SURVEY | effectiveness of light therapy for rosacea and SD

LLLT can include light emitting diodes (LED), lamps and fluorescent tube devices. This form of therapy appears to help the inflammation of rosacea. LED is one example of a gentle form of light which can be used. There are also infra-red and near infra-red forms of light therapy being reported as effective. Drop by here to find out the latest about this emerging treatment area.

Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby Mike T » Mon Jan 10, 2011 2:20 pm

Great idea!

Hopefully anyone who has tried the subject treatment will take a few mins to complete the survey.

The more participants the easier it will be to identify any trends.

Goodluck.
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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby findingaway » Mon Jan 10, 2011 3:05 pm

Hi Mike,

I hope so.

I am currently pulling the survey results into a graphs (using numbers on the mac and although I love Apple, I am rapidly losing love for them right now...It's not as versatile as excel)

It's too early to give any really meaningful data, but from the 3 that have taken the survey, there are some promising results.

3 is disappointingly low number, but the survey only started working a few days ago and some people have still reported problems. That's what you get for using a free service!

In a nutshell:
Symptoms before ranged from none to moderate to severe for facial redness, burning, flushing, bumps etc
All the people had been using RLT for at least 8 weeks (most over 12 weeks)
Most were using it every day. 10-15 mins, 30 minutes and 2-3 times a week respectively
Most people used it 3-5 inches from their face
All used only red, no infrared
No side effects were reported

Most people said their:
    Facial redness has improved a little
    Flushing/blushing has improved a little (duration/intensity)
    Visible blood vessels have improved a little

    Burning has improved a lot
    Itching has improved a lot
    Bumps and/or pustules as improved a lot
    Resilience to triggers has improved a lot
    Ocular Rosacea improved a lot

Some results were split 50/50:
    Rough skin texture (hugely improved & improved a little)*
    Skin thickening (improved a lot & improved a little)*

*Bear in mind that some results show as *Never had and have been therefore excluded.


Also worth noting:
    No one had seborrheic dermatitis, so no word on this yet.
    No one said their symptoms had gotten worse
    One result for bumps and/or pustules said not improved at all
    Some respondents said that RLT had hugely improved their symptoms (itching, rough skin texture and rellience to triggers)
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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby Aurelia » Sat Jan 15, 2011 2:07 pm

I might be wrong but don't think you have posted this at our email-based board.
http://health.groups.yahoo.com/group/rosacea-support/

If you want to include them but would rather not join, I could post it for you, if you like.

Kind regards,

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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby findingaway » Sun Jan 16, 2011 3:13 pm

Hi,

I thought I was a member of that group and had emailed it out, but maybe not...

It would be great if you could. I am about to write a massage post about RLT from some recent research I have found which may help explain why it works for some and others not and why it varies in it's effectiveness. It seems to be quite a precise art.

Thanks Aurelia
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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby findingaway » Sun Jan 16, 2011 8:36 pm

I had done a ton of research and after reading two very interesting articles, have complied an email in the hope I can get some questions answers. I am determined to find out why RLT works better for some then others. And I think I now know.

Anyway, sorry in advance for long post, here is the email I just sent. Some might find it interesting.

_______________________________________________________

Email

With reference to: http://heelspurs.com/led.html

Great article about Light Therapy. Very well written. Apologies in advance for the long email, your response would be extremely welcome :)

I have recently purchased an Omnilux New-U (http://www.photomedex.com/omnilux/newu.htm):
  • 88 LEDs (Red Light 630-640nm - 60, Infrared Light 830nm - 28)
  • Treatment Window: 1.8" x 2.4"
  • LED Density: Red Light 2.09 LED/cm2, Infrared Light 0.98 LED/cm2
  • LED Intensity: Red Light 70 mW/cm2, Infrared Light 55 mW/cm2

As a sufferer of Rosacea, I brought the device after hearing many good reports (and some bad) from people on forums. They all have differing units, thus differing power intensities and wavelengths.

After a shaky start (some increased redness & burning), I decided to do some reading on RLT.

The first article I stumbled upon was this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2790317/ - which talks in some depth about the application of RLT and how the dose is very important.

I then 'googled' 'optimum dose for light therapy J/cm2' and came across your site. Again, very informative, however, the article does raise a couple of points for me, which I was hoping you could answer?

