| |
| |
Since it was first developed in the 1900s, phototherapy (sometimes called light therapy) has become an increasingly
popular and effective treatment for psoriasis, vitiligo, eczema, and other skin conditions. Phototherapy treats skin
conditions by using different wavelengths of ultraviolet (UV) light. These are either UVA (longer wavelength) or
UVB (shorter wavelength).
Phototherapy is prescribed after an evaluation by a dermatologist, who will take into consideration a patient's
medical history and skin condition. Patients should follow the dermatologist's treatment instructions exactly
and should never initiate a phototherapy regimen on their own. Some studies have indicated that too much
unprotected and unregulated exposure to certain types of UV light can contribute to skin cancer, so the quality
and amount of exposure needs to be monitored carefully.
Type of Phototherapy
Ultraviolet B (UVB) Light
There are two types of UVB treatment, broad band (BB) and narrow band (NB). The major difference
between broad-band and narrow-band UVB is that narrow-band UVB units emit a more specific range of UV
wavelengths.
Broad Band - This is the time tested older type of a treatment. It consists of the administration of a variety
of ultraviolet B rays emitted by high energy light bulbs. Treatments are initially administered three or more
times per week and are progressively tapered once remission is achieved, usually after 20 - 30 treatments in
about 70% of patients.
Narrow Band - This is a relatively new type of treatment. It consists of the administration, by specialized
bulbs, of a high concentration of the specific type of ultraviolet B rays that are most effective in reversing
the changes of psoriasis. Treatments are initially administered three times per week and are likewise
progressively tapered once remission is achieved, usually after 15-25 treatments.
PUVA - Psoralen plus Ultraviolet A (UVA) Light
PUVA is our third available treatment choice. It consists of the ingestion or application on the skin of a
medication (Psoralen - a light sensitizing medication) followed by the administration of UVA light rays.
Treatments are initially given 2 - 3 times per week and are tapered upon remission, usually after 20 - 25
treatments.
|
Treating psoriasis
Psoriasis is a chronic skin condition that affects about 7 million people in the United States. The condition occurs equally in men and women of all ages, though it primarily affects adults.
Psoriasis is characterized by patches of inflamed red skin, sometimes called plaques. These develop because the outer layer of skin cells reproduce too fast and pile up on the skin's surface. Psoriasis can cause discomfort, such as pain and itching, limited motion in the joints, as well as emotional distress.
Recent research indicates that psoriasis may be an immune disorder. The immune system has a type of white blood cell, called a T-cell, which normally protects the body against infection and disease. In psoriasis, it is believed that an abnormal immune system causes T-cells to trigger the inflammation and excessive skin cell reproduction in the skin, which results in red plaques.
Exposing these activated T cells to specific wavelengths of UV light causes them to die, a process called apoptosis. Apoptosis reduces inflammation and slows the overproduction of skin cells that cause plaques. Frequent, short, nonburning exposure to UV light can help clear or improve psoriasis for many people. Therefore, many doctors may include phototherapy as a treatment for psoriasis.
When prescribing phototherapy, doctors may select either UVB or UVA light. The administration of UVB is one of the main treatments for patients with mild to moderate psoriasis. Improved understanding of the UVB light spectrum has led doctors to refine their treatment methods to include a very precise range of UVB wavelengths, called Narrow Band UVB light or NBUVB. Evidence suggests that NBUVB phototherapy offers even better treatment results than broad band UVB therapy for certain patients.
When using UVA light, doctors typically will combine oral or topical administration of a medicine called psoralen. This treatment is commonly referred to as PUVA. The addition of psoralen makes the skin more sensitive to the UVA light, producing a greater effect than UVA light alone.
When comparing NBUVB and PUVA therapies, some studies have demonstrated that NBUVB was about as effective as PUVA. However, NBUVB therapy had the added advantage of producing significantly fewer side effects. These were mostly related to the adverse, long-term use of the medication psoralen.
You should talk to your doctor about the advantages of either therapy to decide which may be right for you. It is important to remember-phototherapy is a safe and effective treatment option for psoriasis that has helped many patients.
Treating vitiligo
Vitiligo is a skin condition that affects 1 to 2 percent of the population. About half of all people who have vitiligo develop it before age 20. Vitiligo is characterized by sharply bordered white patches in the skin resulting from a loss of pigment. Any part of the body may be affected, though most commonly vitiligo affects the face, lips, hands, arms, legs, and genital areas
Scientists think vitiligo is an autoimmune process, in which pigment cells in the skin, known as melanocytes, are destroyed by the body's own defense system. When these cells die, they can no longer make melanin (the pigment/color in skin, hair, and eyes). As a result, the skin becomes lighter or completely white.
One method commonly used for treating vitiligo is called repigmentation. Essentially, doctors use UVA light with a medication called psoralen (PUVA) to stimulate color-producing cells, much like tanning. Some studies have shown that the use of Narrow Band UVB light is as effective as PUVA, and there is no need for psoralen with its adverse side effects.
For repigmentation to work, neighboring pigment cells must produce new pigment cells. These may be located on the edge of the vitiligo patch, at the base of hair follicles, or possibly within the patch itself, if the melanocytes haven't been completely destroyed. Generally, patients who respond to Narrow Band UVB phototherapy obtain over 90% repigmentation within a year.
You should talk to your doctor about the advantages of phototherapy to decide if it is right for you. It is important to remember that phototherapy is a safe and effective treatment option for vitiligo that has helped many patients.
Treating eczema
The term "eczema" generally includes many different inflamed skin conditions. But perhaps the most common is atopic dermatitis, or atopic eczema. This skin disorder affects more than 15 million Americans of all ages. It is characterized by itchy patches of dry, red skin, which sometimes appear scaly or crusty.
Scientists believe eczema may be caused by an abnormal response of the body's immune system, similar to that seen with psoriasis (see above). However, it seems that people with eczema have an overactive inflammatory response to irritating substances. In fact, many people who have eczema also suffer from allergies or hay fever, or have members in their families who do.
Doctors have found the administration of UVB light is helpful for patients with eczema. An improved understanding of the UVB light spectrum has led doctors to refine their treatment methods to include a very precise range of UVB wavelengths, called Narrow Band UVB light or NBUVB. Studies suggest that NBUVB phototherapy is an effective treatment option for eczema.
If UVA light is used to treat eczema, doctors may combine an oral or topical medicine called psoralen. This combination treatment is commonly referred to as PUVA. The addition of psoralen makes the skin more sensitive to the UVA light, producing a greater effect than UVA light alone.
You should talk to your doctor about the advantages of either therapy to decide which may be right for you. It is important to remember-phototherapy is a safe and effective treatment option for eczema that has helped many patients.
|
|
To set up an appointment for a physician evaluation call our office at (609) 871-9500, and indicate that you would like to learn more about our Psoriasis Phototherapy Program.
|
|
|
