The World of UV Phototherapy

Archive for the ‘UVGuy's Ramblings’ Category

Bumped Up (2010-03-08)

In the begining “Yes” but now “Absolutely not!” The answer is no. Tanning beds generate UVA or Long Wavelength UV. UVA penetrates the skin very deeply while the shorter wavelengths of UVB do not. UVA is used in photoherapy when combined with a Psoralen drug and the therapy is called PUVA.

In tanning bed antiquity, the UVB content was much higher. Today, in the USA, the FDA has regulated that the UVB content in tanning beds must be very low! Because of regulations, tanning beds produce only 4.2% to 6.5% UVB in the USA and typically 1% to 3% in Europe. To read the US FDA Regulations <Click Here>. The level of UVB radiation is in the following statement “Performance requirements–(1) Irradiance ratio limits. For each sunlamp product and ultraviolet lamp, the ratio of the irradiance within the wavelength range of greater than 200 nanometers through 260 nanometers to the irradiance within the wavelength range of greater than 260 nanometers through 320 nanometers may not exceed 0.003 at any distance and direction from the product or lamp. UVB is commonly defined as 280 to 320 nanometers.

Tanning Salons can be a risk for the typical consumer as the output from these beds can vary greatly from bed to bed and treatment/tanning times must be adjusted based on lamp power. When a bed is re-lamped and you are not told then a sunburn is very likely.

UVA wavelengths pass through the epidermis to the hypodermis Click on the image for a link to this photo's source.

Read this article http://www.pnas.org/content/101/14/4954.full which seems to indicate that UVA may be more dangerous than UVB. This is a complicated subject but it does appear that it is UVA that contributes to premature skin aging and is more likely to cause cancers of the skin.

UNDERSTANDING UV RAYS
“Most everyone is aware of the risks associated with UVB exposure, however there are real risks associated with UVA exposure including skin aging, DNA destruction and even skin cancer. Protecting your skin from UVA rays is just as important as protecting yourself against UVB rays.”  - A quote by Dr. Henry Lim, Vice President-Elect, American Academy of Dermatology and Chairman of Dermatology, Henry Ford Hospital, Detroit, MI.

Here’s another posting at this blog on the diferences twixt UVA and UVB. See PUVA vs UVB NARROWBAND.

Don’t be fooled by the non-medical advice of a tanning salon owner! Check with your dermatologist.

UVB NB Systems are available from off-shore vendors in Israel, Europe and Australia.

I do recommend that you be very cautious for several reasons:

The offshore vendor may be (usually is) offering product(s) that are not approved for use or sale in the USA.

• Products from these vendors are sometimes stopped by US Customs and or the FDA and are typically rejected and you are out of cash!
  • If there are are any warranty issues, returning products for testing/repair can be very very expensive!
• If there are any legal issues then dealing with foreign vendors can be a problem.
• If you are foolhardy enough to purchase overseas then always use a credit card so that if necessary you can try to get any payment or part of a payment reversed by your credit card company.
• Some of these companies say “No Prescription Needed” - This should be a red-flag to you! All UV Ultraviolet systems require a prescription in the USA. If you purchase a non-FDA certified product then you may be in breech of sevreal laws.
• Just because the lamps used are possibly FDA Certified, this does not mean that the system or final product is.
• Check the voltage and frequency. Here in the USA we use 115V 60 Hz. A lot of offshore products operate at 220V/50Hz

There are several vendors/manufacturers here in the USA and we all sell devices that are 510K Certified by the FDA.

The answer is yes but it’s more of a challenge than with UVB Broadband. One of the best features of UVB Narrow Band is that it has an excellent “therapeutic” effect with less risk of a sunburn. How can that be? The answer is quite simple. Our skin is sensitive to all forms of ultraviolet light and from a sunburn viewpoint, our skin is most sensitive to UV light between about 290 nm (nano meters) and 305 nm. Take a look at the graph below.

The Green area is UVB NB and only a small amount of the UVB NB energy is inside our skin's most sensitive wavelengths.

Narrow Band Ultra Violet B Light is a relatively new technology on the vitiligo front. In the past, most doctors have used the PUVA system, which involved the use of Ultra Violet A light exposure and the taking of Psoralen pills. However, side effects for many people were unbearable. Narrow Band UVB light panels and cabinets solve the problems of over-exposure to ultraviolet by maximizing delivery of narrow-band UVB radiation (in the 311-312 nanometer range, the most beneficial component of natural sunlight) while minimizing exposure to superfluous UV radiation.

Read the rest of this entry »

Cheryl and I operate Amjo Corp for fun and profit. If there’s no profit, I can assure you there’s no fun either! We started Amjo in 1998, you can read about us at www.amjo.net. Every now and again, someone wakes us up by thanking us for what we do. This weekend that just passed by was just such a moment. The gentleman who wrote the letter/email below suffers from severe dermatitis on his hands and he recently purchased a National Biological Corp Hand/Foot II unit from us through his insurance company and this is what he was kind enough to  write.

Hi Chris,

I want to thank Cheryl for the wonderful service I received from her. She had a tough and challenging time dealing with my insurance and medical provider. I want you to know how much I appreciated her professionalism and kindness she showed me in dealing with them to get me a light box. I could only wish that there were more people in the medical industry that had Cheryl’s drive to help those of us that don’t understand and haven’t the knowledge of the system to do it as well as Cheryl did. Kudos to Cheryl and yourself for having such a great staff to help us.

