Suitability For Light Therapy
Your dermatologist will meet you to discuss the benefits, risks and alternatives to the procedure, and assess whether light therapy is suitable for you.
They may examine you and ask you questions about your medical history, including the following.
- Whether youre taking any other medicines, including anything you apply to your skin.
- If you have any allergies to medicines.
- Whether you have any history of eye conditions, especially cataracts.
- If you have any problems affecting your kidney or liver. Treatment with Psoralen with UVA may be unsuitable for you if so but you may still be able to have treatment with ultraviolet B .
- If youre pregnant or trying to get pregnant. PUVA is not recommended during pregnancy but you should be able to have UVB.
- Your risk of developing skin cancer. Light therapy may not be recommended if youve had skin cancer or you have family history of the disease.
Youll need to be able to attend regular sessions of phototherapy and be able to stand up unaided for at least 10 minutes.
The phototherapist will work out the best dose for you to start on. This is mainly based on your skin type and how easily you burn in sunlight. Theyll check your skins sensitivity by applying one or more test doses of ultraviolet light to small areas of your skin. How these patches of skin react will help calculate the right dose for you to start on.
What To Expect Afterwards
Youll usually be able to leave the hospital or clinic as soon as your treatments finished. Your phototherapist will give you some advice on how to manage any side-effects.
You should avoid exposure to the sun or other forms of ultraviolet light while youre having a course of light therapy.
Youll need to take extra precautions if youve had Psoralen ultraviolet A , which makes your skin especially sensitive. Youll need to avoid any sun exposure for 12 to 24 hours after your treatment, and carry on wearing ultraviolet protective glasses during this time. Children and people at risk of cataracts should be particularly careful. This includes wearing eye protection outside, and when youre near a window or indoor lighting that can emit UVA, like some energy-saving fluorescent lamps do.
How Red Light Therapy Helps Psoriasis
- Red light stimulates the production of new capillaries, which increases the delivery of nutrients and oxygen to the skin.
- Red light stimulates the lymphatic system, which makes waste removal more efficient and results in healthier skin that is less prone to psoriasis flares.
- Psoriasis and other autoimmune disorders interfere with collagen production. Collagen is a protein that gives skin a firm, supple, and full appearance. Red light stimulates collagen production which can help soothe the skin and reduce flares.
- Most notably, red light stimulates the production of adenosine triphosphate from the cells mitochondria. This is the cells energy source. A cell that has more energy has more capabilities to perform its normal functions, as well as regeneration and self-healing. Researchers found that ATP reduces inflammation that can lead to the main symptom of psoriasis: abnormally rapid replication of skin cells.
Psoriasis causes cells to replicate at 10x the normal rate, which outpaces the bodys ability to shed them this results in those unsightly red, scaly, painful and itchy areas.
Since light therapy helps to restore normal cell function, this means that the rate of growth will normalize and youll experience fewer and less intense flares.
All types of phototherapy require several treatments per week for several months , plus ongoing maintenance treatments.
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What Are The Side Effects Of Puva
The phototherapist will carefully explain all of the possible side effects of phototherapy before a course begins. The most common immediate side effect of PUVA phototherapy is a mild sunburn reaction. This may be more likely if the individual has been using other medications or herbal supplements which can cause sensitivity to light, so it is important to tell the phototherapist of anything being taken. This sunburn reaction is usually not serious, and the phototherapist will adjust the dose of the next treatment or postpone treatments until the redness has settled. Some people report some itchiness in the early stages of treatment, but this should soon settle. People on tablet PUVA may feel a little sick after taking the tablets. This maybe only a mild inconvenience but if it is intolerable, an alternative tablet is available and may help. Taking the tablets will sensitise the eyes to UVA and exposure to the sun may increase the risk of cataract formation, so eyes must be protected from sunlight or other sources of UVA for 12 hours or until night-time. After taking the tablets, patients should wear sunglasses or other UV protective eyewear, or avoid exposure to sunlight altogether.
