Here’s a brochure from Philips that I’m sure you’ll find interesting: <CLICK HERE>

A fluorescent lamp or fluorescent tube is a gas-discharge lamp that uses electricity to excite mercury vapor. The excited mercury atoms produce short-wave ultraviolet light that then causes a phosphor to fluoresce, producing visible light. Wikipedia does a much better job of describing fluorescent lights than I ever could. <<Click Here >>

Philips is the sole maker of UVB Narrow Band lamps at this time. Philips lamps with a “/01″ phosphor are the ones you’ll find in the UVB Narrow Band products we sell <<Click Here>>

UVB Narrowband Spectrum

In the graphic to the above, you’ll see two graphs, one depicting the UVB Broadband spectrum and the other is the UVB Narrowband spectrum which is a very narrow group of wavelengths centered around 311 nm, sometimes UVB NB or Narrow Band is called UVB311.

UVB NB or UVB Narrow Band has replaced PUVA and UVB Broadband in the majority of phototherapy applications today.

We (AMJO CORP) have never run into this before.

There are four HCPCS Codes that we typically file under, these are E0691, E0692, E0693 and E0694, all essentially defining the same equipment in different size ranges.

It seems insane to me that they do not cover all four codes. All the other insurance companies do, some have different allowable amounts for each class but to my knowledge, Humana is the only one that differentiates between the codes.

Medicare does cover E0694 for Psoriasis but not for other diseases.

Read Humana’s Policy (Click Here) (See Page 7 and

Once again we are befuddled by an insurance company!

Although not tested yet, Humana’s policy does read “To qualify for home services, members must be confined to the home, or the condition is such that leaving the home for required services would require considerable effort, impose significant hardship, or expose the patient to undesirable risk.” This sentence may cause claims to be denied also.

Basically, If I had an option I would not choose Humana as an insurance company if I were expecting to benefit from insurance coverage for Ultraviolet UVB Narrow Band) Therapy.

I decided to do some web surfing and have learned that she might be on the right track.

Elsewhere in this blog at http://www.uvbnarrowband.com/index.php/2010/01/uva1-phototherapy-is-it-effective I did write about UVA-1 and its apparent success with Granuloma Annulare.

First a little reading about the disease.

A little reading from several sites provided this information.
For some images of the disease; See http://tinyurl.com/granuloma-annulare

Overview

Granuloma annulare is a long-term (chronic) skin disease consisting of a rash with reddish bumps arranged in a circle or ring.

Causes
Granuloma annulare most often affects children and young adults. It is slightly more common in girls. The condition is usually seen in otherwise healthy people. Occasionally, it may be associated with diabetes or thyroid disease. Its cause is unknown.

Symptoms
Granuloma annulare usually causes no other symptoms, but the rash may be slightly itchy. Patients usually notice a ring of small, firm bumps (papules) over the backs of the forearms, hands, or feet. Occasionally, multiple rings may be found. Rarely, granuloma annulare may appear as a firm nodule under the skin of the arms or legs.

Treatment
I did find an article at http://tinyurl.com/4phduov discussing the use of UVB Narrow Band with Granuloma Annulare and this study concluded that:

• Mayo Clinic: http://www.mayoclinic.com/health/granuloma-annulare/DS00793
• Medline: http://www.nlm.nih.gov/medlineplus/ency/article/000833.htm
• WebMD: http://www.webmd.com/skin-problems-and-treatments/granuloma-annulare
• Google Health: https://health.google.com/health/ref/Granuloma+annulare

LAS VEGAS – Improved understanding of itching and best practices in management of the condition may lead to U.S. medical centers specializing in treating pruritus.

A recent gathering of experts convened by the National Institutes of Health (NIH) may be the first step in this direction, Dr. Timothy G. Berger said at a dermatology seminar sponsored by Skin Disease Education Foundation.

