Can at-home red light therapy devices provide relief for eczema?

For anyone possessing the cosmetic cluelessness of Andy Sachs from The Devil Wears Prada, there is a mascara from Benefit Cosmetics called Better Than Sex. Those who love stiletto-like lashes would agree, but for the rest of us who have eczema that incites itchiness, scratching it is infinitely more orgasmic.

A report by Singapore General Hospital in 2022 showed that one in five children and one in 10 adults in Singapore suffer from eczema. At best, it is minorly annoying, and at worst, it can cause one to scratch their skin raw.

And it seems like we mere mortals aren’t the only ones facing such skin conditions. Kim Kardashian has also mentioned that she’s afflicted with a prickling condition known as psoriasis and, in a TikTok video, shows herself lying in a phototherapy booth in her office and poised to emerge like a sci-fi Botticelli painting of Venus rising from the sea. Phototherapy, to put it simply, is the use of different wavelengths of ultraviolet (UV) light to treat skin conditions ranging from psoriasis to vitiligo and atopic dermatitis, but the question here is: are we able to treat eczema using at-home devices that emit red light?

“There is limited scientific data on the effectiveness of red light in the treatment of eczema”, notes Dr Koh Hong Yi, a MOH accredited dermatologist and a consultant dermatologist at TSN Dermatology Skin Specialist Clinic, who goes on to add that it is not a standard form of therapy for eczema. John O’Shea — the co‐founder of award-winning Singapore skincare brand Suu Balm, which launched in 2015 — even thinks that simplicity in routine works the best. “Like many things in life, doing the boring basic stuff diligently will already make a very positive difference: regular moisturising, stopping itch, and cleansing gently.”

A fact that Daniel Teo, founder of newcomer local skincare brand Serich, agrees with as he thinks that individuals can get caught in a cycle where they try a wide range of products with limited success in relieving their flare-ups.“One effective way to manage eczema requires the strengthening of the skin barrier and promoting a healthy skin microbiome, rather than solely focusing on immediate symptom relief” claims Teo about Serich’s Second Skin Moisturising Cream, $59 (U.P $79), one that he recommends for individuals seeking targeted solutions for their skincare needs. “For individuals with eczema, the condition primarily affects the epidermis”, and thus, Teo recommends looking for solutions like the brand’s product, which also helps the skin retain moisture to reduce transepidermal water loss.

However, my intrusive thoughts led me to wonder if shining a light on one’s skin problems was still worth a shot in the dark. According to Lim Ker Han — the Managing Director of Est.lab, which launched the LumiGlow SmartSkin Buddy, $298 in 2022 — red light therapy is “increasingly being explored as a treatment for eczema due to its anti-inflammatory properties” though he suggests refraining from using such at-home devices if they heat up as it could exacerbate eczema flare-ups.

Instead, Lim gives the green light to use blue light, especially if the device cools the skin down (the LumiGlow SmartSkin Buddy does so by 12 to 15 degrees Celsius) to reduce inflammation and irritation. According to Lim, the blue light spectrum [in the device] borders UVA at wavelengths around 400 nm (in comparison, another popular device is the Dr Dennis Gross DRx SpectraLite™ FaceWare Pro, which operates at 415 nm) and affects the skin in similar ways to UVA Phototherapy treatments. “It penetrates the uppermost layer of the skin, and when used with topical creams and serums, can also target harmful bacteria that thrive on dirt, excess oil (sebum), and dead skin cells which exacerbate secondary infections or inflammation from scratching, irritation, or exposure to external factors.”

But on the other side of the spectrum, and to err on caution, Dr Koh believes that the use of blue light treatments at home should not be considered a standard treatment for eczema as “the scientific evidence supporting the use of blue light in treating eczema is very limited” and that studies have shown such treatments causing photoaging and pigmentation, especially in Asians. A fact proven by a 2021 study by the Frontiers of Dermatological Research, which reported that blue light at 410 and 420 nm causes increased oxidative stress (our mobile phones emit lengths between 400 to 490) and has the potential to be toxic depending on the dose administered.

