Q: How Long Does It Take Phototherapy To Work
A: Phototherapy is most commonly dosed in high outputs of UVB light administered two to three times a week. Treatment lengths start at just seconds in length initially and expand to several minutes of exposure per treatment. On average, 20 treatment sessions are necessary before patients begin to notice results.
How Is Phototherapy Used To Treat Psoriasis
Both UVB and UVA can be used to treat psoriasis. UVB is used on its own, but UVA requires that the skin be sensitised by a plant-derived chemical called psoralen before it is effective. The treatment combining Psoralen and UVA is termed PUVA.
Both forms of phototherapy are given as a course of treatment over many weeks, where the time of exposure to the UV is gradually increased to prevent burning the skin and to allow the skin to acclimatise to the treatment. After a course of phototherapy the treatment is stopped in some cases improvements last for more than a year, while in other cases the psoriasis may start to recur after a few months or even weeks. Further courses of treatment may be given. It is not possible to predict how individuals will respond or how long their response will last after the phototherapy course ends. Psoriasis is the skin condition that responds best to phototherapy and in most phototherapy units 60-70% of the people attending are being treated for psoriasis.
How Is Puva Therapy Administered
The psoralen medication is taken 45-60 minutes prior to the ultraviolet light exposure. The amount of the psoralen is based on the weight of the patient. The length of the exposure depends on the degree of the patient’s pigmentation. Accordingly, the darker the patient, the longer the exposure time. Depending on the equipment used, the exposure may occur in a metal light box surrounding the patient with the bulbs that run vertically and are generally 48 inches long and resemble fluorescent bulbs. In newer boxes, there is an integrated light meter that enables the operator to administer the desired amount of energy with an automatic shut off after that dosage of light is achieved.
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How Well It Works
Phototherapy is usually an effective treatment for psoriasis.footnote 2 Partial to full skin clearing occurs after an average of 20 clinic treatments. More severe psoriasis may require more treatments. Using home equipment, which is less powerful than equipment at a clinic, takes 40 to 60 sessions to clear the skin.
Doses of UVB high enough to cause the skin to turn red, used with petroleum jelly or other moisturizers, can clear psoriasis plaque.
When using UVA alone, treatments may be helpful but take much longer to clear psoriasis. UVA is very effective when used with a photosensitizing drug . This combination treatment is called PUVA.
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.
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Psoralen Plus Ultraviolet A Therapy
This approach uses ultraviolet A light with psoralen, a medication that increases your sensitivity to light. Psoralen can be:
- taken orally
- applied topically
In general, PUVA is highly effective but not widely used or available.
Oral PUVA comes with the highest risk of drug interactions and side effects . Its most effective when combined with an oral retinoid.
Bath PUVA works best for adults with moderate to severe plaque psoriasis.
Its performed more often in Europe than in the United States. This is primarily because it uses trimethylpsoralen, a form of psoralen that the Food and Drug Administration hasnt approved.
Topical PUVA may be of particular benefit to adults with palmoplantar psoriasis or palmoplantar pustular psoriasis. It can also be used for localized psoriasis.
Other types of phototherapy that either arent as effective, widely recommended, or widely used are described below.
Q: How Much Does Light Therapy For Psoriasis Cost
A: Cost is a major factor that will impact the therapy option patients will undergo to treat psoriasis. Topical psoriasis medications might cost $500+ per tube and biologic treatments can cost nearly $20,000 a year. Purchasing a home phototherapy unit may be a beneficial investment, saving patients hundreds in gas and travel time and office co-pays.
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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.
What Are The Different Kinds Of Light Therapy
The type of light therapy that is generally used to treat psoriasis is known as narrow band UVB phototherapy. Here the skin is only exposed to UVB light wavelengths between 311 and 313 nanometers. The idea is that limiting the light spectrum in this way reduces the risk of side effects.
Another kind of light therapy is known as balneophototherapy. Here people bathe in warm water containing specific substances for about 20 minutes. Their skin is exposed to artificial UV light while bathing, or immediately afterwards. The bath often contains a solution made out of common salt or Dead Sea salt.
There is also another option called psoralen plus ultraviolet A therapy. It involves exposing the skin to UVA light and using a medication known as “psoralen” too. The medication makes the skin more responsive to UVA light, increasing its effect. Psoralen can be taken as a tablet, applied to the skin in the form of a gel or cream, or added to a bath.
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Natural Sunlight To Cure Psoriasis
The fact the patients with psoriasis find that their symptoms improve in summer when there is more exposure to the sun is not a coincidence.
It is true that the right amount of exposure to sunlight can prove beneficial for psoriasis.