Dr. Timothy G. Berger

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) pulled together 50 physicians on Oct. 29, 2010, to discuss the topic of pruritus. One of a series of roundtable discussions held by NIAMS, this was the first to focus on itching. A summary of the meeting and a list of attendees will be posted on the NIAMS website by the end of 2010, NIAMS media liaison Trish Reynolds said in an interview.

“These things are usually followed by calls for proposals,” said Dr. Berger of the University of California, San Francisco (UCSF), who did not attend the roundtable discussion. “The NIH is moving to a model of having major itch referral centers at several sites.”

Patients with itch would be referred to a center where their tissue samples and data could be stored and analyzed while they get expert treatment. “There will be direct translational benefits” from this approach, he predicted.

These centers would be patterned after two models – referral centers for pain, and European itch centers. The U.S. itch centers might first appear at UCSF; Washington University, St. Louis; and Harvard University, Boston, he said.

“In Europe, every patient with itch goes to a medical center for itch, is seen in a standard way, and has a defined database established about that patient. They now have tens of thousands of itch patients of various types logged into this database,” and data it provides are helping to build greater understanding of the problem of itching, Dr. Berger said.

One of the key insights into itching in recent years has been the understanding that chronic itch is like chronic pain. Chronic itch is thought to begin peripherally but then trigger anatomic changes in the CNS that make treatment much more difficult. “This suggests that we will have agents that will act both peripherally and centrally” to ease itching, he said. “We’re now at the verge of being able to do something about itching.”

Chronic itching should be treated aggressively because once central sensitization occurs, it is very, very hard to manage, he advised. Chronic itching has a huge impact on quality of life, earning the same scores by patients as the reduced quality of life reported by patients with chronic renal failure on dialysis.

Once itch is chronic, the threshold for sensation of itch is reduced. “Even if you make their rash better, they still itch,” he said. Itch intensity increases with chronicity, producing more itch from the same rash. Even when the skin is clear, patients may have short bursts of spontaneous itch. In atopic dermatitis and perhaps some other forms of itchy lesions, patients may scratch themselves raw because inflammatory mediators of pain are perceived as itch.

“This whole system is miswired” in chronic itch, Dr. Berger said.

Perceived itch is a delicate interaction between the skin, nerves, and immune system, and treatments may target or more of these pathways. The most common medication for chronic itch is second-generation antihistamines, in higher doses than used for the approved indication of allergic rhinitis. “These substances also block other inflammatory mediators that may be important for itch, so they may have benefit beyond what we know,” Dr. Berger said.

Neuroleptic medications for itch include amitriptyline or other tricyclic antidepressants, gabapentin, pregabalin, duloxetine, or thalidomide for prurigo nodularis. “These act primarily on the neural axis,” he said.

Central-acting agents include paroxetine, amitriptyline, doxepin, or mirtazapine. In a large European cohort, 6-9 months of treatment with paroxetine reduced chronic itch by 75% in 70% of patients. “It’s now become one of our drugs to treat itch, and is the treatment of choice for itch in polycythemia vera,” he said.

Research has shown that patients with liver disease can develop itch caused by abnormalities in opiate metabolism, leading some clinicians to treat chronic itch with naltrexone, butorphanol or other agents that act on the opiate pathway.

Phototherapy also has been used to treat chronic itch, including narrow-band UVB, psoralen plus UVA, or broadband UVB for itch associated with renal disease. “Phototherapy probably has an immunomodulatory effect that can benefit itch,” Dr. Berger said.

Several European itch centers incorporate a biopsychosocial approach to managing itch. As with chronic pain, focusing on the itch through education and support from nurses helps reduce the itch and decrease feelings of helplessness or inability to cope. Patients miss less work and report more low-itch days and improved quality of life. “So, there’s a biopsychosocial aspect that probably will need to be addressed,” he said. Some U.S. centers have employed this approach in managing atopic dermatitis.

