| Phototherapy
-- Narrowband UVB Background on Phototherapy Sunlight has been known to have a beneficial effect on certain skin disorders, in particular psoriasis, for many hundreds of years. In the first decade of last century it was discovered that the ultraviolet portion of sunlight was responsible for this effect. Sunlight is a very unpredictable and unreliable source of ultraviolet light and so artificial sources of this light began to be used in treatment. In the 1920's, a combination treatment of ultraviolet light and application of a cream or lotion containing tar, was first introduced and this remained a standard treatment for psoriasis and eczema until the 1970's. Since the 1990's, there has been renewed interest in phototherapy due to the development of narrowband UVB phototherapy. The UVB spectrum contains forty different wavelengths of light and it has been found that only a few of these wavelengths are effective in treating skin disease. These most therapeutic wavelengths from the UVB spectrum - the 'narrowband' -- are generated by the light source for phototherapy treatments, thus increasing the specific response to treatment Click here for our ms word patient handout on UVB Phototherapy Click here for our pdf filepatient handout on UVB Phototherapy UVB Phototherapy Treatment Prior to the first treatment, your response to UVB light is tested by exposing small areas on your back to different doses. The result is read 24 hours later. The initial exposure dose is small, and hence the treatment is brief, but as your tolerance to the light increases, the exposures are progressively increased. treatments are given daily or three times each week in order to clear the skin. Weekly or twice weekly treatment is usually required to maintain a clear state. Prior to each treatment you should apply a moisturizing cream, such as Aquaphor or Aveevo, to the patches of psoriasis since this will increase the effect of the light treatment. Helpful Hints • If your skin disorder involves the scalp you have to help the light reach it. Short hair is obviously one answer. Hair bands and bobby pins should be used to hold hair off the face and neck. • Nail polish may be worn even if the fingernails and toe nails are involved by your skin disorder. However, if the disorder affects the skin under the nails, do not paint your nails. • Scale on the skin tends to block UVB light from penetrating. Try to remove as much scale as possible before each treatment by soaking or applying an emollient. • Regular, punctual treatment are the key to success with phototherapy. Missed treatments simply delay a good response and sometimes lead to failure of therapy. If you are having problems keeping appointments, discuss the matter with the physician so a fresh approach can be developed. XTRAC Excimer Laser XTRAC is an excimer laser is used to treat localized psoriasis. The laser delivers a focused beam of monochromatic narrowband UVB light (308 nm) to the site of disease on the skin. It is fast and effective, and minimizes the risk of exposure to healthy skin. Treatments are quick and painless and usually result in rapid resolution of disease. At our office, the XTRAC laser is being used to treat psoriasis on the scalp. It requires 10 to 30 treatments and often gives long remissions. Phototherapy Frequently Asked Questions 1) What is ultraviolet light, specifically UVB? Ultraviolet light consists of wavelengths of light found in sunlight which are shorter than visible light. It is called ultraviolet because it begins next to the violet end of visible light. Ultraviolet rays cause sunburn and suntan. There are several types of ultraviolet light and the one used in treatment is called UVB light. UVB light is the portion of sunlight responsible for producing a sunburn, a suntan, burning of the eyes, skin cancer and aging changes in the skin. However, it is also the waveband that is most effective in treating disease of the skin. In ultraviolet phototherapy we aim to maximize the treatment benefits of the UVB light and minimize the short and long-term problems that can result from exposure to this light. 2) What types of UVB light are available? High-intensity broadband UVB (290-320 nm) treatment has been used for many decades and is effective in treating psoriasis and eczema. Narrowband UVB (310-312 nm) treatment is a recent development and is more effective in many patients. The choice of treatment is individualized to the patient and disease being treated. 3) How does ultraviolet light affect skin disorders? Recently there has been much research into how ultraviolet light produces a beneficial effect and there appear to be three mechanisms: • Ultraviolet light slows down the multiplication of skin cells by suppressing formation of DNA in cells. This may explain some of its effect in psoriasis, a condition in which cells are multiplying too rapidly. • Ultraviolet light alters the function of immune cells in the skin but in doing so does not appear to affect our normal immunity. This is probably the mechanism whereby ultraviolet light helps some types of eczema and also possibly psoriasis. • Ultraviolet light causes darkening and thickening of skin so that less light can enter the skin. Disorders in which the skin is more sensitive to light than is normal are probably helped via this mechanism. 4) Do you need to be treated in the office? UVB light is present in sunlight and is emitted by sunlamp bulbs used at home and in suntan parlors. A reasonable question is why be treated in a doctor’s office? The answer is very simple: You are more likely to get better. Sunlight certainly improves some skin disorders but it seldom clears them completely. Actually, it is probably not just sunlight that is beneficial but the relaxation and enjoyment that is associated plays a significant role. Sunlight of course, is not available to us on a regular year-round basis and that is a limiting factor. Sunlamps used at home or in suntan parlors are not helpful for treating skin disease because they emit light that does not clear psoriasis or other conditions. Potential Short-Term Problems of UVB Phototherapy The UVB portion of sunlight is responsible for most of the changes we see in our skin after we have been sunbathing. Therefore, most of the problems of UVB phototherapy are the same as those we experience after exposure to sunlight. The immediate side-effects which arise during treatment are usually minor and easily managed. - Sunburn or skin redness - Tanning and/or freckles - Dryness - Eye Damage (if eye protection not used correctly during treatment) Potential Long-Term Problems of UVB Phototherapy UVB treatment, just like ultraviolet light in sunlight, can have cumulative effects on the skin and eyes. - Aging Changes including photoaging - Skin cancer: UVB light produces skin cancer in laboratory animals and there is much evidence that sunlight causes this problem in humans. However, several large investigations have failed to find a link between UVB phototherapy and skin cancer. Regardless of this comforting finding we must assume that UVB phototherapy will add to the cumulative effect of exposure to sunlight and all people should take precautions to reduce risk of skin cancer: For this reason, it is especially important with long term use of UVB (or PUVA) phototherapy, to have a complete skin cancer screening by your general dermatologist at least once per year. If you are in need of a recommendation for a general dermatologist for skin cancer screening, we are happy to offer you contact information for several board certified dermatologists in the area. Male patients should wear an athletic support during treatment if their skin disorder does not involve the genital area because skin in this area is very sensitive to ultraviolet light. If your skin disorder does not involve the face, shield the face during treatment because facial skin already receives a heavy exposure to UV light and it is unwise to increase the exposure if not needed. Any new lump or bump on the skin should be brought to the attention of the physician. Our nursing staff can assist you with these details if questions or concerns arise. Skin Diseases Responsive to Phototherapy Psoriasis Eczema and Dermatitis Vitiligo Photodermatoses (sunlight sensitivity) Mycosis Fungoides (Cutaneous T-Cell Lymphoma) Pruritus (itch) of any cause Eosinophilic pustular folliculitis Pityriasis lichenoides Pityriasis rosea |
| Office Hours: Monday - Friday
9:00 a.m. - 7:30 p.m. EST Dr. Warwick Morison • Dr. Elisabeth Richard, Johns Hopkins at Green Spring 10753 Falls Road, Suite 355 Lutherville, MD 21093 Tel: (410) 847-3700, Fax: (410) 847-3703 |