Sunlight is made up of visible light rays and invisible ultraviolet and infrared rays. These rays are invisible because they have too short a wavelength for the eye to see. The particular wavelength of the ultraviolet rays makes it a good cure for psoriasis.
Ultraviolet rays again have different wavelengths. UVA rays are of longer wavelength and can penetrate deeper into the skin. UVB rays are of shorter wavelength and affect the outer layers of the skin.
How sunlight acts.
When skin psoriasis is exposed to the ultraviolet rays of natural sunlight or artificial sources, these rays penetrate the skin. As a result, the active T cells, which have migrated in large numbers to the skin, begin to die.
This reduces the excessive growth of the skin cells, which is seen to happen in psoriasis. Sunlight exposure results in decreased scales and inflammation of the skin, thus showing improvements in symptoms.
Mode of exposure
The psoriatic skin should be exposed to sunlight daily for brief periods at a time because excessive skin exposure to sunlight can worsen the psoriasis lesions and can also cause skin damage.
You could start with a five to ten-minute exposure and gradually increase by about 30 seconds each time.
Who Should Not Use Phototherapy
Do not use phototherapy if you have a health condition that makes you sensitive to UV light or sunburn very easily, such as: genetic diseases or autoimmune diseases like lupus. Tell your doctor about all the medicines you take. Some can make you more sensitive to ultraviolet light. Also tell your doctor if you start new medicines during treatment.
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How Many Light Therapy Sessions Are Needed
One of the keys and challenges to light therapy is that it has to be done consistently, whether its at a doctors office, a clinic, or at home. For to be effective, for example, patients must come in two to three times per week, which can be onerous, says Dr. Friedman.
Studies, including one in the American Journal of Clinical Dermatology, suggest that using a device known as an excimer laser to administer light therapy can cut down on how many sessions are needed. Laser therapy delivers highly targeted beams of ultraviolet light to specific areas of affected skin. That means higher doses can be safely administered without affecting the surrounding skin.
What Are The Treatment Options For Psoriasis
The medical treatment of psoriasis almost always starts with topicals, which are physician prescribed drugs in the form of creams and ointments applied directly to the skin, such as: various potencies of steroids, the Vitamin D analogue calcipotriol , and topical calcineurin inhibitors . Dovobet® is a very popular topical that combines a steroid and calcipotriol in one cream. All topical treatments have possible side effects, for example, prolonged steroid use can cause skin atrophy , rosacea, irritation and tachyphylaxis . Topicals can also be quite expensive, with one tube costing up to $200 and sometimes a tube or two required per month for extensive psoriasis.
For more severe conditions, the topicals seldom provide much relief beyond itch and flake control, making clinical or home UVB phototherapy1 next in line, which within weeks of diligent use can heal lesions completely such that they become normal, healthy, and clear skin. Lower dose maintenance treatments can then be used to control the condition indefinitely and drug-free with practically no side effects. Plus there is the immense benefit of making large amounts of Vitamin D naturally, which is carried away by the tiny blood vessels in our skin for health benefits throughout the body. As a simple qualification test, if a psoriasis patient responds well to natural summer sunlight or cosmetic tanning , then medical UVB phototherapy will almost certainly work as well, and likely very much better.
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Pulsed Dye Laser Treatment And Its Mechanism
PDL is the preferred therapy for most superficial cutaneous vascular lesions. In recent years, it has been used in some clinical researches to treat non-vascular indications, such as psoriasis, acne vulgaris, papulopustular rosacea, hypertrophic scar, and so on . Erceg et al. have reviewed the efficacy of PDL for inflammatory skin disease and concluded that PDL is an effective and safe method to treat localized plaque psoriasis. In accordance with this, a prospective randomized controlled study was performed to compare the efficacy of PDL with UVB-TL01 in plaque psoriasis. PDL parameters used were 585 nm, a pulse duration of 0.45 ms, and a spot size of 7 mm with spot overlapping about 20% at fluencies 5.56.5 J/cm2 for a total of four treatments at an interval of 3 weeks between two treatments. Improvement of psoriasis lesions was noted at the 13th week, yet with no significant differences between PDL and UVB . A within-patient controlled prospective trial of treatment of localized plaque psoriasis with excimer and PDL showed that excimer and PDL were useful treatments for plaque psoriasis with long-term remission, but psoriasis severity index improvement was significantly greater in excimer than PDL . Studies of PDL in psoriasis also reported low clearance rate, which could be improved by applying keratolytics with salicylic acid on psoriatic plaques before PDL treatment .
Cost And Health Insurance
The cost of phototherapy can vary by your location and the type of procedure performed. Health insurance may cover some of the cost of treatment, but almost invariably requires prior authorization.