Dr. Berger has been a consultant for Prescription Solutions and received research funding from GlaxoSmithKline, Clinsys Clinical Research, Merz Pharmaceuticals, and Pharmanet, none of which is relevant to this topic, he said. All the medications for itching that he discussed are used off-label. SDEF and this news organization are owned by Elsevier.

The article and citations can be found in its entirety at Skin and Allergy News – Click Here

Typical UVB Narrowband Cabinet

We’ve seen a few reports out of New Zealand with respect to the use of ultraviolet light. Here’s one I added to our blog in July: < click here > 

Recently (12 October) another article was posted about the use of UVB and kids. The study involed  116 children. Here’s the essence of the article.

Background:  Phototherapy is effective for many dermatoses in adults, but there is a paucity of data for its use in children. 

Objectives:  To review the efficacy and tolerability of narrowband UVB phototherapy in children at a tertiary centre in New Zealand, and determine if there were any factors that differentiated responders from non-responders. 

Methods:  A prospective analysis of children (<16 years old) who had undergone phototherapy over a 15-year period. 

Results:  116 children received phototherapy with a total of 144 courses. Mean age was 11.0 years with the majority being European and having skin phototype II. Atopic dermatitis was the most common indication for treatment followed by psoriasis, pityriasis lichenoides, nodular prurigo, morphea, vitiligo, urticaria pigmentosa and erythropoietic porphyria. Treatment was effective in the majority of children (72%). Most received only one course. For responders, the mean number of treatments was 32.4. The mean dose per treatment to achieve clearance was 886 mJ/cm2 and the mean maximum treatment dose per treatment was 1328 mJ/cm2. All children tolerated treatment well with 36% developing brief, minimally symptomatic, erythema. Only two children experienced exacerbations of their underlying dermatoses. 

Conclusions:  This study shows that phototherapy is an effective and well-tolerated treatment modality in children. 

UVB Narrowband products for home and clicical use can be found at www.homephototherapy.com

The part of the sun’s spectrum that we concern ourselves with is the Ultraviolet portion which is by definition 200 nM to 400 nM (nM is nano meter or a billionth of a meter). The UV Spectrum is broken up (by definition) into three bands, UVA, UVB and UVC. Science has arbitrarily defined these as

• UVA – Long Wavelength             320 to 400 nm
• UVB – Medium Wavelength       290 to 320 nm
• UVC – Short Wavelength            200 to 290 nm (Sometimes called ‘Germicidal Light’)

UVB Narrow Band is a small slice of the UVB Spectrum at 311 nM and is identified as that part of the UV Spectrum that seems to provide the optimal therapeutic effect with the lowest risks including lower risk of cancer, lower risk of sunburn and very low risk of contributing to premature skin aging.

OK I’m rambling a bit. People ask, how does UVB NB equate to sunlight? This is an impossible question to answer.

This question is impossible to answer as the sun’s measurable output varies depending on:

• Our Latitude.
• The time of day.
• The season.
• The time of year.
• Cloud cover.
• Relative humidity.
• One’s elevation.

Suffice it to say, one of the advantages of UV Phototherapy is the constancy that one can achieve in one’s treatment from day to day.

Sunlight presents a ‘full spectrum’ of UV light whose energy level arriving on the surface of our planet is dependent on all of the above factors and perhaps others.

Hope this helps?

Do you have any suggestions?

Many psoriasis sufferers seek light therapy, the standard of which is narrowband ultraviolet B (UVB) light therapy, which mimics the portion of the sun’s invisible light rays known to trigger the skin’s production of vitamin D.

Because previous research in people with psoriasis has shown that this treatment raises levels of vitamin D and improves the skin condition, Dr. Caitriona Ryan and her colleagues at St. Vincent’s University Hospital in Dublin, Ireland, wondered if these benefits might be linked.

