Uv Light Therapy For Moderate To Severe Cases
, also known as UV light therapy, is one of the most effective treatments for psoriasis. It involves exposing the skin to controlled amounts of ultraviolet radiation similar to that from the sun. It is usually prescribed with other treatments when conservative therapies fail to provide relief and is especially useful for moderate to severe psoriasis covering large portions of the body.
Phototherapy is performed in a dermatologist’s office under controlled conditions. Side effects tend to be mild. In addition to psoriasis, phototherapy may also be used to treat eczema, vitiligo, lichen planus, and cutaneous T-cell lymphoma.
Light Therapy For Psoriasis: Soothing Skin With Red Light
If youre among the 8 million Americans that are affected by psoriasis , you may be wondering if light therapy actually works for your condition or is just another hyped upyet ineffectivetreatment.
The truth is, theres no one-size-fits-all medication or modality for psoriasis, but red light therapy for psoriasis just might be as close as we can get.
Thats because it works not just to reduce symptoms, but also to improve cellular function, so your skin can fight redness, and become blemish-free naturally.
In a moment, well discuss photo-, and red light therapy in-depth, but first, lets review standard, conventional treatments, so we have an accurate basis for comparison.
Treatment Protocols And Follow
Although minimal erythema dose determination and subsequent dose calculation is the formal method of establishing initial dose, this process is often cumbersome and labor intensive. Therefore, most phototherapy centers have now adopted the use of initial dose determination based on patients Fitzpatrick skin type. Increments of dose increase are also determined by skin type in addition to response to previous treatments. The underlying principle is to increase the UVB dose gradually until the MED is reached and then try to maintain the UVB dose just below the MED . This approach eliminates the need for formal MED testing in most patients. It is also simpler and more efficient than methods using incremental dosages calculated as a certain percentage of the previous dosage.
A standard protocol for UVB phototherapy is treatment three times per week with a minimum of 24 hours between sessions. Treatment every other day is effective for most patients. Patients should be instructed to dose phototherapy as per treatment protocol and use proper technique as taught during outpatient phototherapy and home phototherapy orientation. Moisturizer should be immediately applied following treatment to prevent excessive dryness and subsequent itching.
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When Is Uv Therapy Used
The National Institute for Health and Care Excellence recommends that UVB therapy be offered to people with plaque or guttate psoriasis that cannot be controlled with topical treatments alone. They are likely to have tried a number of different topical treatments before being offered UVB therapy . It recommends that PUVA treatment be considered to treat palmoplantar pustulosis .
If it is found that some areas of psoriasis are slow to respond, do not show a satisfactory response, or are in some hard-to-treat areas , a topical treatment might be prescribed alongside UV therapy. It is important to remember that the effects of UV therapy are temporary in most cases the psoriasis will come back at some point. If psoriasis is returning very quickly after a course of UV therapy, it may be time to move on to another type of treatment.
Uvb Therapy For Psoriasis
Light therapy for psoriasis is becoming more widely prescribed due to its positive effects on the incidence of plaques and remission of the disease. If you have psoriasis, you likely have the hallmark plaques covering the skin of one or more areas of your body. These red and scaly patches can be painful, itchy, and even embarrassing. If youve tried oral and topical medications with little or no relief, your doctor may recommend treatment using ultraviolet light instead. Light therapy for psoriasis is becoming more widely prescribed due to its positive effects on the incidence of plaques and remission of the disease.
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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.
What Are The Risks/side Effects Of Uv Therapy
- Exposure to UV light can cause skin damage, premature ageing and increases the risk of skin cancer. However, it is important to note that this is true of natural sunlight as well as artificial UV light. For these reasons, the British Photodermatology Group have issued guidelines as to the total number of UV treatments an individual can have in a lifetime.
- Some redness of the skin and tanning is likely, but you should let the staff in the department know if you experience any burning sensations .
- If you are using other treatments, including topical treatments, you should check with your doctor or pharmacist that it is appropriate to keep using it during your UV treatment. This is because some other treatments can make the skin more sensitive to UV light, which may increase the likelihood of side effects if used at the same time.
- UV treatment can make the skin dry and itchy apply plenty of moisturiser after treatment in order to overcome this. However, if the itching continues or gets worse, do tell the phototherapy staff or your Dermatologist.
- Oral Psoralen used in PUVA can make some people feel sick. Do tell your Dermatologist if this happens for you, as they may be able to change the type of Psoralen, or prescribe another medication to help you stop feeling sick.
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What Happens During A Light Therapy Procedure
When you undergo light therapy for psoriasis, you will be committing to treatments several times a week. The doctor will typically ask you to come in 3 to 5 times a week for a short duration of ultraviolet light exposure. During these outpatient appointments, the doctor may target your whole body with the UV lights in a booth similar to one at a tanning salon. However, if your plaques are fairly limited to one area of your body, you may receive treatment in which only that part is exposed to the light. In these cases, you may be able to receive your UVB light therapy at home with a portable lamp. Over the course of the 2 to 3 months of treatment, most patients see a quick improvement in the first few weeks. Many patients remain in remission following UV light treatments for 3 months up to a full year.
What Are The Side Effects Of Light Therapy
As compared with other treatment options, light therapy poses fewer side-effects risks. Most people do not experience side effects when they are treated with phototherapy, says Shari Lipner, MD, PhD, an assistant professor of dermatology at Weill Cornell Medicine in New York City. The most common side effect is a mild sunburn reaction, and this is more likely to occur if the person is taking a medication that causes sun sensitivity.
