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Light therapy

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Bright light therapy is a common treatment for seasonal affective disorder and for circadian rhythm disorders.

Light therapy or phototherapy (classically referred to as heliotherapy) consists of exposure to daylight or to specific wavelengths of light using lasers, light-emitting diodes, fluorescent lamps, dichroic lamps or very bright, full-spectrum light, usually controlled with various devices. The light is administered for a prescribed amount of time and, in some cases, at a specific time of day.

Commercially, the common use of the term is associated with the treatment of skin, sleep disorder and some psychiatric disorders. Light therapy directed at the skin is used to treat acne vulgaris and neonatal jaundice. Light therapy which strikes the retina of the eyes is used to treat circadian rhythm disorders such as delayed sleep phase syndrome and can also be used to treat seasonal affective disorder, with some support for its use also with non-seasonal psychiatric disorders.

The medical (mainstream and complementary and alternative medicine) applications of light therapy also include pain management, accelerated wound healing, hair growth, acupuncture, improvement in blood properties and blood circulation, and sinus-related diseases and disorders. Many of these use low level laser therapy and red light therapy in the 620–660 nm range.

The National Center for Complementary and Alternative Medicine has listed "Light Therapy" as a practice that involves "veritable forms of energy that include those involving electromagnetic fields".[1]

History

Indian medical literature dating to 1500 BC describes a treatment combining herbs with natural sunlight to treat non-pigmented skin areas. Buddhist literature from about 200 AD and 10th-century Chinese documents made similar references.

Danish physician Nils Finsen is believed to be the father of modern phototherapy. He developed the first artificial light source for this purpose, and used his invention to treat lupus vulgaris. He received the Nobel Prize in Physiology or Medicine in 1903.

Since then a large array of treatments have been developed from the use of controlled light. Though the popular consumer understanding of "light therapy" is associated with treating seasonal affective disorder, other applications, growing in recognition include the application of low level laser, red light, near-infrared and ultraviolet lights for pain management, hair growth, skin treatments, accelerated wound healing. The modalities include light-based acupuncture, directing light on painful areas, blood irradiation therapy and photodynamic therapy.

Acne vulgaris

Sunlight was long known to improve acne, and this was thought to be due to antibacterial and other effects of the ultraviolet spectrum which cannot be used as a long-term treatment due to the likelihood of skin damage.[2]

It was found that some of the visible violet light present in sunlight (in the range 415–430 nm) activates a porphyrin (Coproporphyrin III) in Propionibacterium acnes which damages and ultimately kills the bacteria by releasing singlet oxygen. A total of 320 J/cm2 of light within this range renders the bacteria non-viable.[3]

The use of light therapy for three consecutive days has been shown to reduce the bacteria in the pores by 99.9%.[citation needed] Since there are few porphyrins naturally found in the skin, the treatment is believed safe except in patients with porphyria;[4] although eye protection is used due to light-sensitive chemicals in the retina. The light is usually created by superluminous LEDs. This form of treatment has been approved by the FDA for some lightwave systems .[citation needed] Overall improvements of on average 76% for 80% of patients occurs over three months; most studies show that it performs better than benzoyl peroxide and the treatment is far better tolerated. However, approximately 10% of users see no improvement.[3]

Psoriasis and eczema

A feature of psoriasis is localized inflammation mediated by the immune system. UV radiation is known to suppress the immune system and reduce inflammatory responses. Light therapy for skin conditions like psoriasis or eczema use UV-A (315–400 nm wavelength) or UV-B (280–315 nm wavelength) light waves. UV-A, combined with a drug taken orally, is known as PUVA treatment. Narrow band UV-B is the 310 nm wavelength and is given as a light therapy treatment rather than full spectrum UV-B.

Tanning

Tanning is caused by the effects of two different spectrums of ultraviolet radiation: UV-A and UV-B.