Firstly, the New-U is FDA approved to treat proverbial wrinkles. I am not bothered if it works for this purpose or not as at 27, I hopefully shouldn't have to worry about wrinkles for a while :)

So, the treatment plan in the booklet, probably doesn't apply for the use I want it for. For your info though it is:

Treatment
20 minutes per area - Twice weekly. Interval between treatments 2-5 days. Move the switch UP for Infrared light Move the switch DOWN for Red light. Alternating between the two. Must be 1/2 or less from the face. Treatment continues for 5 weeks.

I have only used it a four times, always leaving a gap or 3 days and always Red. I upped the dose from 2 minutes to start, to 14 minutes the last time.

What I am interested in, is the dose requirement and whether I am working it out right. I created a survey which many rosacea sufferers have taken as I wanted to gauge why RLT was working for some and not others. I think your article and the other I read touches on this in the way that too little LLLT is no good and nor is too much.

So...lets take infrared for a start as it' in the peak wavelength range that is mentioned in your article. It appears 633nm is much weaker.

The intensity of the device is 55mW/cm2. You say in your article:

Healing Dosage and Application Time
'Several journal articles indicate about 4 Joules of energy (J) applied to each 1 cm by 1 cm area (1 cm^2) once or twice per day is the best dosage for healing cells that are directly exposed to the light. At 8 J/cm^2, the dosage may be too high and there will be less benefit than at 4 J/cm^2. LED devices specifications should always include W/cm^2 so that the application time can be calculated. A Joule (J) is a Watt (W) applied for 1 second. So 4 J/cm^2 is the same as applying an LED device with a strength of 0.03 W/cm^2 for 133 seconds (133 seconds x 0.03 W/cm^2 = 4 J/cm^2). The only benefit of stronger LED devices is a shorter treatment time'


So it means my device, for a 20 minute infrared session is producing a dose of (1200 x 0.055) 66 J/cm2. Way more then the optimum 4 J/cm2 - unless I am working something out wrong?

Duration vs depth
Should my calculation be correct, that part is fairly simple, but this is where I get lost a bit.

You say in your article:

'To help tissue that is 1 cm beneath the skin, a much long application time is needed. It is very difficult to know how much light is being blocked by tissue, but 1 cm of tissue allows roughly only 10% of the light through. So 10 times as energy (Joules) is required to treat tissue that is 1 cm deep compared to tissue at the surface of the skin, or 10 x 4 = 40 J/cm^2. For a 0.03 W/cm^2 LED device, 40/0.03 = 1333 seconds = 22 minutes'


So considering the skin is about 2–3 mm thick, I would want to have a (3 x 4 J/cm2) 12 J/cm2 session or (12 / 0.055mW/cm2) 218 second session. Have I worked this out correctly?

The question would then be that considering:

'at 8 J/cm^2, the dosage may be too high and there will be less benefit than at 4 J/cm^2'


am I losing the benefit to the top layers of the skin and only benefitting the bottom layers of skin?

Rest period
As I said earlier, some who have used RLT have run into difficulties and stopped because it made things worse (although the vast majority have benefited greatly). I think this is because they have used it WAY beyond the 4 J/cm2 optimum and as I read in the other article mentioned:

'LLLT delivered at low doses tends to work better than the same wavelength delivered at high levels, which illustrates the basic concept of bipha-sic dose response or hormesis (Calabrese 2001b). In general, fluences of red or NIR as low as 3 or 5 J/cm2 will be beneficial in vivo, but a large dose like 50 or 100 J/cm2 will lose the beneficial effect and may even become detrimental'


I received a copy of the Omnilux Revive rosacea instructions, which is the saloon model (the same strength apparently as the Omnilux New-U, but a bigger treatment area) and this states that at least 48 hours should be given between treatments. The treatment plan is identical as I outlined for the New-U, only with just red.

You say in your article that recent serious injuries benefit from several treatments per day. Since Rosacea is a chronic disease, to keep the inflammation at bay, the device is going to see it's fair share of use. I was not intending to stop after 5 weeks as suggested in the manual. I wondered what you think would be a good "dose" and the frequency, i.e. daily, every week etc.