To investigate, they followed 60 psoriasis patients during an Irish winter — between October 2008 and February 2009. Half were treated with UVB light therapy three times a week until their psoriasis cleared; the others received no light therapy. Vitamin D levels in the blood were measured along the way.

The researchers found that the average patient undergoing UVB light therapy more than doubled their blood levels of vitamin D by the end of the treatment period, which most completed in about 50 days. All of them reached vitamin D sufficient levels, the researchers report in the Archives of Dermatology.

As expected, psoriasis also significantly improved with UVB light therapy. Half the patients started out with psoriasis severity scores above 7.1, and by the end of treatment half had scores of 0.5 or below.

In contrast, three out of every four patients not receiving light therapy remained vitamin D insufficient at the end of the study. They also experienced no overall improvement in psoriasis severity.

When the researchers analyzed the levels of vitamin D and the extent of psoriasis relief, however, they could find no association between the two.

“The improvement in both vitamin D status and psoriasis may be contemporaneous, but unrelated, consequences” of UVB light therapy, Ryan told Reuters Health in an email.

This finding came as no surprise to Dr. Leon Kircik of Indiana University in Indianapolis.

“Any vitamin D in the blood is not going to help psoriasis. You need it on the skin,” he told Reuters Health, pointing to topical vitamin D as an effective psoriasis treatment.

Still, he noted that UVB light therapy is one of the best and safest options for combating psoriasis. So far, it has not been shown to increase the risk of skin cancer, he said, “and it’s been used for a long time, even for pregnant women.”

But Dr. Amra Osmancevic of the University of Gothenburg in Sweden cautions that UVB light therapy remains a known human carcinogen. Its intentional use in healthy people to only induce vitamin D production is not recommended, Osmancevic told Reuters Health in an email.

SOURCE: archderm.ama-assn.org/ Archives of Dermatology, online August 17, 2010

Arch Dermatol. 2010;146(8):836-842. doi:10.1001/archdermatol.2010.195

Phototherapy with ultraviolet (UV) radiation of wavelengths between 280 and 320 nm (UVB) is a safe and effective treatment for a variety of diseases. In addition to standard broadband UVB (bUVB), narrowband phototherapy with fluorescent bulbs emitting near monochromatic UV around 311 nm (nUVB) has become an important treatment for diseases such as psoriasis, atopic dermatitis and vitiligo. In addition to these indications, the number of diseases for which nUVB phototherapy is reported to be effective is continuously growing. The differential effects of nUVB phototherapy in comparison to other UV wavelengths as well as established and new indications for this treatment modality are reviewed.
<See Entire Article – Click Here>

Another UVB BB vs NB Study (Japan 1999) Click Here

A question that comes up quite often is “Should I use Protopic?” or perhaps “Should I use Elidel?” and then the question continues “… while using UVB Narrow Band?”.

Generally speaking, any drug or cream should be avoided and not be applied immediately before or during UVB Narrow Band treatment. Elidel and Protopic and most other things you apply to your skin, change the skin’s sensitivity to UV light. Some drugs increase your sensitivity (Psoralens & others) while others reduce your skin’s sensitivity (sun blocks and the like). All of these should be avoided UNLESS SPECIFICALLY PRESCRIBED by your Dermatologist.

I do recommend that if Protopic, Elidel or other Corticosteroid has been prescribed that you use it following UV treatment or on the alternate days. Do not apply these creams before treatment UNLESS SPECIFICALLY PRESCRIBED by your Dermatologist. It is not safe to apply these creams before treatment as they can increase your skin’s sensitivity to UV light and increase the risk of severe erythema (sunburn).

Do no assume that you know more than your dermatologist!

Avoid sunlight, sun lamps, tanning beds, and phototherapy treatments with UVA or UVB light. If you must be outdoors, wear loose clothing over the skin areas treated with Protopic. Do not use sunscreen on treated skin unless your doctor has told you to.

• Read more: http://www.drugs.com/protopic.html
• Read more: http://www.drugs.com/elidel.html