Wound healing

Lightwave therapy has been suggested for use in healing of wounds. Some[5] say that low-level laser therapy does not appear to be effective, while others[6] find that it can be effective. Lightwave therapy is used clinically in many areas outside the United States including Canada, Europe and Asia.[5]

Photodynamic therapy

Visible blue light is used with aminolevulinic acid for the treatment of actinic keratosis. This is not a U.S. FDA-approved treatment for acne vulgaris.[7]

Light boxes

The production of the hormone melatonin, a sleep regulator, is inhibited by light and permitted by darkness as registered by photosensitive ganglion cells in the retina. To some degree, the reverse is true for serotonin, which has been linked to mood disorders. Hence, for the purpose of manipulating melatonin levels or timing, light boxes providing very specific types of artificial illumination to the retina of the eye are effective.[citation needed]

Light therapy either uses a lightbox which emits up to 10,000 lux of light, much brighter than a customary incandescent lamp, or a lower intensity of specific wavelengths of light from the blue (470 nm) to the green (525 nm) areas of the visible spectrum.[8] Newer light therapy devices use LED technology, making them much smaller and more convenient for users.[9] A 1995 study showed that green light therapy at doses of 350 lux produces melatonin suppression and phase shifts equivalent to 10,000 lux bright light therapy[10][11] and another study published in May 2010 suggests that the blue light often used for SAD treatment should perhaps be replaced by green or white illumination.[12]

In treatment, the patient's eyes are to be at a prescribed distance from the light source with the light striking the retina. This does not require looking directly into the light.

Seasonal affective disorder

While full sunlight is preferred for seasonal affective disorder (SAD)[citation needed], light boxes may be effective for the treatment of the condition. Light boxes for seasonal affective disorder are designed to filter out most UV light, which can cause eye and skin damage.[13] The U.S. Food and Drug Administration has not approved the use of light boxes to treat SAD due to unclear results in clinical trials,[14] but light therapy is still seen as the main form of treatment for SAD.[15] Direct sunlight, reflected into the windows of a home or office by a computer-controlled mirror device called a heliostat, has also been used as a type of light therapy for the treatment of SAD.[16][17]

It is possible that response to light therapy for SAD could be season dependent.[18]

Non-seasonal depression

Light therapy has also been suggested in the treatment of non-seasonal depression and other psychiatric disturbances, including major depressive disorder, bipolar disorder[19] and postpartum depression.[20][21] A meta-analysis by the Cochrane Collaboration concluded that "For patients suffering from non-seasonal depression, light therapy offers modest though promising antidepressive efficacy."[22]

Circadian rhythm sleep disorders

Chronic CRSD

In the management of circadian rhythm disorders such as delayed sleep phase syndrome (DSPS), the timing of light exposure is critical. For DSPS, the light must be provided to the retina as soon after spontaneous awakening as possible to achieve the desired effect, as shown by the phase response curve for light in humans. Some users have reported success with lights that turn on shortly before awakening (dawn simulation). Morning use may also be effective for non-24-hour sleep-wake syndrome, while evening use is recommended for advanced sleep phase syndrome.[23]

Situational CRSD

Light therapy has been tested for individuals on shift work,[24][25] and for jet lag.[26][27]

Neonatal jaundice

A newborn infant undergoing white-light phototherapy to treat neonatal jaundice.

Light therapy is used to treat cases of neonatal jaundice[28] through the isomerization of the bilirubin and consequently transformation into compounds that the newborn can excrete via urine and stools. A common treatment of neonatal jaundice is the Bili light.

Parkinson's disease

Bright light therapy may ease Parkinson's disease by reducing patients' tremors.[29][30]

Safety

Ultraviolet light causes progressive damage to human skin. This is mediated by genetic damage, collagen damage, as well as destruction of vitamin A and vitamin C in the skin and free radical generation. Ultraviolet light is also known to be a factor in formation of cataracts. Researchers have questioned whether limiting blue light exposure could reduce the risk of age-related macular degeneration.[31]

Modern phototherapy lamps used in the treatment of seasonal affective disorder and sleep disorders either filter out or do not emit ultraviolet light and are considered safe and effective for the intended purpose, as long as photosensitizing drugs are not being taken at the same time and in the absence of any existing eye conditions. Light therapy is a mood altering treatment, and just as with drug treatments, there is a possibility of triggering a manic state from a depressive state, causing anxiety and other side effects. While these side effects are usually controllable, it is recommended that patients undertake light therapy under the supervision of an experienced clinician, rather than attempting to self-medicate.[32]

