Even without treatment, the skin may remain clear for some months. However, psoriasis may later flare up again, and further UVB treatment may be necessary. Those cases of psoriasis which appear to be resistant to UVB may still be helped by another form of ultraviolet treatment called PUVA , or other treatments e.
UVB is occasionally used for severe cases of dermatitis , especially atopic eczema. Frequency and dosage of treatment are similar to that used for psoriasis. However, a course of phototherapy may need to be more prolonged than that generally required for psoriasis. UVB is one of the most effective treatments for vitiligo. Treatments must be cautious as the white skin burns easily. It may take several months to see an improvement.
Many other skin conditions have been effectively treated with UVB, including generalised itch , prurigo , cutaneous T-cell lymphoma , pityriasis lichenoides , and symptomatic dermographism. See smartphone apps to check your skin. DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Although BB-UVB is now rarely used for psoriasis, it can be effectively used for atopic dermatitis and generalized pruritus.
Typically, patients with moderate-to-severe psoriasis require 20—36 sessions of NB-UVB phototherapy at a frequency of three sessions per week to see a significant improvement in their skin [ 9 ]. Each phototherapy appointment usually lasts about 15 min, although some patients may require up to 30 min, if more time preparing for phototherapy is needed.
A minimum of 24 h is required between each session. Additionally, physician follow-up is required every 3 months for the first year of treatment and then every 6 months thereafter. After skin clearing, the frequency of phototherapy is gradually reduced to once weekly for long-term maintenance. If a patient is on a concomitant photosensitizing drug at the start of treatment, the initial dose is shifted down one level to that of the preceding Fitzpatrick skin type.
As treatment progresses, small incremental increases in dose are introduced as tolerated to minimize skin toxicity and total UVB exposure. The treatment goal is to maintain a mild amount of erythema for optimal results [ 12 ]. Finally, 28 or more days off requires the patient to start the regimen again. Patients are encouraged to consistently use topical medications as prescribed in conjunction with phototherapy to achieve the best results.
This may include topical corticosteroids, topical vitamin D analogs, or topical retinoids [ 13 — 16 ]. Biologic agents can be successfully combined with phototherapy for enhanced efficacy. Other systemic agents such as cyclosporine and methotrexate are not typically used in conjunction with phototherapy [ 17 ] due to a possible increased risk of skin cancer or phototoxicity, respectively [ 18 ].
Below, we will describe the safety considerations, flow of treatment, appropriate skin care, and possible side effects of UVB phototherapy. This article does not involve any new studies of human or animal subjects performed by any of the authors.
All photos are printed with the consent of the subject s. The phototherapy is delivered in a light box with adjustable energy settings, a fan, and a timer that are all controlled by a nurse. Although the light administration itself is often very brief ranging from several seconds to a few minutes , much of the appointment consists of before-and-after precautions taken to ensure patient safety while maximizing treatment efficacy.
Therefore, each appointment generally lasts about 15 min, although some patients may require up to 30 min, if more time preparing for light therapy is needed. Patients must bring a list of all current medications, including herbs and supplements, to the first appointment for review with the phototherapy nurse Table 2 ; Fig. In general, patients should notify the nurse of any medication changes as they arise. For each session of phototherapy, patients must have bare skin that is free of lotions and perfumes or colognes, as these may make skin more sensitive to light.
Eye protection with UVB-filtering goggles provided in the clinic is required unless there are periorbital lesions skin involvement around the eyes that may benefit from UVB light.
In that case, closing the eyelids during irradiation will suffice, as it has been shown that UV light does not penetrate the eyelids [ 19 ]. A towel is also generally wrapped around the face if the skin condition is not present there. Finally, genital coverage is required of all male patients unless an exception has been approved by a physician. NB-UVB is also safe for use in pregnancy [ 20 , 21 ]. Eye protection with clean goggles or close the eyes Fig.
At each session of phototherapy, the patient checks in at the front desk and proceeds to gather all necessary supplies, which include clean goggles, a hospital gown, towels, and genital coverage for men Table 3 ; Fig. The patient then changes into a hospital gown in a dressing room. This helps the nurse determine if any phototherapy dose adjustment will be required for the session. Next, the patient is asked to step into the UVB box and to assume a position that ensures maximal light penetration to all affected areas.
This is because the arms and legs can typically withstand higher doses of light without burning, and higher doses of light may be required to treat the affected areas on the arms and legs compared to the face and trunk. In some cases in which the patient has psoriasis lesions on the lower legs, the patient may be asked to stand on a step stool to allow for a greater amount of light to reach the lower legs. Following this, the patient can get dressed and the treatment session is complete.
It is important to minimize skin irritation post-phototherapy Table 4. When bathing, patients should use a mild soap or skin cleanser.
Shortening shower times and limiting showers to once per day is helpful. In addition, water temperature should be warm at most, but not hot. It is important for patients to moisturize their skin very thoroughly at least twice daily while receiving phototherapy. The best time to moisturize is immediately after bathing. Although maintenance of a mild skin erythema is desired for optimal results, burning should be avoided Table 5.
Signs and symptoms of burning post-phototherapy include moderate-to-severe redness, tenderness, pain, tightness, itching, and rarely blistering of skin.
Normally, if a burn is secondary to light treatment, it will become noticeable 4—6 h after the phototherapy session. If patients experience any of the signs or symptoms of burning, they should promptly apply a topical steroid to the affected skin in an effort to lessen and arrest the burn. Patients are also encouraged to call their phototherapy clinic for further assistance if needed.
Other possible side effects of phototherapy include photoaging and tanning [ 12 ]. UVB phototherapy is a safe and effective treatment option for patients with psoriasis, eczema, vitiligo, and other photo-responsive disorders.
The key to success with phototherapy is consistency. Booths come in several designs. Some look like phone booths and you can stand in them. Others look like tanning beds and you can lie down during treatment. The booth will record the total amount of light you are exposed to.
In general, your entire body is exposed to the light. If psoriasis affects only certain areas of your body, UV light may be directed at these selected areas only. You will wear sunglasses that block UV light and goggles or a blindfold to protect your eyes from getting cataracts. Men may also need to shield their genitals to protect them from an increased risk of genital cancer. As your skin recovers from treatment, it should be checked at least once or twice a year for signs of skin damage or skin cancer.
PUVA the use of psoralen medicines with UVA light therapy is usually used when psoriasis is disabling and safer treatments have not worked. Phototherapy is usually an effective treatment for psoriasis. 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 such as Vaseline 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 psoralen.
This combination treatment is called PUVA. Phototherapy requires a lot of time for treatment, and UV booth equipment is expensive. For people who have erythroderma or pustular psoriasis, UV treatment may make the condition worse. The National Psoriasis Foundation provides information on where you can buy home light therapy equipment. Home light therapy should only be done under your doctor's supervision.
For more information, see the organization's website at www. Author: Healthwise Staff. This information does not replace the advice of a doctor.
0コメント