Inverse square law
Also, I understand that light follows an inverse square law, so at twice the power will be distributed over 4x the area (so effectively, 4x less effective or have to use it 4x as long to get the same effect). I am presuming that when you say 4 J/cm2 that is without any loss of light with the LEDs almost directly on the skin. And this doesn't take into account the lack of uniformity of LEDs?

Calculations
I read this on the other article which confused me somewhat:

'Energy (J) or energy density (J/cm2) is often used as an important descriptor of LLLT (low level light treatment) dose, but this neglects the fact that energy has two components, power and time, and it has been demonstrated that there is not necessarily reciprocity between them; in other words, if the power doubled and the time is halved then the same energy is delivered but a different biological response is often observed'


As 1 Watt = 1 Joule per second, isn't x J/cm2 a power/area/time calculation all in one?

Red or NIR
I was going to stick with NIR as this LED is within the optimum band you mention, unless you think Red LED at 633nm will be better for rosacea inflammation and if so, as it isn't in the optimum range (rather the opposite) would you use it for longer?

Rosacea and LLLT
Posts on forums come up from time to time, giving a little insight into new treatments. Recently someone posted about the way in which LLLT may interact with rosacea in a positive way. But this is a little confusing too:

'Recent research has shown an increase of specific proinflammatory cytokines, including tumor necrosis factor (TNF-α) and interleukin (IL-1β), in biopsies of inflammatory lesions from acne patients.9 These cytokines trigger a chain of chemical responses in the body, including the release of certain matrix metalloproteinases (MMPs); specifically, MMP-1, -3, and -9.10,11 These MMPs are involved in collagen matrix degradation and inflammatory damage. The likely result is the development of papulopustular lesions. Owing to the similarities between these lesions in acne and rosacea, this evidence offers insight into the inflammatory nature of rosacea.

Two additional inflammatory mediators thought to incite the symptoms of rosacea are reactive oxygen species (ROS) and nitric oxide (NO). Clinical trial evidence reports that patients with severe rosacea have a reduced capacity to counter the negative effects of ROS; thus, experiencing an increased inflammatory response.11,12 This may also explain the connection between photodamage and rosacea since sun exposure is known to induce the release of ROS which subsequently activates MMPs.13 The role of NO involves vascular changes and is believed to be partially responsible for the erythema, edema, and telangiectatic symptoms of rosacea.11,13 Vasodilation plausibly results in vascular instability leading to increased vessel permeability, edema, and fixed vessels. This may worsen with increased sun exposure as an increase of NO in the keratinocytes has been linked with UVB rays.9"

Thus, according to the inflammatory theory of rosacea, since TNF-a (tumor necrosis factor) stimulates many of the other cytokines and enzymes involved in the inflammatory process and also in much of the tissue destruction we see with rosacea, decreasing TNF-a levels should theoretically help minimize the increased symptoms of inflammation we see with rosacea. Studies seem to support claims that low-level light therapy reduces levels of TNF-a.

Also, according to the inflammatory theory of rosacea, since rosaceans have a reduced capacity to counter the negative effects of reactive oxygen species (ROS), increasing levels of superoxide dismutase (SOD), which is key in the process of clearing ROS, should theoretically help to prevent or even reduce some of the damaging effects ROS has on rosacea affected tissues. Studies so far indicate that low-level light therapy increases levels of SOD. (See the page on GliSODin for more information about the effects of SOD on ROS)'


Now, in the other article, it mentions that ROS - reactive oxygen species - is increased during LLLT along with NO - nitric oxide. Both are seemingly bad for rosacea according to the above:

Reactive Oxygen Species (ROS)
'LLLT was reported to produce a shift in overall cell redox potential in the direction of greater oxidation (Karu 1999) and increased ROS generation and cell redox activity have been demonstrated (Alexandratou et al. 2002; Chen et al. 2009b; Grossman et al. 1998; Lavi et al. 2003; Lubart et al. 2005; Pal et al. 2007; Zhang et al. 2008). These cytosolic responses may in turn induce transcriptional changes. Several transcription factors are regulated by changes in cellular redox state. But the most important one is nuclear factor B (NF-B). Figure 5 illustrates the effect of redox-sensitive transcription factor NF-κB activated after LLLT and is instrumental in causing transcription of protective and stimulatory gene products'