It is reported that bright light therapy may activate the production of reproductive hormones, such as testosterone, luteinizing hormone, follicle-stimulating hormone, and estradiol.[33][34]

There are few absolute contraindications to light therapy, although there are some circumstances in which caution is required. These include when a patient has a condition that might render his or her eyes more vulnerable to phototoxicity, has a tendency toward mania, has a photosensitive skin condition, or is taking a photosensitizing herb (such as St. John's wort) or medication.[35] Patients with porphyria should avoid most forms of light therapy. Patients on certain drugs like methotrexate or chloroquine should use caution with light therapy as there is a chance that these drugs could cause porphyria.

Side effects

Side effects of light therapy for sleep phase disorders include jumpiness or jitteriness, headache, and nausea. Some nondepressive physical complaints (such as poor vision and skin rash or irritation) may improve with light therapy.[36]

See also

References

  1. ^ National Center for Complementary and Alternative Medicine. "What is Complementary and Alternative Medicine?" Retrieved 2010-10-07.
  2. ^ "Health effects of UV radiation". Ultraviolet radiation and the INTERSUN Programme. World Health Organization. Retrieved 2010-02-23.
  3. ^ a b Papageorgiou P, Katsambas A, Chu A (May 2000). "Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris". Br. J. Dermatol. 142 (5): 973–8. doi:10.1046/j.1365-2133.2000.03481.x. PMID 10809858.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  4. ^ Hebel, JL (2009-01-12). "Congenital Erythropoietic Porphyria". eMedicine. Retrieved 2009-06-09. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ a b Posten W, Wrone DA, Dover JS, Arndt KA, Silapunt S, Alam M (March 2005). "Low-level laser therapy for wound healing: mechanism and efficacy". Dermatol Surg. 31 (3): 334–40. doi:10.1111/j.1524-4725.2005.31086. PMID 15841638.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ Journal of Wound, Ostomy and Continence Nursing January/February 2008 Volume 35 Number 1 Pages 116–117 [1]
  7. ^ Aetna policy bulletin re: Phototherapy for Acne
  8. ^ Wright HR, Lack LC, Kennaway DJ. (March 2004). "Differential effects of light wavelength in phase advancing the melatonin rhythm". J. Pineal Res. 36 (2): 140–4. doi:10.1046/j.1600-079X.2003.00108.x. PMID 14962066.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  9. ^ Litebook LED SAD Light
  10. ^ Saeeduddin Ahmed, Neil L Cutter, Alfred J. Lewy, Vance K. Bauer, Robert L Sack and Mary S. Cardoza (1995). "Phase Response Curve of Low-Intensity Green Light in Winter Depressives". Sleep Research. 24: 508. The magnitude of the phase shifts [using low-level green light therapy] are comparable to those obtained using high-intensity white light in winter-depressives.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ^ Michel A. Paul, James C. Miller, Gary Gray, Fred Buick, Sofi Blazeski and Josephine Arendt (July 2007). "Circadian Phase Delay Induced by Phototherapeutic Devices". Sleep Research. 78 (7): 645–652.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ^ J.J. Gooley, S.M.W. Rajaratnam, G.C. Brainard, R.E. Kronauer, C.A. Czeisler, S.W. Lockley (May 2010). "Spectral Responses of the Human Circadian System Depend on the Irradiance and Duration of Exposure to Light". Science Translational Medicine. 2 (31): 31–33. doi:10.1126/scitranslmed.3000741. PMID 20463367.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ^ "Seasonal affective disorder treatment Choosing a light box". Mayo Clinic. 2010-10-01. Retrieved 2011-01-07.
  14. ^ "Light therapy – why it's done". Mayo Clinic. 2008-10-07. Retrieved 2009-06-09.
  15. ^ McGinniss Paul (2007-09-24). "Seasonal affective disorder (SAD) – Treatment and drugs". Mayo Clinic. Retrieved 2009-06-09.
