What is phototherapy?

The term phototherapy literally means the use of light to treat medical conditions. Natural sunlight has been known to be beneficial in certain skin disorders for thousands of years, and it is the ultraviolet part of the radiation produced by the sun that is used in phototherapy, in particular the ultraviolet A (UVA) and ultraviolet B (UVB) wavelengths.

Types of phototherapy

There are 3 main types of phototherapy:

Broadband UVB in which the skin condition is treated with the full UVB spectrum.
Narrowband UVB in which just a small part of the UVB spectrum is used to treat the skin condition.
PUVA (Psoralen + UVA), also sometimes called photochemotherapy, in which UVA radiation is combined with a sensitiser (a chemical that increases the effect of UVA on the skin) called a psoralen.

The choice of the type of phototherapy to use is dependent on the type of skin condition, previous responses to treatment among other factors.

  • How does phototherapy work?
  • Narrowband UVB Phototherapy
  • What are the side effects of Narrowband UVB?
How does phototherapy work?

Ultraviolet light reduces inflammation of the skin and can help in various inflammatory skin disorders. However, although it can cause skin conditions to clear, this is usually temporary and not a cure. PUVA is a more potent form of treatment, so is usually reserved for people who do not respond to UVB.

What conditions can be treated with phototherapy?

UVB is used to treat common skin conditions such as psoriasis, atopic eczema, other forms of dermatitis, polymorphic light eruption, generalised itching, pityriasis lichenoides, cutaneous T cell lymphoma, lichen planus, vitiligo and other less common conditions.

PUVA is generally indicated for chronic plaque psoriasis and atopic eczema if UVB has not been effective. Failure to respond adequately to UVB does not predict failure of response to PUVA. PUVA is favoured over UVB for some indications, such as mycosis fungoides beyond patch stage, adult pityriasis rubra pilaris, pustular psoriasis, hand and foot eczema.

Narrowband UVB Phototherapy

Narrowband UVB is the most common form of phototherapy used to treat skin diseases. “Narrowband” refers to a specific wavelength of ultraviolet (UV) radiation, 311 to 312 nm.

The narrowband range of UV radiation has proved to be the most beneficial component of natural sunlight for psoriasis. Narrowband UVB may also be used in the treatment of many other skin conditions including; Atopic eczemaVitiligoBody itching (pruritus), Lichen planuspolymorphous light eruption, early cutaneous T-cell lymphoma and dermographism.

Compared with broadband UVB:

    • Exposure times are shorter but of higher intensity.
    • The course of treatment is shorter.
    • It is more likely to clear the skin condition.
    • Longer periods of remission occur before it reappears
What are the side effects of Narrowband UVB?

Narrow-band UVB can result in burning, just like sunlight and broadband UVB. Frequent emollients such as petroleum jelly should be applied to burned skin, and if recommended by the therapist, topical steroids.

Long term exposure to ultraviolet radiation ultimately causes skin ageing and skin cancers. In theory, less UV exposure occurs because the patient is only exposed to therapeutic wavelengths. Although the risk from narrow-band UVB is unknown, research to date suggests it is no more risky than broadband UVB and probably less risky than photochemotherapy (PUVA).

What does narrowband UVB treatment involve?

Patients attend for phototherapy two to five times weekly. If whole-body treatment is recommended, the patient is placed in a specially designed cabinet containing fluorescent light tubes.

The patient stands in the centre of the cabinet, undressed except for underwear, and wears protective goggles. Usually the whole body is exposed to the UVB for a short time (seconds to minutes).

Shorter bulbs can be used for localised UVB treatment, eg of hands and feet or a small body region.

The amount of UV is carefully monitored by the phototherapy staff. A number of protocols exist depending on the individual’s skin type, age, skin condition and other factors.

What is the result of narrowband UVB?

The skin may remain pale or turn slightly pink (the Minimal Erythemal Dose) after each treatment. Let your therapist know if you experience any discomfort.

Patches of psoriasis generally start to become thinner after five to ten treatments. Most patients with psoriasis require 15 to 25 treatments to clear. Results vary.

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