Before receiving light therapy, patients should tell their doctor about any drugs theyre taking. The treatment also may not be an option for people who should avoid sunlight exposure, such as those with lupus.
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How Is Puva Treatment Administered
Like UVB treatment, PUVA is administered in hospital phototherapy or physiotherapy units. As with UVB phototherapy, there are different methods for deciding on a starting dose of UVA and how to increase the dose to a therapeutically effective level. Some centres measure the sensitivity of the individuals skin to PUVA by applying test doses to small areas of skin, in a similar way to the MED test described previously. Because PUVA involves sensitising the skin before UV exposure, the sensitivity testis called the minimal photosensitivity dose test. Other centres may use phototype-based treatment schedules or a table of doses.
Treatment times for bath PUVA are shorter than for tablet PUVA and may range from less than a minute up to 5-8 minutes, depending on the output of the PUVA cabin and the dose scheme used. Tablet PUVA times may extend to15 minutes or more. If any session produces a sunburn reaction, or if any other symptoms are reported, the subsequent doses may be altered.
Bath PUVA phototherapy is usually given twice a week or three times every fortnight, whereas tablet PUVA is usually given twice a week for 15-25 treatment sessions or until the psoriasis has cleared to an acceptable amount.
How Long Is One Uvb
Just like the treatments you would receive at your doctors office, you will likely need to use these machines in small increments, say, two 5-minute sessions, three times a week, Dr. Kaffenberger says. This isnt usually a big time commitment and is definitely less of a time commitment than applying topical therapies, she says. Ive found that patients are likelier to do UVB therapy when the unit is in their home than if they have to travel to my office for it.
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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.
Sunbeds Sunlamps And Natural Sunshine
Using a sunbed at a gym, salon or spa is not the same as having UV therapy in a hospital setting. Firstly, hospital-based UV treatment uses only the specific part of the spectrum that is useful to treat skin conditions. This is not the case on a sunbed, where a much broader spectrum is used. Many sunbeds use mostly, or entirely, UVA light, which is ineffective for treating psoriasis without the added psoralen. Therefore, using sunbeds means taking on the risks of UV exposure, without much of the benefit to psoriasis.
UV treatment in hospital is very carefully controlled a Dermatologist will administer the right amount of exposure for each individual, and monitor the results. If a person uses sunbeds or an at-home lamp in addition to this, it makes it difficult to ensure they are receiving the correct dose for them.
It is also important to follow sun safety advice, even if your psoriasis improves in the sunshine, in order to prevent potential side effects such as skin cancer and premature ageing. Sunburn can actually aggravate psoriasis or trigger a flare, so do use a suncream with a high SPF and re-apply it regularly. Aim to cover up with a hat, t-shirt and sunglasses, and avoid being out in the intense sunlight in the middle of the day.
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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.
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.
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Can Anyone Who Has Psoriasis Use Phototherapy
While dermatologists prescribe phototherapy for many people, it is not recommended for anyone who has:
Had a melanoma or any other type of skin cancer
A medical condition that makes you more likely to develop skin cancer, such as Gorlin syndrome or xeroderma pigmentosum
A medical condition that makes you sensitive to UV light, such as lupus or porphyria
To take medicine that makes them more sensitive to UV light, such as some antibiotics, diuretics, and antifungals
Myth: Uvb Phototherapy Causes Skin Cancer
Evidence suggests that UVB phototherapy remains a safe treatment modality. In a 2005 analysis of prospective and retrospective studies on skin cancer risk from UVB phototherapy, 11 studies were reviewed and the researchers concluded that all studies eventually showed no increased skin cancer risk with UVB phototherapy. One of the PUVA cohort studies examined genital skin cancers and found an increased rate of genital tumors associated with UVB phototherapy.
Another analysis to define the long-term carcinogenic risk for narrowband UVB treatment found that there was no association between narrowband UVB exposure alone and any skin cancer. For patients treated with narrowband UVB and PUVA, there was a small increase in basal cell carcinomas.
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What Are The Side Effects Of Uvb Treatment
The most common immediate side effect of UVB phototherapy is a mild sunburn reaction. This maybe more likely if the person being treated has been using other medications or herbal supplements which can cause sensitivity to light. It is, therefore, important, before starting any course of any treatment, to inform the healthcare professional or doctor of any products 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 itchiness in the early stages of treatment, but this should soon settle.
The long-term effects of phototherapy include increased ageing of the skin and an increased risk of certain skin cancers. In the 30+ years of the medical use of narrowband UVB phototherapy, increased skin cancer has not been reported. UVB causes very little photoageing. Nevertheless, if someone has had 500 or more UVB treatments it is recommended that the risks and benefits of further UVB are re-evaluated and their skin checked for signs of skin cancer.
How Does It Work
If you end up purchasing an at-home unit, your doctor will prescribe you a set amount of usages per week, and time per use. Its easy: You lightly place the hand-held device over the affected area of exposed skin for the prescribed time or disrobe and step into the full-body unit, standing equidistant from all sides.
Some machines require you to set a countdown clock and monitor your time, while others can be pre-programmed by your dermatologist for time, UVB dose, and number of sessions. Youll be able to access a certain number of sessions in accordance with a regimen prescribed by your healthcare provider, Baker says. After that, youll check in with your doctor to review your results and make any necessary adjustments to the program youre following.
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