Check with your insurance company to find if phototherapy is covered in your schedule of benefits and what your copay or coinsurance costs will be.
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Side Effects Of Treatment
PUVA is reserved for stubborn psoriasis cases because it has some irritating, and at times dangerous, side effects. It is estimated that one-third of patients have nausea after their treatments. In addition, the use of psoralen increases the risk of skin cancer. The risk is even greater in patients with fair skin.
Psoralen is thought to increase the risk of skin cancer, as opposed to the light itself. According to Health, Psoralen, which is ingested orally or applied topically, enters the bodys cells and, when activated by UV light, changes their DNA. This process kills off immune cells close to the skin and helps control psoriasis, but it also leads to collateral damage that can cause skin cancer in the long run.
UVB is not without side effects, although the side effects are minimal comparatively. UVB phototherapy can cause photosensitivity, which can increase the risk of sunburns. It also increases the risk of skin cancer, but not like PUVA does.
This risk should be weighed heavily when deciding if these treatments should be used to treat psoriasis.
Q: Is A Tanning Bed Good For Psoriasis
A: Phototherapy is safe and effective in treating psoriasis because it harnesses safe wavelengths of light specifically UVB light, which ultimately slows the growth of skin cells, effectively blocking the formation of plaques. While the appeal of using a tanning bed instead of a medical light unit is apparent, there are important safety issues that should deter a patient from using a tanning bed for psoriasis treatment. Tanning beds utilize UVA light, which does not treat psoriasis, and has a higher associated risk of causing skin cancer.
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What Kinds Of Light Therapy Are There
Different forms of light therapy vary according to the type of light exposure and whether its combined with medication. Ultraviolet B can be delivered as broadband UVB or narrowband UVB . BB-UVB therapy was developed first, but NB-UVB is now more commonly used for its effectiveness and fewer side effects. A benefit of narrowband UVB is that patients are exposed to a more specific and therapeutic wavelength of light. UVB phototherapy is used to treat moderate to severe psoriasis.
For people with more advanced psoriasis, another form of light therapy combines ultraviolet A with a psoralen drug . In this combination therapy, known as PUVA, the patient takes the medication shortly before light treatment to boost the lights effect on the immune system.
A study published in April 2013 in the American Journal of Clinical Dermatology found that PUVA therapy was most effective among adults with moderate to severe plaque psoriasis. According to the study, between 60 and 75 percent of patients overall who received some type of light therapy achieved at least 75 percent improvement in their condition. The results were based on the Psoriasis Area and Severity Index, an assessment tool used to score a persons condition according to disease progression.
PUVA isnt without side effects, however, including a heightened risk of skin cancer, severe burn, and nausea.
Broadband Ultraviolet B Light Therapy
Broadband ultraviolet B light therapy is an older form of phototherapy than NB-UVB. The two treatments are similar.
However, BB-UVB lamps and light bulbs emit wavelengths of light between 270 and 390 nm.
As with NB-UVB, your starting dose will depend on your skin type.
According to a small 1981 study, 90 percent of people had clear skin after having sessions three times a week and an average of 23.2 treatments.
One hundred percent of people had clear skin after having sessions five times a week and an average of 27 treatments.
BB-UVB is considered less effective than NB-UVB and is more likely to cause side effects. It should be reserved for instances where NB-UVB isnt a treatment option.
BB-UVB is most effective for plaque psoriasis, although it can also be used for guttate psoriasis.
It can be prescribed as a monotherapy or alongside retinoid acitretin . In combination therapy, the skin clears up faster, and lower doses of UVB can be used.
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Does Light Therapy Increase The Risk Of Skin Cancer
Regular exposure to UV light increases the risk of skin cancer. There is some that PUVA therapy with psoralen tablets in particular increases the risk of non-melanoma skin cancer. The higher the dose of radiation used and the more light therapy sessions you have, the greater the risk. The risk is also higher in people who have a fair complexion, people who have had skin cancer in the past, and people who are taking medication to suppress their immune system such as azathioprine, ciclosporin or methotrexate.
Narrow band UVB phototherapy is probably associated with a lower risk of skin cancer than PUVA therapy using psoralen tablets. But this isn’t yet known for sure because there are hardly any studies on the risk of skin cancer caused by UVB radiation. There is also a lack of good research on the risk of skin cancer associated with PUVA therapy using psoralen that is added to a bath or applied directly to the skin.
To limit the risk of skin cancer, people are advised not to have more than 150 sessions of PUVA therapy using psoralen tablets in their lifetime. A “UV diary” can help you keep track of the number of sessions and type of light therapy you have had, as well as the radiation dose used.