Phototherapy
What is UVB and how does it work?
Present in natural sunlight, ultraviolet light B (UVB) is an effective treatment for psoriasis. UVB treatment involves exposing the skin to an artificial UVB 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.
There are two types of UVB treatment, broadband and narrow band. Broad-band UVB is an older method that has been more commonly used in the United States; however, narrow-band UVB is similar in many ways and is becoming more widely used. The major difference between broadband and narrow-band UVB is that narrow-band UVB units emit a more specific range of UV wavelengths. UVB includes all wavelengths of light between 290-320nm. Narrowband UVB (NBUVB) includes only wavelengths between 311-313nm.
Several studies indicate that narrow-band UVB clears psoriasis faster and produces longer remissions than broad-band UVB. Narrow-band UVB may be effective with fewer treatments per week than broad-band UVB. Narrow-band UVB is also emerging as an alternative to PUVA, the light-sensitizing medication psoralen plus exposure to ultraviolet light A. Although not quite as effective as PUVA, narrow-band UVB is easier for people to undergo and may be safer over the long term.
The use of narrow-band UVB is increasing as doctors and patients learn more about its effectiveness and improved safety. Dr. Rosenberger’s phototherapy units utilize Narrow-band UVB bulbs. She is pleased to offer this advanced and cutting-edge therapy.
How is UVB administered?
The patient stands in a treatment lightbox lined with UVB 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 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 UVB light is not an exact science, each person’s reaction to the light is not completely predictable. Subsequent sessions of UVB 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. To learn more about that therapy, see our Excimer Laser page.
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 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 stopped. They should be resumed if the lesions begin to reappear. Sometimes UVB 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 UVB treatment?
During treatment, psoriasis may worsen temporarily before improving. The skin may itch and become red because of exposure to the UVB light. The amount of UVB administered may need to be reduced to avoid further irritation. Occasionally, temporary flares occur even with non-burning doses of UVB. These reactions may resolve with continued UVB treatment.
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 UVB 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 increased risk of skin cancer from UVB treatment for psoriasis. 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 UVB. The face, for example, is exposed to a great deal of natural sunlight. If there is no psoriasis on the face or genitalia, a person should avoid UVB exposure there.
Insurance Coverage and Prior Authorization
You will need to contact your insurance company regarding insurance coverage and prior authorization. The code you will need are CPT 96910. It is covered by most insurances including Medicare. When not covered, we do out best to make this excellent treatment affordable to our patients.
For more information, we recommend you visit the National Psoriasis Foundation site, to full explore this and other treatment options.
If you are interested in starting NBUVB treatments, please schedule an appointment for evaluation.
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