Phototherapy for Skin Disorders

Have you ever hung out with a dermatologist?  We’re the ones applying sunscreen every few hours, nagging our families, and wearing hats and long-sleeves in the middle of summer.  After removing and treating skin cancers every day, dermatologists develop a healthy respect for the sun and its UV rays. So, patients are often surprised to find that I have two “tanning bed” like devices in my office.  As much as dermatologists hate to admit it sometimes, the sun and UV rays are not all bad.  In fact, we often use UV light to treat skin conditions both with a light booth and an excimer laser.

What is Phototherapy?

The use of light to treat a skin condition is called Phototherapy. There are many types of UV light – UVA, UVB, and UVC. Both UVA and UVB are used in dermatology to treat skin disorders.  There are two types of UVB treatment, broadband and narrow band. Broadband UVB is an older method. Narrowband UVB has become the predominant type of treatment over the past 15 years.  The major difference between broadband and narrowband UVB is that narrowband UVB units emit a more specific range of UV wavelengths. Broadband UVB includes all wavelengths of light between 290-320nm.  Narrowband UVB (NBUVB) includes only wavelengths between 311-313nm.

Present in natural sunlight, NBUVB is an effective treatment for a number of skin disorders including psoriasis, atopic dermatitis, mycosis fungoides, vitiligo, and many more.  NBUVB treatment involves exposing the skin to an artificial NBUVB light source for a set length of time on a regular schedule. As we learn more about these diseases, the theories on how UVB is effective constantly changes and is clearer.  For now, we know it works.  In treatment-resistant conditions, just knowing it works is often good enough.

Our phototherapy units utilize Narrowband UVB bulbs.  Plus, we have an excimer laser that also uses the NBUVB wavelength.  We are pleased to offer this advanced therapy, and we have many patients that travel hours to receive it on a regular basis.  We have offered NBUVB light booth treatments since 2006 and Excimer laser treatments since 2012.

How is Phototherapy administered?

The patient stands in a treatment lightbox lined with NBUVB lamps.  A person undresses to expose all affected areas to ultraviolet light. A patient generally will receive treatments two to three times per week. It takes an average of 25 treatments to reach maximum improvement of psoriasis or atopic dermatitis lesions.

The first exposure to the light is usually quite short, lasting as little as a few seconds. Exposure time depends on the person’s skin type and the intensity of the light emitted from the bulbs. People with lighter skin start with shorter exposure times than people with darker skin.

Normally, treatment times are gradually increased until clearing occurs, unless the last session produced itching and/or skin tenderness. Because administering NBUVB light is not an exact science, each person’s reaction to the light is not completely predictable. Subsequent sessions of NBUVB are adjusted according to a person’s individual response.

For people with psoriasis in more limited areas, we also have the same light in laser formulation called Excimer laser.

UVB requires a significant time commitment. People get the best results when they keep scheduled appointments and follow treatment directions carefully.

In order to improve the safety and efficacy of NBUVB treatments we recommend patients:

-make our staff aware of any medical or medication changes that occur during treatment.

-cover or apply sunscreen to uninvolved areas to shield from unwanted light exposure.

-apply mineral oil in a thin layer before treatment to improve the ability of the light to penetrate the skin.

What happens once the skin clears?

Once the skin clears, the treatments can be weaned and then stopped. They should be resumed if the lesions begin to reappear. Sometimes NBUVB is continued on a maintenance basis. This varies a lot from person to person.  Some patients prefer to continue maintenance once a week or once every other week.  Other patients tend to pop in in the winter when their skin begins to flare.

What are the side effects of NBUVB treatment?

During treatment, psoriasis may worsen temporarily before improving. The skin may itch and become red because of exposure to the NBUVB light. The amount of NBUVB administered may need to be reduced to avoid further irritation. Occasionally, temporary flares occur even with non-burning doses of NBUVB. These reactions may resolve with continued NBUVB treatment.  The most common side effects are phototoxicity (sunburn) and skin cancer.

Sunburn – certain medications, herbal supplements, and topical ingredients can cause sensitivity to light; it is important to tell your doctor about all medications, treatments, and supplements you are taking. Patients should avoid exposure to natural sunlight on NBUVB treatment days. Overexposure to ultraviolet light can cause a serious burn.

Skin Cancer – UVB is an established carcinogen (cancer-causing substance or agent) in humans. However, there is no direct evidence of an increased risk of skin cancer from NBUVB treatment for skin disorders. It is important to have a doctor examine your skin periodically. Skin cancers generally can be removed easily if detected early.

As stated above, we recommend the use of sunscreen on uninvolved skin as a means of minimizing exposure to NBUVB. The face, for example, is exposed to a great deal of natural sunlight. If there is no skin disorder on the face or genitalia, a person should avoid UVB exposure there.

If you are interested in starting NBUVB treatments, please schedule an appointment for an evaluation.

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