Excessive ROS
'As discussed in 2.5 the light mediated generation of reactive oxygen species has been observed in many in vitro studies and has been proposed to account for the cellular changes observed after LLLT via activation of redox sensitive transcription factors (Chen et al. 2009a). The evidence of ROS mediated activation of NF-κB in MEF cells presented in 4.1 provides additional support for this hypothesis (Chen et al. 2009a). It is well-accepted that ROS can have both beneficial and harmful effects (Huang and Zheng 2006). Hydrogen peroxide is often used to kill cells in vitro (Imlay 2008). Other ROS such as singlet oxygen (Klotz et al. 2003) and hydroxyl radicals (Pryor et al. 2006) are thought to be harmful even at low concentrations. The concept of biphasic dose response in fact is well established in the field of oxidative stress (Day and Suzuki 2005). If the generation of ROS can be shown to be dose dependent on the delivered energy fluence this may provide an explanation for the stimulation and inhibition observed with low and high light fluences'

Nitric Oxide (NO)
'Light mediated vasodilation was first described in 1968 by R F Furchgott, in his nitric oxide research that lead to his receipt of a Nobel Prize thirty years later in 1998 (Mitka 1998). Later studies conducted by other researchers confirmed and extended Furchgott’s early work and demonstrated the ability of light to influence the localized production or release of NO and stimulate vasodilation through the effect NO on cyclic guanine monophosphate (cGMP). This finding suggested that properly designed illumination devices may be effective, noninvasive therapeutic agents for patients who would benefit from increased localized NO availability'

Excessive Nitric Oxide
'The other mechanistic hypothesis that is put forward to explain the cellular effects of LLLT relates to the photolysis of nitrosylated proteins that releases free NO (see section 2.6). Again the literature has many papers that discuss the so-called two-faced or “Janus” molecule NO (Anggard 1994; Lane and Gross 1999). NO can be either protective or harmful depending on the dose and particularly on the cell or tissue type where it is generated (Calabrese 2001a)'


I understand that NO is certainly released by LLLT in short term but in long term due to
anti-inflammatory effect iNOS activity is reduced. Is this the same with ROS? I wondered where SOD came into the equation in reducing ROS?


____________________________________________

Hopefully, I will be lucky enough to get some answers!
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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby findingaway » Tue Jan 25, 2011 11:38 pm

Survey Results

OK. Spent an inordinate amount of time setting up the spreadsheet, so not only can I just input new results and quickly publish the results in nice looking graphs, but also so I can cross anaylise the data. So for example, I can see if there are any corrlesations in the data (e.g. people using the unit for 25 minutes daily are getting the best results - although this is just an example and may not be true!)

I am also not a details person, so please tell me if anything is amiss. All in all, some very positive results!

Some notes:
    > There were more then 10 entires (which this data is based on), but some of the data was so incomplete (people not completing the AFTER section of the survey), I had to exclude the data.
    > I have set the graph to 1 numeric above the top entry (rather then uniform across the board) as this seemed to make more sense.
    > I have excluded the entries where the option 'never had' was ticked for the AFTER section. I kept this in for the BEFORE section as I though people might find it interesting, but it's not relelvant to the AFTER section.

Right here goes, hopefully it will come out OK...it'll have to be over several posts as it won't let me post all at once...

Survey results as at 25th January 2011.

Image

Image

ImageImage

ImageImageImage
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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby Aurelia » Mon Jan 31, 2011 10:33 pm

Hi findingaway,

As discussed, on my computer screen these graphs appeared cut off on the right of the screen. Once you posted a re-sized version, the original displayed perfectly, so I've now deleted the posts related to my query and will apologise for the interruption. (blush)

Kind regards,

Aurelia
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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby oldredlady » Fri Jun 10, 2011 11:55 am

Just took this survey, am hopeful when I see the results to date, and hope with longer use (I've only been using my all red Acnelamp for about 3 weeks) I'll see a decrease in my facial redness and visible capillaries, my two biggest concerns.

Thanks for posting the survey and the results, most encouraging. :)

Best to all,
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Re: SURVEY | effectiveness of light therapy for rosacea and SD

Postby fanny » Fri Jun 10, 2011 1:08 pm

Hi
I suppose I'm reading it wrong but it did not look that encouraging to me?
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