Another way of stepping into the light, according to Dr Koh, is when certain spectrums of ultraviolet light — UV-B (311 to 312 nm), UVA-1 (340 to 400nm), or UVA (the latter is combined with a medication called psoralen, in the form of treatment called PUVA) — are used as they are proven treatments for eczema. “These are usually prescribed by dermatologists when the severity of eczema warrants such treatment and are administered using specialised machines. They are definitely more effective than red light therapy.”

Though if one is still thinking of scratching that proverbial itch by trying an at-home light treatment, Lim advises that it could be a useful addition to an existing routine consisting of medically prescribed treatments instead of being thought of as a cure.

And as for those noticing an alarming amount of red bump patches sprouting on their bodies, here’s a guide — the myths, truths, and products to use — on how to deal with eczema.

What are some of the myths surrounding eczema?

Daniel Teo (DT): Stress does not directly cause eczema, but it is a significant aggravating factor that can trigger flare-ups. Stress can make eczema itchier and make the individual scratch more. Another would be that some people believe that eczema will resolve itself without treatment. However, untreated eczema can worsen over time and lead to complications such as skin infections and significant discomfort.

John O’Shea (JOS): One myth is that you shouldn’t exercise: exercise is great for your overall health, both mental and physical; by taking some simple and practical precautions, you can manage to exercise with eczema: moisturise well around 20 minutes before exercising, then do your exercise in an air-conditioned environment, to reduce sweating, or bring a towel with you to mop off your sweat periodically. Then shower straight away after exercising with a gentle wash and moisturise

Dr Koh Hong Yi (DK): I think one of the most frequent misunderstandings about eczema is that it is caused by a single external factor, which, if identified and removed, can lead to its cure. Unfortunately, eczema is a complex inflammatory disease influenced by genetics and multiple environmental factors. Patients with eczema are more prone to allergies such as to house dust mites, animal dander, certain foods, perfumes and preservatives in skin products, etc.

What are some of the common causes of eczema?

DK: Genetics is the main reason why most people develop eczema. The main genetic defects are a deficient skin barrier and a hypersensitive or unbalanced immune system. While some patients may argue that they do not have family members who also suffer from eczema, we must remember that eczema is under the control of multiple genes, so one’s risk of developing eczema depends on the combination of genes one inherits from both parents. Genes are also influenced by the environment, sometimes remaining dormant and other times being activated when exposed to some triggers. This does not mean that eczema cannot be well treated and controlled. There are now many good treatments for eczema, and many patients with eczema live healthy, normal lives. 

Is there an easy way to differentiate one’s type of eczema?

DK: Different types of eczema often share similar and overlapping clinical features. However, most types can be easily differentiated by the dermatologist treating the patient based on certain clinical features such as the appearance and configuration of the rash, location, degree of itch or pain, and other associated symptoms.

Should you self-medicate?

JOS: In general, if you have a new or recurring rash that isn’t improving with your current plan, then it is best to see a doctor. However, if you get a new or recurring rash that is not too extensive on the body and you are otherwise well (no fever, etc), then it is reasonable to try to manage it with moisturising creams from the pharmacy.  

DT: The symptom quiz on the Serich website is designed to empower users to identify potential eczema symptoms and triggers while learning how the Second Skin Moisturising Cream can help alleviate their concerns. While it offers valuable insights into the product and helps users better understand their skin conditions and contributing factors, its effectiveness ultimately relies on the depth of information provided. Users may find the quiz beneficial as a starting point for managing their eczema; however, we always encourage individuals to consult healthcare providers for medical advice or diagnosis.

