SURVEY | Effectiveness of light therapy for rosacea and/or seborrheic dermatitis

[Rand627]

Hm. Interesting. I can't really tell i've done anything as of yet, which isn't surprising seeing as it's been 7 minutes over 4 days, hah. Anyway, I'm going camping for the weekend out in the dirt and sun. Should be interesting to see what happens to my skin. Wish me luck!

[findingaway]

Hm. Interesting. I can't really tell i've done anything as of yet, which isn't surprising seeing as it's been 7 minutes over 4 days, hah. Anyway, I'm going camping for the weekend out in the dirt and sun. Should be interesting to see what happens to my skin. Wish me luck!

Have fun Rand. Remember to wear plenty of sunblock!

You know it's weird, just looked in the mirror again and although I still feel burning, my face is as calm as anything. It looks less red then it usually does. In fact it looks positively brilliant. God knows what's going on!

The only thing I can think is that the RLT is making me slightly more prone to flushing but reducing the base redness. If this is true, I hope the former is just a temporary side effect. From all bar one of the surveys, people said it really helped reduce their flushing.

[findingaway]

Updates

Rand,

I've been doing some more research on RLT.

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 i'm only young so 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 the
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!

*moderators, sorry for duplicating some of the information here from the other post.

[Rand627]

So I basically destroyed my skin on the campout. Was in the desert sun for about 4 hours without a hat or a drop of sunscreen. Got badly burnt and am still recovering 3 days later. Skin's quite a bit more red than usual.

So, any results from the RLT is null for a bit.

And I'm throwing caution to the wind for now. Taking 3k IU of D3 as well as the RLT every other day with quinacrine every day. Taking Vitamin D is something alot of people do..and its pretty natural, so I don't think it'll hurt. We will see though.

[findingaway]

Well as long as you had a good time

I've been doing a LOT of reading on RLT and feel I have moved an inch forward. Enough, however, to adjust my "dose" accordingly - educated guess I think they call it.

In a nutshell, been emailing professors that have written/conducted studies with RLT and asked them the questions outlined in a previous post.

The only response (not surprisingly) I have got back is, "try the Near-Infrared as it has more effective anti-inflamatory effects" and "LLLT can be anti-inflammatory but can also increase blood flow and angiogenesis so it is not a clear cut application in rosacea" - very helpful of them to get back, but i'm not sure it answered my question.

So now I have administering 6 minutes of NIR (Near Infrared) every 48 hours based on experiences on this forum and studies I read.

The burning has gone!! Yay! But, my eye went crazy the other day :/ and I have been experiencing some flushes more then usual - this might be due to the fact that - and this is my theory based on others experiences - new blood vessels are formed as a result of the RLT prior to the anti-inflamatory action taking effect (which is cumulative), so basically you flush more to start with and then it calms down.

I *think* this has something to do with the immediate release of NO (Nitric Oxide) and then later, a cumulative effect takes place which actually inhibits NO (iNOS). It's all very complicated.

BTW, by "dose" I mean J/cm2.

Example:

A LED device has these specifications:

Red (wavelength 633 nm). Power output 8.4 mW/cm2. A mW is a milliWatt, or a thousandth of a Watt.

The light output is 8.4 mW per cm2 and your goal is 4 Joules per cm2 per treatment. One Joule is defined as one Watt per second, so in order to achieve that, you should know that J = W x S (Joule is Watt x Seconds)

In our case, we want to know how many seconds, so our equation becomes S = J / W. We just said 4 Joules is the target energy to be delivered to a square centimeter of skin, and the output of LED devices is stated in mW, so the formula to use is: Seconds of treatment per cm2 of skin = 4000 mJ / milliWatt per cm2 of skin.

4000 mJ divided by 8.4 = 476 seconds.

So each time you use the device, you should apply it for 476 seconds (8 minutes) on a skin surface area with the same size as the light emitting surface area as the device. This means that if you want to treat a skin area that is four times larger than the light emitting part of the LED device, that you need to move it over the skin for 4 x 8 = 32 minutes in total.

If the output per cm2 is not specified, look for the total output of the device and divide the total output by the total area of the panels with LEDs. This will give the Wattage per cm2. Example: Output area is 10 cm2, total Wattage is 50 mW. Wattage per cm2 is 50 divided by 10 = 5 mW.

This is completely fictional as my device has an output of 70mW/cm2 (red) and 55mW/cm2 (Near Infrared), so 8.4 is very low.

I think the LEDman's device has an output of 25mW/cm2 and if this is the case, to adminster 4 J/cm2 you would use the device as close to your skin as you can for (4 / 0.025) 160 seconds (2 minute 40 seconds).

I have been admistering 6 minutes at 55mW/cm2 so (360 x 0.055) 19.8 J/cm2.

To get 19.8 J/cm2 from the LEDmans, assuming the intensity is 25mW/cm2, you would need to use the unit for (19.8 / 0.025) 792 seconds (13 minutes 12 seconds).

However, I have no real clue as to whether this is an optimum dose, so by all means do your own research!

A bare minimum of 4 Joules per cm2 per treatment is required to attain any kind of biological effect. Again, there is a maximum threshold too (although this is harder to determine) and just to complicate things, 4 J/cm2 is not the same as 4 J/cm2 with different time or intensity...

For example:

When cooking a lamb joint you know how to get the right temperature for the right time, e.g. 220º C for 1 hour (never having cooked a lamb joint, I guess this is right.

