled by the Department of Internal Medicine, Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy.
  • All patients underwent blue light therapy following a schedule of 10 weekly treatments (60 seconds per wound area) based on the protocol in the Blue Light for Ulcers Reduction Study. In cases of rapid healing before the 10th treatment, blue light therapy was discontinued.
  • Wounds were irradiated after a proper cleansing of the wound and were treated according to the standard of care after each Blue Light treatment.
  • Results were evaluated as reduction of the wound area in percentage.



  • 11 patients with type 1 (T1D) and type (T2D) diabetes were enrolled. Two patients had T1D, and nine had T2D, with a diabetes history ranging from 2 to 35 years. All patients had cardiovascular and neurological complications due to diabetes, with various comorbidities.
  • Four patients had undergone foot amputation and two patients had undergone amputation of part of the leg.
  • All the patients had ulcers in the lower limbs of various aetiology and at least 6 months duration that previously received standard treatments with unsatisfactory results.
  • Blue light therapy significantly improved reepithelisation and healing in all the 11 patients studied, with the majority showing a complete recovery of the ulcers with no side effects.
  • Overall, 64% (n=7) of the patients completely recovered within 10 weeks of blue light treatment (100% reepithelialisation). Two patients had the lesion area reduced by 80% and 90%, respectively, and two patients had smaller reductions, with 30% and 50%, respectively.
  • The blue light therapy allowed preparation of the wound bed for skin transplantation (autologous skin graft or regenerative dermal substitute) in three cases observed, which led to complete reepithelialisation and healing.
  • The treatment positively contributed to wound healing in patients with severe vascular impairment and was also effective in managing ulcer recurrence in a patient with complex clinical pictures, including kidney and heart failure.



According to the authors the promising results achieved indicate that Blue LED Light (EmoLED) irradiation could be an effective and safe adjuvant therapy in managing recalcitrant ulcers in patients with diabetes, not responding to the standard of care.

Patient with two ulcers. The ulcer on the right malleolus (a) completely healed after five blue light treatments with Blue Light (b). The ulcer on the left calcaneus, of 6 years’ duration (c), fully healed after 10 blue light treatments (d).
Patient with ulcer in the left leg stump with necrosis and sepsis, at first admission (a). After surgery and standard care, with evident wound dehiscence (b). The wound after the first blue light treatment (c) and after 10 treatments (d), leading to 80% ulcer reduction. The stump about 8 months after first healing and an episode of heart failure, with ulcer recurrence, secretion, and keratosis in the margins (e). The ulcer completely healed after seven blue light treatments (f).
Patient with broad ischaemic-infected ulcer in the III middle and lower right leg with tendon exposure, at first admission, (a), after Negative Pressure Wound Therapy (NPWT) in (b), and after 10 Blue Light treatments in (c), with 50% reduction in size. This improvement in reepithelization allowed for a dermal substitute graft to be performed, leading to complete recovery.