Lim Ker Han(LKH): We always recommend customers consult medical professionals and dermatologists when treating cases of eczema and psoriasis, especially because most first-line treatments involve prescribing some form of topical steroids, and we normally defer to the advice of these medical professionals about the use of complementary skincare products and devices for that customer.

What is the biggest product myth?

JOS: A myth is that natural ingredients are best as they can, unfortunately, often include traces of irritants in them. Natural origin ingredients are generally safer, as they have been processed or purified to ensure they are safe; ideally, look out for hypoallergenic products, like all Suu Balm products.

DT: Individuals are becoming increasingly educated about products that contain synthetic chemicals, involve animal testing, or have significant carbon footprints (Serich’s products are EWG-verified, PETA-approved, and produced locally by a Good Manufacturing Practice manufacturer). Thus, they are seeking eco-friendly products containing natural alternatives. However, not all natural ingredients are effective for eczema, and without proper formulation knowledge, users may not achieve the desired results.

Is Topical Steroid Withdrawal real?

DK: Topical Steroid Withdrawal (TSW) is a condition characterised by side effects from inappropriate use of topical steroids. Many of these side effects have been recognised by dermatologists for a long time, though some of them are now placed under the category of TSW. In general, TSW is not common if topical steroids are used appropriately under the guidance of an experienced doctor.

What is the recommended routine?

JOS: The key is that you need to use the moisturiser you purchased from a pharmacy often. Five times a day is the goal, and the moisturiser should ideally have a texture that feels good to use in Singapore’s hot, humid climate and also contains ceramides like our Rapid Itch Relief Moisturiser, $23.90, which is formulated with five skin-identical ones. One problem with other moisturisers is that people forget to use them as they don’t get any immediate relief from the itch. Ours effectively relieves said itch within five minutes as it contains menthol, which does exactly what people want —breaking the itch-scratch cycle. Finally, you should also ensure you use a very gentle body wash like the Gentle Moisturising Facial Cleanser, $23.90 or Dual Cooling & Moisturising Cream Body Wash, $30.90, and keep your showers short and with lukewarm water.

DT: Look for a product that effectively alleviates symptoms such as itchiness, dryness and redness while adhering to high ethical and safety standards. It should also be at an optimal pH and penetrate different layers of the skin, ensuring that the ingredients are delivered effectively in high functional dosages for optimal effectiveness. Serich’s Second Skin Moisturising Cream also contains a second skin formulation that mimics both the stratum corneum and the epidermis. This design allows our active ingredients — Lactobacillus Ferment (probiotic) that is beneficial to the skin’s microbiome, Phytosphingosine to strengthen the skin barrier, ingredients that enhance skin hydration while enhancing elasticity and barrier health, plant extracts to soothe redness and irritation —  to be fully absorbed by the stratum corneum, followed by the epidermis, maximising their effectiveness.

DK: I think the most effective routine for eczema treatment is to follow the guidance of your dermatologist. Ask questions if you have any doubts so that their advice makes sense to you. Components of a good eczema care routine would include the use of a gentle skin cleanser, regular application of moisturisers, appropriate use of topical medications (including topical steroids and topical non-steroidal medications) of the right strength, at the right place and time, avoidance of triggers including exposure to excessive dust, airborne pollutants, and allergens that one is allergic to (such as animal dander or foods).

LKH: Again, we want to emphasise that treatments for eczema should be prescribed by a medical professional. Having said that, we do have a range for customers with sensitive skin called ActivCalm, which is specially formulated to be ultra-gentle for hyper-sensitive skin and aims to calm, soothe, repair and protect delicate skin. In particular, the ActivCalm Skin Soothing SOS Serum, $160 (which can be used with the ActivCalm Anti-Stress Hydra Cream, $118), is clinically proven to soothe irritated skin by up to 60% within 1 hour and up to 100% in 24 hours, with an anti-pollution defence shield against skin inflammation and oxidative stress, and can balance the skin’s microbiome while strengthening the skin barrier to minimise sensitised reactions from external aggressors.