But 2200º for 25 mins or 22ºc for 10 hours would not get the same cooked lamb joint. Get the heat right then get the cooking time right don't multiply one by the other to get a single number.

This is the same with RLT.

(Power / area) x time is J/cm2
e.g. (0.001W / 0.2cm2) x 80 seconds = 4J/cm2 (this would heal a wound)
also (10W / 0.001cm2) x 0.0004 second = 4J/cm2 (this may burn a patient)
also (0.00001W / 10cm2) x 4,000,000 seconds = 4J/cm2 (will have no effect)

Each is 4J/cm2.

To heal a wound you need 10mW/cm2 - 50mW/cm2 max for a minute or so apparently.

How this translates to an effective dose for rosacea? I'm not sure...yet.

PS - Really annoying as I found this page: http://members.rosacea-research-and-...p?showtopic=71 - on the RRDi, but they have deleted the part when he mentions exactly the wavelength and J/cm2 that you need to get great results with RLT.

His name is Matthew Iris and he writes a lot of the Rosacea Community Forum - which I think is the other one. But I cannot find him. Annoying.

[Rand627]

My goodness it sounds like you've been doing quite a bit of research. I think tomorrow I'm going to do 6 minutes of red and on the last 3 minutes add the IR. I pretty much hold it against my skin as well, so I should get quite a bit of light in there.

So you say your burning has completely gone? If so, that's quite remarkable. Burning is one of the most annoying parts of this disease.

[findingaway]

My goodness it sounds like you've been doing quite a bit of research. I think tomorrow I'm going to do 6 minutes of red and on the last 3 minutes add the IR. I pretty much hold it against my skin as well, so I should get quite a bit of light in there.

So you say your burning has completely gone? If so, that's quite remarkable. Burning is one of the most annoying parts of this disease.

Yep. Gone apart from when I flush, but even it's just a light feeling, 10% of where it was before.

Just remember that 6 mins on your device is not the same as 6 mins on mine.

Also, from the reading ive done, I would mix the wavelenghths. I can't explain why more then to say almost exclusively, every study used just one wavelength at a time. This may be because red and infrared do slightly different things. Maybe like trying to microwave a meal while it's cooking in the oven...?? Lol, I love my analogies.

[Rand627]

Hah..maybe, I do have time to use both at different times. This is on a completely different subject, but how do you shave? Electric or a razor?

[findingaway]

Hah..maybe, I do have time to use both at different times. This is on a completely different subject, but how do you shave? Electric or a razor?

Hi Rand,

I would just stick to red. If I had a 660nm as opposed to a 633nm, I'd be using red too. In fact thinking of getting a LEDman unit too. Is it good quality?

Re shaving, I use a wet shaver every 2-3 days. Never used an electric one. I do get some irritation, but it goes after a while.

[Rand627]

Interesting, what are the supposed benefits of 633 vs 660? I didn't even realize the omnilux and the ledman's unit were different in terms of wavelength.

And yeah, it's definitely good quality. Really light, but I guess that's just because they are LEDs.

[findingaway]

Interesting, what are the supposed benefits of 633 vs 660?

That, Rand, I have no idea! But I'd love to know! The only thing I have managed to find is in this article, but does really explain why (plus I also found a post from someone saying not to use 630nm for healing): http://heelspurs.com/led.html

630 is not as beneficial as 660, but it's still a good wavelength at least for skin. 660 nm will penetrate deeper because 630 is blocked more by blood and collagen, and 660 nm has a better biological response. *630 nm red is slightly orange and 660 nm red is a "deeper" red. *Since 660 nm is almost infrared, the human eye is not able to see it as well. *630 nm red is used in key rings, traffic lights, and car tail-lights because it's 6 times easier to see than 660 nm (see the photopic response factor - chart ). *The eye doesn't suddenly stop sensing light at 700 nm, but it is a gradual decline in sensitivity. *You can see the healing and pain relief effect of light therapy by applying a laser pointer or a key ring light to small cuts for 2 minutes or to an arthritic finger joint for 20 minutes.

The article also touches on other wavelenghths.

[Rand627]

Hm, interesting stuff as always. Today was the first day I could feel the sensitivity after the RLT. I did 6 and a half minutes with all of the minutes with red and 5 minutes of IR.

Taking a picture of myself tomorrow for an application. Hah, gonna have to do some photoshopping. Wish me luck.

[findingaway]

Hm, interesting stuff as always. Today was the first day I could feel the sensitivity after the RLT. I did 6 and a half minutes with all of the minutes with red and 5 minutes of IR.

Taking a picture of myself tomorrow for an application. Hah, gonna have to do some photoshopping. Wish me luck.

Good luck Rand.

I would build up slowly though. I dived straight in there because I wanted to see results and it back fired. Plus, I'd stick to one wavelenghth per session if I were you.

[Rand627]

Hm. Well maybe I'll try 3 minutes of IR and 4 minutes of red tomorrow. There are so many variables that it's going to take quite a bit of time before I know what I'm doing. Why do you think having both on at the same time affects anything?

[findingaway]

Hm. Well maybe I'll try 3 minutes of IR and 4 minutes of red tomorrow. There are so many variables that it's going to take quite a bit of time before I know what I'm doing. Why do you think having both on at the same time affects anything?

If you meant 3 mins of IR today and 4 of IR tomorrow, then that would be cool. Personally I'd give it 48 hours between sessions. The second day is always my best day.