Campaigning for the approx. 2 million people in the UK
adversely affected by modern lighting.
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Letters of Support
1. Prof. Anthony Pinching, Professor of Immunology, Peninsula Medical School, Truro
2. Prof Hawk, Consultant Dermatologist and Chair of the European Association of Dermatologists
3. Dr Sarkaney, Head of Photobiology, St John's Dermatology, St Thomas', London
4. Dorothy Crystal MCOptom, Optometrist
5. Abstract from British Journal of Dermatology October 2013
Professor Anthony J Pinching
Associate Dean for Cornwall
Peninsula Medical School
Royal Cornwall Hospital
Low-Energy Lighting and Chronic Fatigue Syndrome (CFS/ME)
This consultation response is from Professor Anthony Pinching, Associate Dean and Professor of Clinical Immunology at Peninsula College of Medicine & Dentistry. I have wide experience of Chronic Fatigue Syndrome (CFS/ME), through caring for over 4,000 patients with over 25 years, and am an experienced clinical academic. I was Clinical Lead for CFS/ME at Department of Health during the service investment programme and Deputy Chairman of the Independent Working Group on CFS/ME to the Chief Medical Officer. I have no expertise in lighting technologies.
I have, over many years, been struck by the consistency with which a proportion of CFS/ME patients report adverse experiences in settings lit with fluorescent lights. This is especially, but not exclusively, amongst those in whom general light sensitivity is present; this tends to affect those with more severe disability, but can be present in less severely affected people.
These patients have a disability that already has a pervasive effect on their lives, and greatly constrains their functioning in all domains. It greatly reduces their ability to achieve basic activities of daily living, to do basic shopping, to participate in social activities with others, let alone to be able to function within their limitations in working environments.
For most patients until now, it seems that fluorescent tubes have been most likely to cause problems. Note that we are not talking about defective fluorescent tubes, but about a problem resulting from the characteristics of the light emitted when they are functioning as intended. The use of other low-energy bulbs is not sufficiently widespread yet to have an estimate of how widely such effects occur with other products, but patients have already expressed serious concerns. I understand that representative organisations have heard from dozens of people with CFS/ME who have tried to use the new low-energy bulbs, and have had bad reactions to them.
The effect of fluorescent lighting is immediate, and it generally means that the patient has to leave the environment (eg a store) or get the lights switched off (eg in clinics). The symptoms evoked vary from headaches and visual distortion, to more general increases in their wide-ranging CFS/ME symptoms, the latter being most common. In many cases, such exposures can trigger relapses that may last for days; I am aware of severe instances that have lasted for months.
The mechanism of this effect and its relation to the physical properties of the lighting products is unclear. It is likely to relate to the wider sensory distortion and overload experienced by patients with CFS/ME, probably consequent upon altered neural processing and cognitive changes. The observations are consistent, and were being made long before the present discussions.
As with much else in CFS/ME, this effect has not yet been researched, and it is inadequately documented in formal research studies. It is only of late that serious and high quality research studies are being done on CFS/ME (see the 2003 MRC Report on Research needed on CFS/ME). However, the clinical phenomenon has been consistently noted as a feature by patients and by experienced clinicians for years, and well before the present proposals.
The proposal to switch to low energy bulbs obviously has much to commend it in environmental terms, but was launched with little warning, and seemingly little prior investigation into potential health impacts, as judged by the material provided supporting this consultation. Understandably, it has not yet been possible to conduct systematic research studies to give more detail on the concerns expressed by various disease groups, and the clinicians caring for them, since the proposals were announced.
Normally, if a new product is being introduced, the onus is on those who would introduce that product, and those who produce it, to demonstrate safety or lack of harm. I have been troubled by some comments of those proposing this change that seem: a) to diminish and undermine the legitimate concerns represented by patients and clinicians; and b) to dismiss them because of lack of evidence. It is of course well known that absence of evidence is not evidence of absence (of effect).
I would argue that it is essential that those who are proposing this widespread change in the built environment should conduct surveys and studies on the impact of the new lighting products on those disease groups where legitimate concerns have been raised. In this way, it can be determined the extent to which such problems affect these populations, and in particular, if different new products differ in the extent to which such things occur.
In the light of such evidence, proposals could be modified or safeguards introduced to avoid creating new health problems by the mass introduction of an inadequately researched set of products. I am sure that – with appropriate resources – clinicians and academics with groups supporting patients with a range of relevant diseases would be pleased to assist in obtaining such evidence.
Professor Anthony J Pinching
Associate Dean and Professor of Clinical Immunology
FROM PROF. HAWK;
I know for sure from my professional experience as a Professor of Dermatology specialising in lighting effects on skin at the St John's Institute of Dermatology for the past thirty years that a significant number of people with certain skin disorders such as seborrhoeic eczema and lupus cannot tolerate any form of fluorescent lighting in their vicinity (say within twenty to thirty feet) but only incandescent lighting from tungsten filament bulbs. The precise reason for this has not been elucidated but may relate to atmospheric ionisation effects near the bulbs. However, whether the reason for the effect is known or not does not negate the fact that some patients with these conditions definitely find any fluorecent lighting intolerable in their environment, in that their exposed skin develops a most unpleasant stinging or burning sensation throughout the exposure.
