Pressure ulcers, also known as bed sores, are damages to the skin usually between the surface in contact with the patient and bony projections. Wiki authors cite poor circulation and biofilms as components of the pathology. The noun decubitus refers to the laying down position and is often used to describe sores acquired in that position. The featured image shows the four stages of these ulcers. Most studies used laser light rather than the LED light panels commercially available direct to consumers. One would think that the convenience of such a panel at stage 1, or before the ulcer even starts, would provide some benefit. Sometimes pressure ulcers can be infected with maggots as shown in this YouTube video. Some of these studies were inconsistent, others showed some amazing results. In these studies patients prone to bed sores, are the elderly and those with spinal cord injuries (SCI). Red Light Therapy Home sells a very affordable panel of LED lights as well as a suggestion for dealing with pressure ulcers in conjunction with standard of care and a licensed healthcare provider. Note that these suggestions target areas where pressure ulcers commonly form.
Position and where to shine the light:
- Aim the light directly at the bed sore and the surrounding margin of skin (about 1 to 2 inches around it)
- Because the Mini is a small, targeted panel, treat one sore at a time, if you have more than one, split the 15 minutes between them (for example, 8 minutes on the worst area, 7 minutes on the second area)
- Common locations and easy positioning ideas:
- Tailbone or sacrum area: lie on your side so the sore side faces the panel, or stand with your back to the panel so the sore area is the closest surface to the light
- Hip area: lie on your side with the sore facing the panel
- Heels or ankles: sit with your foot propped on a stool or chair so the sore faces the panel
What this targets: Supports local circulation and cellular energy in the tissue, helping the skin recovery process
IMPORTANT PRACTICAL NOTES FOR BED SORES
- Keep the area clean and dry before the session, and avoid shining the light through thick bandages (thin, transparent dressings are usually fine, but do not disturb a dressing plan given by your clinician).
- If the area feels too warm or looks more irritated after sessions, increase distance to 2 feet and reduce to 10 minutes for the first week, then build back up as tolerated.
- If you notice signs of infection or worsening such as spreading redness, heat, swelling, foul odor, pus like drainage, fever, or increasing pain, please seek medical care promptly. Bed sores can progress quickly and sometimes need professional wound management.
WHY THIS PLAN IS A GOOD FIT
- The Wound Healing mode is designed specifically for tissue repair support, using a blend of red and near infrared for cellular energy and circulation support, plus a controlled amount of blue for skin surface support.
- The 1 to 2 feet distance and 15 minute session time are set to give a useful dose without overdoing it, especially important for fragile or compromised skin.
When should I use the “Full Power” mode?
Complex Conditions:
Multifaceted Health Issues: For conditions where inflammation, pain and tissue repair are all concerns (healing large or complex wounds where multiple layers of tissue are involved), full power might be used to address multiple aspects simultaneously.
Mode Settings: Red (633, 660nm, 100%), NIR (810, 830, 850 nm, 100%), Deep NIR (1064 nm, 100%), Blue (OFF), Pulse (OFF)
Table of Studies
| Publication | location | objective | design | participants | treatment | outcome measure | results | conclusions |
|---|---|---|---|---|---|---|---|---|
| Salzburg 1995 | New York USA | Does high frequency PEMF increase pressure ulcer healing in SCI veterans? | randomized double blind | 30 spinal cord injury patients 10 stage III, 20 STAGE II 20 min 2x.day until healed | high frequency PEMF | % healed | statistical increase in healing stage II, trend stage III | improves healing |
| Lucus 2000 | Netherlands, multi-center | LLLT healing stage III pressure ulcers in nursing homes. | prospective randomized, single blind, multicenter clinical trial in four nursing homes, | nursing home residents | 904 nm LLLT in addition, five times a week over a period of 6 weeks. | wound size 6 weeks compared to baseline | There was significant wound decrease within treatment arms (Friedman two-way analysis, p<0.001). | nursing home studies are feasible, Stage III healing debatable |
| Lucus 2003 | Netherlands | LLLT healing stage III pressure ulcers in nursing homes. | prospective, observer-blinded | consensus decubitus treatment (n=47); one group + LLLT (n=39) | 5x week for 6 weeks | absolute (mm2) and relative (%) wound size reduction at 6 weeks compared to baseline. | no difference in relative and absolute ulcer size. Some in both groups developed sage IV ulcers | no evidence for use on stage III ulcers |
| Dehlin 2003 | Sweden geriatrics | does light increase healing? | red/NIR vs placebo light | 164 patients with grade 2 or 3 ulcers | 30 diodes @956nm & 80@637 nm pulsed | ulcer size | trend towards reduction i in size, better in <20 BMI p=0.06 | trend justified 2007 study |