  16. ^ "Applications: Health". Practical Solar. Retrieved 2009-06-09.
  17. ^ "Grab the Sun With Heliostats". New York House. 2009-06-01. Retrieved 2009-12-08.
  18. ^ Thompson C, Stinson D, Smith A (September 1990). "Seasonal affective disorder and season-dependent abnormalities of melatonin suppression by light". Lancet. 336 (8717): 703–6. doi:10.1016/0140-6736(90)92202-S. PMID 1975891.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  19. ^ Benedetti F, Colombo C, Pontiggia A, Bernasconi A, Florita M, Smeraldi E, (2003) Morning light treatment hastens the antidepressant effect of citalopram: a placebo-controlled trial, J Clin Psychiatry. Jun; 64(6):648-53.
  20. ^ Prasko J (November 2008). "Bright light therapy". Neuro Endocrinol. Lett. 29 Suppl 1: 33–64. PMID 19029878.
  21. ^ Terman M (December 2007). "Evolving applications of light therapy" (pdf). Sleep Med Rev. 11 (6): 497–507. doi:10.1016/j.smrv.2007.06.003. PMID 17964200.
  22. ^ Tuunainen A, Kripke DF, Endo T (2004). "Light therapy for non-seasonal depression". Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004050 (2): CD004050. doi:10.1002/14651858.CD004050.pub2. PMID 15106233. Retrieved 2010-02-02.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  23. ^ Light therapy for DSPS treatment. Retrieved 01/11/2010
  24. ^ Smith MR, Eastman CI (December 2008). "Night shift performance is improved by a compromise circadian phase position: study 3. Circadian phase after 7 night shifts with an intervening weekend off". Sleep. 31 (12): 1639–45. PMC 2603486. PMID 19090319.
  25. ^ How an SAD light box can help shift workers. Retrieved 01/11/2010
  26. ^ Brown GM, Pandi-Perumal SR, Trakht I, Cardinali DP (March 2009). "Melatonin and its relevance to jet lag". Travel Med Infect Dis. 7 (2): 69–81. doi:10.1016/j.tmaid.2008.09.004. PMID 19237140.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  27. ^ How to use a light box to prevent a cure jet lag. Retrieved 01/11/2010
  28. ^ Newman TB, Kuzniewicz MW, Liljestrand P, Wi S, McCulloch C, Escobar GJ (May 2009). "Numbers needed to treat with phototherapy according to American Academy of Pediatrics guidelines". Pediatrics. 123 (5): 1352–9. doi:10.1542/peds.2008-1635. PMC 2843697. PMID 19403502.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. ^ Paus S, Schmitz-Hübsch T, Wüllner U, Vogel A, Klockgether T, Abele M (July 2007). "Bright light therapy in Parkinson's disease: a pilot study". Mov. Disord. 22 (10): 1495–8. doi:10.1002/mds.21542. PMID 17516492.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. ^ Willis GL, Turner EJ (2007). "Primary and secondary features of Parkinson's disease improve with strategic exposure to bright light: a case series study". Chronobiol. Int. 24 (3): 521–37. doi:10.1080/07420520701420717. PMID 17612949.
  31. ^ Glazer-Hockstein C, Dunaief JL (January 2006). "Could blue light-blocking lenses decrease the risk of age-related macular degeneration?". Retina (Philadelphia, Pa.). 26 (1): 1–4. doi:10.1097/00006982-200601000-00001. PMID 16395131.
  32. ^ Terman M, Terman JS (August 2005). "Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects". CNS Spectr. 10 (8): 647–63, quiz 672. PMID 16041296.
  33. ^ "Bright Light May Boost Testosterone". WebMD. Retrieved 2008-12-15.
  34. ^ Danilenko KV, Samoilova EA (2007). "Stimulatory effect of morning bright light on reproductive hormones and ovulation: results of a controlled crossover trial". PLoS Clin Trials. 2 (2): e7. doi:10.1371/journal.pctr.0020007. PMC 1851732. PMID 17290302.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  35. ^ Gagarina, AK (2007-12-08). "Light Therapy Diagnostic Indications and Contraindications". American Medical Network. Retrieved 2009-06-09.
  36. ^ Roger DR (2007-12-04). "Practical aspects of light therapy". American Medical Network. Retrieved 2009-06-09.
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