I was assured while being interviewed on a BBC Radio 4 Today Programme in early January this year by a co-interviewee who was a lighting advisor to the relevant government body that a facility would definitely remain for affected patients to have access to incandescent rather than fluorescent bulbs for lighting. I think that retaining such an option is absolutely essential for such patients and I would be prepared to assist you in very firmly advocating that approach, or the patients in question will not have any access to lighting after dark.
Please do contact me further as required.
Best wishes and very good luck with this matter.
FROM DR SARKANEY;
Dear Evelyne Muller
Thank you for your email. There is no doubt that there are some patients who are treated by Dermatologists who suffer problems from standard domestic (and other) fluorescent lights. Magnus in the 1970s demonstrated that domestic fluorescent sources can trigger or exacerbate the ultraviolet sensitive eczema known as 'chronic actinic dermatitis'. There is good evidence in the literature about the possible role of fluorescent lights in exacerbating cutaneous lupus. There is also a group of patients with specific fluorescent light sensitivity whose skin reacts in an 'allergic' and unpleasant manner to fluorescent lights with in seconds or minutes of being exposed to the light, and these patients do not seem to suffer the same problems with incandescent lights in my experience. I have seen a relatively small number of patients with this syndrome . However, for them it is extremely disabling, unpleasant and often long term. Also we do not know how common this is as a disease in the general population--it may well be commoner than we think with patients not perhaps always being referred to a Dermatologist because of the nature of the problem. It may well be the case, that many or most patients with fluorescent light sensitivity syndromes are reacting to ultraviolet in the emitted light. However there are other differences between incandescent and fluorescent lights such as the 'spikiness' of the spectrum of emitted light. Given that the clinical symptoms are so varied it is likely that 'fluorescent light sensitivity' is caused by a variety of disease processes many of which are not currently understood.
Thus, it is likely that , whatever UV protection is put into place with fluorescent lights, there will always be a group of patients who react to the fluorescent light and can only tolerate incandescent lights. Certainly more reserch would be helpful and the HPA's recent work is very helpful in this regard.
Dr R Sarkany, FRCP MD
Consultant Dermatologist and Head of Photodermatology, St John's Institute of Dermatology, St Thomas' Hospital, London
I am seeing increasing numbers of patients with problems which are caused by low energy lighting.
I have four patients who are badly affected by low energy lighting and whose lives are severely restricted because of this problem. Those in employment have had to be given home working arrangements by their employers because of they cannot tolerate the lighting in their workplaces. None of them is able to go into supermarkets or many other public places. Their lifestyles are limited and they cannot take part in the usual day-to-day activities that we all expect to be able to do because of low energy lighting. Other buildings such as theatres, churches and other public buildings are problems for them and are becoming more so with the increasing use of low energy lighting.
The people I see who are badly affected by low energy lighting are not affected by incandescent light bulbs, which are being withdrawn. Their problem is due to the increasing use of low energy lighting.
The problems are not only restricted to those who are badly affected. I am also seeing more and more patients who have had their eyes tested within the last 6 months or so. They come to me saying that their eye sight has become worse. I test their eyes and there is no change. My next question is have they changed the lighting in their house? The answer is always yes they have gone over to low energy lighting. I advise them to use incandescent bulbs, at least in the areas where they will be reading.
There are increasing problems in workplaces for people that I am seeing too as employers are encouraged to install low energy lighting.
These problems are not just for me with my patients but for all optometrists. The problem is becoming more widespread and needs to be addressed.
Dorothy Crystal MCOptom
8 Rodney Street
British Journal of Dermatology Oct 2013
A preliminary investigation showed that ultraviolet radiation (UVR) emissions from compact fluorescent lamps (CFLs) can pose a risk to the skin of photosensitive individuals.
To carry out a larger-scale study, in patients with a range of photodermatoses, to assess this risk. To determine a safe alternative light source for photosensitive individuals. To investigate if CFL emissions have the potential to induce skin responses in normal individuals.
Two hundred patients were directly exposed to a single-envelope CFL as part of their routine management. Irradiation was carried out on the inner forearm with lamps positioned at 5 cm. Skin assessments were made immediately and 24 h postirradiation. Eleven of these patients were further tested to a double-envelope CFL. One hundred and one patients were tested to emissions from a light-emitting diode (LED). A study involving 20 healthy individuals was carried out with exposure to the single-envelope CFL.
Skin erythema was induced by the single-envelope CFL in the following cases: 16 of 53 chronic actinic dermatitis, seven of 52 polymorphic light eruption, five of nine solar urticaria, one of two actinic prurigo, one of one erythropoietic protoporphyria and two of 20 healthy subjects. The double-envelope CFL eliminated or reduced the skin response in all 11 patients tested. The LED did not induce any UVR-provoked skin responses.
UVR from CFLs can aggravate the skin of photosensitive and healthy individuals when situated in close proximity. Double-envelope lamps reduce this risk. LEDs offer a safer alternative light source that eliminates the risk of UVR-induced skin erythema.