| Dehlin 2007 | geriatric centers Sweden & Denmark | Does red.NIR promote healing of grade 2 ulcers? | red/NIR vs placebo light | Some 2003 patients plus some new ones. | 12 weeks, probe 30 diodes @956nm & 80@637 nm pulsed | pressure ulcer size | 79% reduction red light, 50% reduction placebo, p=0.039 | this particular brand of red light works on grade 2 pressure ulcers |
| Shojaei 2008 | Tehran, Iran | LLLT for stage1 and 2 pressure ulcers. | randomized triple blind | SCI veterans, | 980 nm, continuous and red; 650 nm, continuous 4-6 J/cm2 | pressure ulcer size | 87.5% in the treatment group saw decrease in size vs 75% standard therapy | LLLT potential, other lifestyle factors? |
| Taradaj 2013 | Poland | assess the efficacy of laser therapy (different wavelengths—940, 808, and 658 nm) for the treatment of pressure ulcers. | randomized | Limf-Med Clinic in Chorzow, Poland | 5x per week for 1 month, plus standard care | healing rate, wound temperature | Fig 6 and Fig 7 show some remarkable before and after photos of actual pressure ulcers. | 658 nm laser light gave greater reduction of ulcer surface area and % wound healing. |
| Taradaj 2018 | International | how does red light effect cytokines and growth factors in pressure wounds? | randomized doubled blind | non-infected pressure ulcers, all grades, standard of care. most ulcers over sacrum bone, see Fig 2 | 1x day, 5x per week for 1 month. 4 J/cm2 4Hz,1Hz x/y-axes. 658, 940, and 808nm lasers. three light one control n=17 or 18 | Cytokines: IL-2, TNF-α (wulcer & sera) VEGF & TGFβ1 (ulcer only) | 658 is more effective than 940 and 808 nm in increasing TGFβ1 All other outcome variables decreased in sham and other wavelengths | 658nm is what works. |
| Taly 2004 | India | pressure ulcers in subjects with spinal cord disorders. | randomized | 14 sessions of 660-940nm from a gallium-aluminum-arsenide laser source, 3x/week 4.5 J/cm2 | healing of ulcer by stage | Time taken for stage 3 and 4 ulcers to reach stage 2 was 2.25+/-0.5 weeks in treatment group and 4.33+/-1.53 weeks in control group ( P =.047). | Limited evidence suggested that it improved healing of stage 3 and 4 pressure ulcers. |
What I find very encouraging is the use of red light to increase . This paradox was introduced in the cellulite post. This post addresses the paradox of how red light can promote wound healing and yet reduce cellulite, that is also a product of collagen production. The finding by Taradaj 2018 that 658nm red light increases TGFβ1, the collagen growth factor is particularly exciting. Does this mean that red light can strengthen skin before pressure ulcers develop? And promote blood flow before the damage occurs in the first place? This user who is not elderly or with a SCI, it sure feels good!
References
- Dehlin O, Elmståhl S, Gottrup F. (2003)Monochromatic phototherapy in elderly patients: a new way of treating chronic pressure ulcers? Aging Clin Exp Res. 2003 Jun;15(3):259-63. PubMed
- Dehlin O, Elmståhl S, Gottrup F. (2007) Monochromatic phototherapy: effective treatment for grade II chronic pressure ulcers in elderly patients. Aging Clin Exp Res. 2007 Dec;19(6):478-83. PubMed
- Lucas, C., C. H. M. Coenen and R. J. De Haan (2000) The effect of low level laser therapy (LLLT) on stage III decubitus ulcers(pressure sores); A prospective randomised single blind, multicentre pilot study. Lasers Med Sci 15, 94–100. free abstract
- Lucas, C., M. J. Van Gemert and R. J. Haan (2003) Efficacy of low-level laser therapy in the management of stage III decubitus ulcers: a prospective, observer-blinded multicentre randomized clinical trial. Lasers Med Sci. 18, 72–7. PubMed
- Petz FFC, Félix JVC, Roehrs H, Pott FS, Stocco JGD, Marcos RL, Meier MJ. (2020) Effect of Photobiomodulation on Repairing Pressure Ulcers in Adult and Elderly Patients: A Systematic Review. Photochem Photobiol. 2020 Jan;96(1):191-199. . PubMed
- Salzberg CA, Cooper-Vastola SA, Perez F, Viehbeck MG, Byrne DW. The effects of non-thermal pulsed electromagnetic energy on wound healing of pressure ulcers in spinal cord-injured patients: a randomized, double-blind study. Ostomy Wound Manage. 1995 Apr;41(3):42-4, 46, 48 passim. PubMed.
- Shojaei, H., Y. Sokhangoei and M. R. Soroush (2008) Low level laser therapy in the treatment of pressure ulcers in spinal cord handi-capped veterans living in Tehran. Iran J MedLow level laser therapy in the treatment of pre Sci. 33, 44–8. fre
e paper - Taly AB, Sivaraman Nair KP, Murali T, John A. (2004) Efficacy of multiwavelength light therapy in the treatment of pressure ulcers in subjects with disorders of the spinal cord: A randomized double-blind controlled trial. Arch Phys Med Rehabil. 2004 Oct;85(10):1657-61. PubMed
- Taradaj, J., T. Halski, M. Kucharzewski, T. Urbanek, U. Halska and C. Kucio (2013) Effect of Laser Irradiation at Different Wavelengths (940, 808, and 658 nm) on Pressure Ulcer Healing: Results from a Clinical Study. Evidence- Based Complementary and Alternative Medicine. 2013, 960240. free paper
- Taradaj J, Shay B, Dymarek R, Sopel M, Walewicz K, Beeckman D, Schoonhoven L, Gefen A, Rosińczuk J. (2018) Effect of laser therapy on expression of angio- and fibrogenic factors, and cytokine concentrations during the healing process of human pressure ulcers. Int J Med Sci. 2018 Jul 13;15(11):1105-1112. . PMC free paper
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