Light therapy
Light therapy | |
---|---|
ICD-10-PCS | 6A6, GZJ |
ICD-9 | 99.83, 99.88 |
MeSH | D010789 |
Light therapy, also called phototherapy or bright light therapy is the exposure to direct sunlight or artificial light at controlled wavelengths in order to treat a variety of medical disorders, including
Medical uses
Nutrient deficiency
Vitamin D deficiency
Exposure to light to wavelengths of 290-300 nanometers enables the body to produce
Skin conditions
Light therapy treatments for the skin usually involve exposure to
Acne vulgaris
As of 2012[update] evidence for light therapy and lasers in the treatment of acne vulgaris was not sufficient to recommend them.[4] There is moderate evidence for the efficacy of blue and blue-red light therapies in treating mild acne, but most studies are of low quality.[5][6] While light therapy appears to provide short-term benefit, there is a lack of long-term outcome data or data in those with severe acne.[7]
Atopic dermatitis
Light therapy is considered one of the best monotherapy treatments for atopic dermatitis (AD) when applied to patients who have not responded to traditional topical treatments. The therapy offers a wide range of options: UVA1 for acute AD, NB-UVB for chronic AD, and balneophototherapy have proven their efficacy. Patients tolerate the therapy safely but, as in any therapy, there are potential adverse effects and care must be taken in its application, particularly to children.[8] According to a study involving 21 adults with severe atopic dermatitis, narrowband UVB phototherapy administered three times per week for 12 weeks reduced atopic dermatitis severity scores by 68%. In this open study, 15 patients still experienced long-term benefits six months later.[9]
Cancer
According to the American Cancer Society, there is some evidence that ultraviolet light therapy may be effective in helping treat certain kinds of skin cancer, and ultraviolet blood irradiation therapy is established for this application. However, alternative uses of light for cancer treatment – light box therapy and colored light therapy – are not supported by evidence.[10] Photodynamic therapy (often with red light) is used to treat certain superficial non-melanoma skin cancers.[11]
Psoriasis
For
Vitiligo
About 1% of the human population has vitiligo which causes painless distinct light-colored patches of the skin on the face, hands, and legs. Phototherapy is an effective treatment because it forces skin cells to manufacture melanin to protect the body from UV damage. Prescribed treatment is generally 3 times a week in a clinic or daily at home. About 1 month usually results in re-pigmentation in the face and neck, and 2–4 months in the hands and legs. Narrowband UVB is more suitable to the face and neck and PUVA is more effective at the hands and legs.[14]
Other skin conditions
Some types of phototherapy may be effective in the treatment of polymorphous light eruption, cutaneous T-cell lymphoma[15] and lichen planus. Narrowband UVB between 311 and 313 nanometers is the most common treatment.[16]
Retinal conditions
There is preliminary evidence that light therapy is an effective treatment for
Seasonal affective disorder
The effectiveness of light therapy for treating seasonal affective disorder (SAD) may be linked to the fact that light therapy makes up for lost sunlight exposure and resets the body's internal clock.[19] Studies show that light therapy helps reduce the debilitating and depressive behaviors of SAD, such as excessive sleepiness and fatigue, with results lasting for at least 1 month. Light therapy is preferred over antidepressants in the treatment of SAD because it is a relatively safe and easy therapy.[20] Two methods of light therapy, bright light and dawn simulation, have similar success rates in the treatment of SAD.[21]
It is possible that response to light therapy for SAD could be season dependent.[22] Morning therapy has provided the best results because light in the early morning aids in regulating the circadian rhythm.[20] People affected by SAD have low levels of energy and have difficulty concentrating. They usually have a change in appetite and experience trouble sleeping.[23]
A 2007 systematic review by the Swedish agency SBU found insufficient evidence that light therapy was able to alleviate symptoms of depression or seasonal affective disorder.[24] The report recommended that: "Approximately 100 participants are required to establish whether the therapy is moderately more effective than placebo".[24] Although treatment in light therapy rooms was well established in Sweden, no satisfactory, controlled studies had been published on the subject.[24] This led to the closure of a number of clinics offering light therapy in Sweden.[25]
A Cochrane review conducted in 2019 states the evidence that light therapy's effectiveness as a treatment for the prevention of seasonal affective disorder is limited, although the risk of adverse effects are minimal. Therefore, the decision to use light therapy should be based on a person's preference of treatment.[26]
Non-seasonal depression
Light therapy has also been suggested in the treatment of non-seasonal depression and other psychiatric mood disturbances, including
A 2016 meta-analysis showed that bright light therapy appeared to be efficacious, particularly when administered for 2–5 weeks' duration and as monotherapy.[34]
Chronic circadian rhythm sleep disorders (CRSD)
In the management of
Circadian rhythm sleep disorders and jet lag[37]
Situational CRSD
Light therapy has been tested for individuals with shift work sleep disorder and for jet lag.[38][39]
Sleep disorder in Parkinson's disease
Light therapy has been trialed in treating sleep disorders experienced by patients with Parkinson's disease.[40]
Sleep disorder in Alzheimer's disease
Studies have shown that daytime and evening light therapy for nursing home patients with Alzheimer's disease, who often struggle with agitation and fragmented wake/rest cycles effectively led to more consolidated sleep and an increase in circadian rhythm stability.[41][42][43]
Neonatal jaundice (Postnatal Jaundice)
Light therapy is used to treat cases of neonatal jaundice.[44] Bilirubin, a yellow pigment normally formed in the liver during the breakdown of old red blood cells, cannot always be effectively cleared by a neonate's liver causing neonatal jaundice. Accumulation of excess bilirubin can cause central nervous system damage, and so this buildup of bilirubin must be treated. Phototherapy uses the energy from light to isomerize the bilirubin and consequently transform it into compounds that the newborn can excrete via urine and stools. Bilirubin is most successful absorbing light in the blue region of the visible light spectrum, which falls between 460 and 490 nm.[45] Therefore, light therapy technologies that utilize these blue wavelengths are the most successful at isomerizing bilirubin.[46]
Techniques
Photodynamic therapy
Photodynamic therapy (PDT) is a form of phototherapy using nontoxic light-sensitive compounds (
Photodynamic cancer therapy
Various cancer treatments utilizing PDT have been approved by the FDA. Treatments are available for
Antimicrobial photodynamic therapy
PDT may also be utilized to treat
Increased antimicrobial activity and wound healing speeds are typically observed when PDT is combined with photothermal therapy in photodynamic/photothermal combination therapy.