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Recommendations For People Undergoing Uvb Or Puva Phototherapy
- Courses of phototherapy are much more effective if administered without interruption. So, attend every appointment and avoid arranging a holiday during a phototherapy programme.
- Please inform your phototherapist nurse if you have been started on any new medication, as some medicines make you more sensitive to UV light.
- Dry, itchy skin can be treated by creams such as aqueous cream or emollients these are available on prescription and over the counter. It is advisable not to use bubble baths as these can dry out the skin. Instead, add prescribed bath oils or emollient to the bath water and soak the body for 10-15 minutes.
- Women of childbearing age should not become pregnant while having PUVA, but previous use of PUVA does not affect subsequent pregnancies.
- Do not wear deodorants, perfume or aftershave during treatment. Some of them contain chemicals which sensitise the skin to UV light and may result in a sunburn reaction.
This article is adapted from the Psoriasis and phototherapy leaflet.
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Types Of Uv Light Treatment
UV light treatment comes in three forms with Narrow Band Ultraviolet B Light being the most common these days. NB-UVB systems try to produce a narrow band of light only in the ranges that are effective in treating psoriasis.
NB-UVB is also preferred because it causes side effects in fewer people, is easier to use, and has a wider range of uses in treating skin conditions.
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Consists of a handle-type unit, which can be put in the special box with a 90° rotator, if you need to affect a larger area. It has two Philips bulbs with a long service life that can work by the wire or battery. UV-blocking goggles are included. If you want the 220V or 240V type, sellers are always in touch. Remember that the minimal distance to the light should be 3 cm .
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Preparing For Light Therapy
Your phototherapist is likely to ask you to follow certain rules during light therapy treatment. These may include the following.
- Limit your exposure to any additional ultraviolet light cover your skin when out in sunlight, and dont use sunbeds.
- Dont eat a lot of foods that contain natural psoralen, as these can make you more sensitive to ultraviolet light. These include celery, carrots, figs, citrus fruits, parsnips and parsley. Avoid these foods for at least two hours before a session.
- Dont use perfumed products, creams, ointments and lotions on treatment days, unless told to by your phototherapist.
- Dont cut your hair during your course of treatment as you may expose skin that was previously covered by hair.
Before a treatment session, let your phototherapist know about any new medicines youve started taking . This is because some medicines can make your skin more sensitive to light.
The psoralen you take for Psoralen ultraviolet A light therapy can interact with medicines for other conditions, such as warfarin and antipsychotics. These may need to be monitored during your therapy. Psoralen can also increase your response to caffeine and give you headaches or make you jittery. Your phototherapist may advise cutting down on drinks containing caffeine on the days you have light therapy treatment.
Narrowband Ultraviolet B Light Therapy
Narrowband ultraviolet B is the most common form of phototherapy. It can be used to treat plaque or guttate psoriasis.
NB-UVB lamps and light bulbs emit wavelengths of light between 311 and 313 nanometers , according to recent clinical guidelines on phototherapy.
Your starting dose will depend on your skin type and how easily you burn or tan.
However, NB-UVB light therapy is most effective when performed two or three times a week. An emollient such as petroleum jelly may be applied before each session.
According to a 2002 , people who had twice-weekly sessions saw their symptoms clear up in an average of 88 days. Those with sessions three times a week saw their symptoms clear up in an average of 58 days.
Once the skin is clear, maintenance sessions can be performed on a weekly basis.
A 2017study showed that around 75 percent of people receiving NB-UVB treatments found it cleared their psoriasis or led to minimal symptoms. They used fewer prescription creams for their condition, too.
NB-UVB treatments may prove more effective when combined with topical treatments, such as vitamin D analogues and corticosteroids.
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What Happens During A Light Therapy Session
There are slight differences in the procedure depending on the type of light therapy youre having.
