Blue light therapy can allay inflammation

20 November 2014

There is hope for people suffering from neurodermatitis: PD Dr. Detlef Becker, senior physician at the Department of Dermatology at the Mainz University Medical Center, has achieved fantastic results with photodynamic therapy, a treatment with blue light. But it is expensive and the statutory health insurance does not cover it. A new clinical study shall provide reliable data on the efficacy of the method.

"Neurodermatitis patients are poorly cared for in this country", says PD Dr. Detlef Becker, "and this is increasingly the case with allergy sufferers as well. They don't have a lobby." The senior physician of the Department of Dermatology at the Mainz University Medical Center is very critical of the direction that healthcare policies have taken in recent years. "I hope that at some point the pendulum will swing the other way."

Becker works with neurodermatitis patients on a daily basis. They come to Mainz for treatment from all over Germany. "One patient even comes here all the way from Hamburg." This is because the dermatologist offers a treatment that can achieve remarkable results – photodynamic or blue light therapy. There has been no treatment to date that can provide long-term alleviation of the symptoms of neurodermatitis. "But our outlook for success is good. Three out of four patients benefit from photodynamic therapy. Unfortunately, the statutory health insurance does not cover this treatment – and it is expensive."

Major study in the works

Becker is currently planning a major clinical trial in collaboration with colleagues from Munich and Vienna to acquire reliable data on the effects of photodynamic therapy. "We want to publish results that cannot be ignored," states the dermatologist emphatically.

The Department of Dermatology in Mainz has had the equipment for photodynamic therapy since 2007. "This is only manufactured by one single small company," explains PD Dr. Detlef Becker. The patient rests on a couch within a glass chamber over which passes a cylinder that emits a pulsating blue light. Two fans hum at the foot end. The airflow keeps the patient's skin cool under the warmth of the light. "The method is effective at a temperature of 37 degrees Celsius, but no longer works at 39 degrees Ceslius," Becker continues.

While it is necessary to wear goggles to protect the eyes from the light, the treatment itself seems on the whole to make a rather less spectacular impression. "I can understand that people are skeptical when they hear about this method," adds the dermatologist. "You really have to know the background information to properly understand what we are doing here."

In the industrialized countries, 10 to 15 percent of the population suffers from atopy-related syndromes. In many cases this takes the form of neurodermatitis, a disorder associated with dry, inflamed skin and itching, painful eczema. This condition is due to a physiological bodily function that originally served as a survival mechanism.

Atopy as a defense against worms

The mechanism is called atopy. "It can have certain benefits, like protection against tapeworm infection," explains Becker. Individuals with atopy produce massive amounts of immunoglobulin E (IgE) when exposed to exogenous proteins with certain properties. This IgE enhances, for example, the defense reactions of the body to parasites which could harm it. "At the time when it was a question of survival whether you were sharing your food with a tapeworm or not, this was very useful."

But tapeworms and lack of food are no longer a problem in industrialized countries. So immunoglobulin E has sought another outlet and now attacks substances which will not necessarily harm the body. This, put very simply, is basically how allergies develop. The immune defense system reacts by generating inflammations. Mucous membranes swell or eczema develops – as in the case of neurodermatitis.

"But we also have regulatory elements in our body. These control cells are meant to prevent adverse or excessive inflammation." However, they do not have the capacity to alleviate all the symptoms of allergy and neurodermatitis in patients with atopy.

"The standard treatment for neurodermatitis is rather like a hammer in that it simply flattens everything in its path." Cortisone, immunosuppressants, and UV radiation suppress the immune response. So the symptoms disappear, but only temporarily. Once the treatment ends, everything starts over from the beginning. And then there are the side effects associated with treatment. Overdoses of UV radiation can even cause cancer.

Alternatives to the hammer effect

The so-called blue light therapy takes another approach. "Our working hypothesis is that blue light therapy has an effect on regulatory mechanisms. The blue light activates oxygen. In fact, that's about all it does really. But we think that this oxidative stress could stimulate the activity of the control cells." It gives them a boost and provides them with the ideal environment for their work. "We see a similar phenomenon in the case of malignant tumors. They create oxidative stress in their vicinity and thus stimulate the control cells, which prevent the effective combat of the tumors by the immune system.

In recent years, Becker and his team have achieved positive outcomes using their therapy, even if it is an organizational challenge for doctors and for patients. "The time window is very narrow. When an inflammation flares up in an atopic patient, we need to be able to initiate treatment with blue light here on the very next day.

On five consecutive days, patients are exposed to the light for 48 minutes, and this is then supplemented by the use of standard medications. After four such courses of treatment, a beneficial effect usually becomes apparent. "In very rare cases, it may take longer; but once you exceed eight courses, the questions of cost and whether the treatment is really appropriate in that particular case arise." One day of treatment costs EUR 177.

"Patients who respond to the treatment often have years of remission and if symptoms do return, everyone says they are never as bad as they previously were." But that does not seem to be a strong enough argument to convince the health insurance companies and the policy-makers. They need to see scientifically-verifiable study results.

A study with neurodermatitis patients

"That is one of the reasons why we plan to initiate a new study, particularly with neurodermatitis patients over 18 and under 35 years of age." This is the group in which predictably good results have been achieved. "We have also had very good results in children, but many other factors relating to their growth are involved here. So they are not really suitable for study purposes." And in older patients with atopy and persistent neurodermatitis, it seems to be much more difficult to have a significant effect on their status by means of stimulation of the control cells. The study is planned to start in spring 2015. Neurodermatitis patients interested in taking part in the study may then contact the Department of Dermatology in Mainz.

During the study, 45 patients will be treated for six months with blue light, while a control group of equal size will receive the standard treatment. Then the physicians will compare the results for the two groups. The study will then be continued for an additional six months, during which all 90 patients will receive photodynamic therapy. But at the core of the study are the findings of the first six months.

If the results are as hoped, Becker and his colleagues will be able to force a fundamental rethink, ensuring that patients with neurodermatitis will receive more effective treatment that has a more lasting effect on their condition – and not just in Germany alone.