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Rosacea is a chronic skin condition primarily characterized by facial redness and swelling. It affects about 5% of the global population. Although its causes are known, they aren't widely recognized. This condition is most common among European/Caucasian women over the age of 30, but it can affect anyone and has several subtypes.
Red light therapy has been extensively studied for its benefits in skin healing, reducing inflammation, promoting collagen production, and treating various skin conditions like acne. Given these benefits, there is growing interest in using red light therapy to treat rosacea. In this article, we will explore whether red light therapy, also known as photobiomodulation, LED therapy, laser therapy, cold laser, light therapy, or LLLT, can be effective in managing rosacea.
Types of Rosacea
Rosacea presents with a range of symptoms, making each case unique. While it is often associated with facial redness, especially around the nose and cheeks, there are several other symptoms that can be categorized into distinct subtypes:
1. Subtype 1: Erythematotelangiectatic Rosacea (ETR)
- This is the most common form of rosacea, characterized by persistent facial redness, skin inflammation, visible blood vessels near the skin's surface, and episodes of flushing. The term "erythema" is derived from the Greek word "erythros," meaning red, which refers to the redness of the skin.
2. Subtype 2: Papulopustular Rosacea (Acne Rosacea)
- This type combines red skin with persistent or intermittent acne-like breakouts, including pustules and papules, but not blackheads. It may also cause a burning or stinging sensation on the skin.
3. Subtype 3: Phymatous Rosacea (Rhinophyma)
- A rarer form of rosacea, phymatous rosacea involves the thickening and enlargement of facial skin, typically affecting the nose (often referred to as "potato nose"). This subtype is most common in older men and usually develops from another form of rosacea.
4. Subtype 4: Ocular Rosacea
- Ocular rosacea affects the eyes, causing symptoms such as bloodshot or watery eyes, a sensation of something in the eye, burning, itching, and crusting.
Understanding Rosacea Subtypes
Recognizing the subtypes of rosacea is essential for determining whether you have the condition. If left untreated, rosacea often worsens over time. Fortunately, the effectiveness of red light therapy in treating rosacea remains consistent across all subtypes, meaning the same therapy protocol can be applied universally. But why is this the case? To answer that, let's explore the underlying causes of rosacea.
The Root Cause of Rosacea
*(and why light therapy can help)*
Decades ago, it was believed that rosacea was caused by a bacterial infection. Since antibiotics, including tetracycline, could manage symptoms to some extent, this theory seemed plausible. However, it was soon discovered that no bacteria are involved in rosacea.
Today, most doctors and rosacea experts agree that the condition is enigmatic, with its true cause still undetermined. Some suggest that Demodex mites are to blame, but since nearly everyone has these mites and not everyone develops rosacea, this theory falls short.
Instead of pinpointing a specific cause, experts often list various 'triggers' or attribute the condition to a combination of genetic and environmental factors. While genetics may predispose someone to rosacea, they don’t determine the condition outright.
Certain factors, like caffeine, spicy foods, extreme temperatures, stress, and alcohol, can certainly exacerbate rosacea symptoms, but they are not the root cause.
Clues to the Real Cause
One significant clue lies in the fact that rosacea typically appears after age 30, coinciding with the onset of aging. Around this age, many people notice their first gray hairs and minor skin wrinkles.
Another clue is the effectiveness of antibiotics in managing symptoms, even though rosacea isn’t caused by an infection. Antibiotics can have short-term anti-inflammatory effects, which might explain their usefulness in symptom management.
Additionally, blood flow to rosacea-affected skin is three to four times higher than to normal skin. This hyperemia occurs when tissues and cells are unable to extract oxygen from the blood.
Rosacea is more than just a cosmetic issue; it involves significant fibrotic changes in the skin (as seen in subtype 3 with rhinophyma) and invasive blood vessel growth (which causes visible veins and flushing). Similar symptoms elsewhere in the body, like uterine fibroids, would prompt significant medical investigation. However, in the skin, these issues are often dismissed as cosmetic and are "managed" by avoiding triggers or even undergoing surgery to remove thickened skin.
The underlying cause of rosacea involves physiological processes deep within the body. These processes don't only affect the skin; they impact the entire body. The visible symptoms of rosacea, such as flushing, invasive blood vessel growth, and skin thickening, are external signs of an internal problem. In this way, rosacea can be seen as a warning signal that something is wrong inside. Male pattern hair loss is a similar indicator, pointing to underlying hormonal imbalances.
Mitochondrial Dysfunction
The evidence points to mitochondrial dysfunction as the root cause of rosacea. Damaged mitochondria struggle to use oxygen effectively, which increases blood flow to the affected tissue.
When mitochondria can't access or utilize oxygen, they produce lactic acid, leading to immediate vasodilation and fibroblast growth. If this problem persists, new blood vessels begin to grow.
Various hormonal and environmental factors can contribute to poor mitochondrial function, but in the context of red light therapy, the most critical factor is a molecule called Nitric Oxide (NO).
Red Light Therapy and Rosacea
The primary theory behind the effectiveness of light therapy in treating rosacea revolves around Nitric Oxide (NO). This molecule plays a crucial role in the therapeutic effects of red light therapy.
This molecule, Nitric Oxide (NO), can have various effects on the body, including inhibiting energy production and causing vasodilation (the widening of blood vessels). In the context of light therapy, NO binds to a critical site in the mitochondrial electron transport chain, disrupting energy flow.
By blocking the final stages of cellular respiration, NO prevents the production of ATP (the main source of cellular energy) and carbon dioxide from glucose and oxygen. This is particularly relevant as people age or experience prolonged stress or starvation, leading to permanently lower metabolic rates—often due to elevated NO levels. While this mechanism may have been advantageous in nature or survival situations, where lowering metabolic rates could conserve energy during times of food scarcity, it’s less beneficial in the modern world. Today, NO levels can be influenced by diet (certain amino acids), air pollution, mold, artificial light, and other factors. The resulting lack of carbon dioxide in the body exacerbates inflammation.
Cellular Respiration and Red Light Therapy
Red light therapy enhances our natural ability to produce cellular energy. It increases the production of both ATP and carbon dioxide (CO2). CO2, in turn, inhibits various pro-inflammatory cytokines and prostaglandins, thereby reducing inflammation in the body.
For rosacea, the key takeaway is that light therapy can reduce inflammation and redness in the affected areas while addressing the underlying issue of low oxygen consumption, which leads to the abnormal growth of blood vessels and fibroblasts.
Summary
Rosacea has various subtypes and manifestations.
It is often a sign of aging, similar to wrinkles and gray hair.
The root cause of rosacea is reduced mitochondrial function in cells.
Red light therapy restores mitochondrial function and reduces inflammation, helping to prevent and manage rosacea.