If youre having Psoralen ultraviolet A treatment, youll be told how to take the psoralen before your session. This may be:
- taking a psoralen tablet or capsule with a light meal, a couple of hours before your therapy session
- having a psoralen bath at the hospital or clinic before your therapy
- applying psoralen cream, lotion or gel if youre getting treatment for small areas of your skin
If youve had a psoralen tablet, youll be asked to wear ultraviolet protective glasses from the time you take your tablet, until at least 12 hours after your light therapy. This is to prevent damage to your eyes, because psoralen makes your eyes more sensitive to natural sunlight.
At the start of your session, youll be asked to remove any clothing from the area to be treated. If your whole body is being treated, youll need to undress fully but men will need to use a genital shield. Youll also be given goggles to protect your eyes or a clear visor to cover your face if its not being treated. You may be advised to apply sunscreen to protect certain parts of healthy skin, such as your lips.
If youre having treatment for your palms and or soles only, a smaller unit can be used to just treat these areas.
In the first few sessions, your treatment may last for less than a minute. The duration will be gradually increased in later sessions, depending on how you respond to light therapy.
Types Of Uv Light Treatment For Psoriasis
Your doctor may suggest one or more of the following UV phototherapy or combination therapy approaches:
- Ultraviolet A One of the most common options is short bursts of UVA, typically starting at 30 seconds in length and building in duration as a patient adapts to the exposure. A conventional treatment schedule calls for three sessions per week for 4 to 50 sessions, until the psoriasis has cleared. We typically go for 20 sessions at first, says Dr. Miller. If we dont see anything at all after 20 sessions, we rethink the treatment.
- Ultraviolet B The Mayo Clinic notes that coal tar treatment makes skin more receptive to light, so some doctors combine UVB and coal tar treatments for a more effective therapy. The combination once required a three-week hospital stay, but a modification can be performed in a doctor’s office, according to Mayo.
- PUVA For advanced cases of psoriasis, a physician might suggest augmenting UVA treatment with an oral medication called psoralen. Taken shortly before light treatment, psoralen seems to boost the therapeutic effect of light on the immune system. PUVA is spectacularly effective, says Miller. Because PUVA can be so powerful, the treatment is rarely used in children.
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How To Use Phototherapy At Home
A doctor will explain how a person should use the phototherapy unit at home. People will need to follow their instructions carefully, as UV rays can damage the skin, causing premature aging, sunburn, and skin cancers.
Some doctors will start phototherapy in a hospital setting before recommending that a person continue the treatment at home. The doctor will explain the importance of protecting sensitive areas of the body, such as the eyes and genitals, and when to apply moisturizers. They will also explain how to position the light box to target the appropriate area and how far away from the unit a person should stand.
The doctor will assess a persons medical history and note any medications they are taking, including supplements and herbs. Based on the persons skin type, they will recommend an initial dose for the first few treatments, building up gradually from there.
A person must allow at least a 24-hour interval between sessions and will need to reduce their exposure time if they regularly miss treatments.
How Does Phototherapy Work
The exact cause of psoriasis is not fully understood and the effects of UV on the skin are complicated, so a precise explanation of how phototherapy works is not possible. PUVA and UVB phototherapy may also work in slightly different ways. However, a simplified description of the mechanisms of phototherapy will help to explain some of its side effects and restrictions.
Taking a simplified model of psoriasis as an example, the too-sensitive skin immune system causes localised patches of inflammation and the overproduction of skin cells, in turn causing the visible plaques. Phototherapy stops the overproduction of skin cells by either damaging their DNA or by preventing the cells from dividing by locking the DNA . It also suppresses the skin immune system to stop the psoriasis process. The twin processes of interfering with DNA and suppressing the immune system in the skin can also cause skin cancer, so phototherapy can increase cancer risk. Therefore, to safely benefit from UV phototherapy it is best administered under professional medical supervision.
During treatment, goggles must be worn to protect the eyes and most people also wear a clear UV-blocking visor to protect the skin of the face . Men must wear genital protection.
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