Photothermal Therapy
Photothermal therapy (PTT) is a form of phototherapy that uses non-toxic compounds called photothermal agents (PTA) that, when irradiated at a certain wavelength of light, converts the light energy directly to heat energy. The photothermal conversion efficiency determines the amount of light converted to heat, which can dictate the necessary irradiation time and/or laser intensity for treatments. Typically PTT treatments use wavelengths in the near-infrared (NIR) spectra, which can be further divided into NIR-I (760-900 nm), NIR-II (900-1880 nm), and NIR-III (2080-2340 nm) windows.[55] Wavelengths in these regions are typically less phototoxic than UV or high-energy visible light. In addition, NIR-II wavelengths have been observed to show deeper penetration than NIR-I wavelengths, allowing for treatment of deeper wounds, infections, and cancers. Important considerations for the development of a PTA include photothermal conversion efficiency, phototoxicity, laser intensity, irradiation time, and the temperature at which human cell viability is impaired (around 46-60 °C).[56] Currently, the only FDA-approved photothermal agent is indocyanine green which is active against both tumor and bacterial cells.[52][57]
PTT is less selective than photodynamic therapy (PDT, see above) due to its heat-based mechanism of action, but also less likely to promote drug resistance than most, if not all, currently developed treatments. In addition, PTT can be used in hypoxic environments and on deeper wounds, infections, and tumors than PDT due to the higher wavelength of light. Due to PTT activity in hypoxic environments, it may be also used on more developed tumors than PDT. Low-temperature PTT (≤ 45 °C) for treatment of infections is also a possibility when combined with an antibiotic compound due to heat's proportionality with membrane permeability - a hotter environment causes heightened membrane permeability, which thus allows the drug into the cell.[58] This would reduce/eliminate the impact on human cell viability, and aiding in antibiotic accumulation within the target cell may assist in restoring activity in antibiotics that pathogens had developed resistance to.
PTT is typically seen to have improved antimicrobial and wound healing activity when combined with an additional mechanism of action through PDT or added antibiotic compounds in the application.
Light boxes
The production of the hormone
Light therapy uses either a light box which emits up to 10,000
Risks and complications
Ultraviolet
Visible light
Optical radiation of any kind with enough intensity can cause damage to the eyes and skin including photoconjunctivitis and photokeratitis.[72] Researchers have questioned whether limiting blue light exposure could reduce the risk of age-related macular degeneration.[73] According to the American Academy of Ophthalmology, there is no scientific evidence showing that exposure to blue light emitting devices result in eye damage.[74] According to Harriet Hall, blue light exposure is reported to suppress the production of melatonin, which affects our body's circadian rhythm and can decrease sleep quality.[75] It is reported that, in reproductive-age females, bright light therapy may activate the production of reproductive hormones, such as luteinizing hormone, follicle-stimulating hormone, and estradiol[76]
Modern phototherapy lamps used in the treatment of seasonal affective disorder and
Side effects of light therapy for sleep phase disorders include jumpiness or jitteriness, headache, eye irritation and nausea.[80] Some non-depressive physical complaints, such as poor vision and skin rash or irritation, may improve with light therapy.[81]
History
Many ancient cultures practiced various forms of heliotherapy, including people of
The
From the late nineteenth century until the early 1930s, light therapy was considered an effective and mainstream medical therapy in the UK for conditions such as varicose ulcer, 'sickly children' and a wide range of other conditions. Controlled trials by the medical scientist Dora Colebrook, supported by the Medical Research Council, indicated that light therapy was not effective for such a wide range of conditions.[90]
See also
- Blood irradiation therapy
- Chromotherapy
- Crib A'Glow
- Free-running sleep
- Low level laser therapy
- Photodynamic therapy
- Sun tanning
- UV-B lamps
References
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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.
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External links
Media related to Phototherapy at Wikimedia Commons