Thanks again for everything

RP in California

It feels good to be thanked for the job we do every day.

Recently I became aware of a blog that’s been running for some time, the blog focuses on Vitiligo and the author whose name is not published on the blog does have a couple of articles on UVB NB used in Vitiligo Treatment. The blog can be found at http://www.vitiligoskindisorder.com. The UVB NB article that I found is http://www.vitiligoskindisorder.com/treating-vitiligo-with-puva-vs-narrowband-uvb/

I’ll keep reading this blog for a while but it would be nice to know who is publishing it and why?

With tongue in cheek I penned the title above. I have to admit the first time I heard that “just itching” line was from a person with Psoriasis who had a serious itch associated with his disease. In this case, I am using to attract readers with generalized pruritus. It would seem that HIV Positive patients with pruritus can be helped with UVB311 or UVB Narrowband Therapy.

There are several scientifi articles one can find on the nest. I suggest us search for Pruritus AND UVB Narrow Band for more help at Bing or Google.

I came across a medical paper at:
http://www3.interscience.wiley.com/journal/118530749/abstract?CRETRY=1&SRETRY=0#ss9

Title: “Generalized pruritus treated with narrowband UVB”

Authors: Dilek Seckin, MD, Zeynep Demircay, MD, and Ozlem Akin, MD

From Department of Dermatology, Marmara University School of Medicine, Altunizade, and Department of Dermatology, Maltepe University School of Medicine, Maltepe, Istanbul, Turkey 

Background: Narrowband UVB phototherapy has been increasingly used in a variety of dermatological diseases. We planned to evaluate its efficacy in generalized pruritus in this prospective study.

Methods: Forty-six patients were included and then divided into two groups: group 1 and group 2 consisted of patients with uremic pruritus and “idiopathic pruritus”, respectively. Phototherapy was given three times a week. Efficacy assessments were made by means of visual analog scale (VAS) and pruritus grading score.

Results: Thirty-five patients completed the treatment. Mean VAS decreased from 8.2 ± 1.5 to 3.6 ± 3 in group 1 and from 7.1 ± 2.3 to 2.3 ± 2.8 in group 2 (P < 0.0001). Mean percentage of change in VAS was 54.2% (95% CI 32.6–75.9) and 67.9% (95% CI 53.8–81.9) in group 1 and group 2, respectively. Mean number of treatments was 22 in both groups. Mean cumulative UVB dose was 24,540 mJ/cm² and 20,801 mJ/cm² in group 1 and group 2, respectively.

Conclusion: Narrowband UVB is an effective and well-tolerated treatment option for patients with generalized pruritus.

 Links to other articles

HIV & Pruritus: See http://cat.inist.fr/?aModele=afficheN&cpsidt=2823520

From: http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102210196.html

I found “A 38-year-old Japanese man suffered from hemophilia B and had become infected with HIV through the administration of coagulation factor concentrates. The patient had exhibited small, firm, well-demarcated, skin-colored papules (usually 1-8 mm) symmetrically distributed on the trunk, extremities and face. Intense pruritus usually began with the appearance of the lesions. Scratching led to excoriations, prurigo-like lesions and marked post-inflammatory hyperpigmentation. The serum eosinophil count was elevated, but IgE was normal. Biopsy specimens showed a moderately intense perivascular infiltrate composed of mononuclear cells without eosinophils. The lesions and pruritus failed to respond to the topical administration of corticosteroids, crotamiton cream or emollients, or to oral antihistamines or dapsone. Light treatment was given 8 times for 1 month using an ultraviolet B (UVB) lamp. The severity of the pruritus diminished after a few treatments. New prurigo-like eruptions disappeared with UVB treatment. The lesions and pruritus responded only to UVB phototherapy. While the mechanism is not known, UVB phototherapy may provide relief of AIDS-related pruritus.”

Several times over the years, I’ve heard that Dead Sea Salt can help with the treatment of Psoriasis coupled with UVB Narrow Band. I decided to do some googling and learned some interesting stuff.

The interesting thing is that many folks go to the Dead Sea for the treatment of Psoriasis and this has caused the belief that the Dead Sea Salt is the contributor to the clearing of their Psoriasis, the conclusion that I draw based on the article below and others that I’ve read is that it’s not the salt but the sunlight which contains a reasonable proportion of UVB/UVB NB, possibly because of the filtering effect of the mists and atmosphere around the Dead Sea that contribute to the healing/clearing.

Of course the secondary my more mercenary conclusion says, don’t waste your money on a trip to the Dead Sea, just purchase a UVB Narrow Band system for your home or just head to your doctor’s UVB311/UVB NB Clinic and save lots of cash!

I’d be interested in your comments!

Here’s one article from the British Journal of Dermatology (ISSN 0007-0963 ) from 2005 that concluded “In this population the addition of pretreatment Dead Sea salt soaks to NB-UVB did not result in a clinically important improvement in clearance of psoriasis.”

Document title: A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis

Author(s): DAWE R. S. ; YULE S. ; CAMERON H. ; MOSELEY H. ; IBBOTSON S. H. ; FERGUSON J.
from the Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, ROYAUME-UNI

Abstract: Background Dead Sea (DS) salt solution soaks are used in combination with narrowband ultraviolet B (NB-UVB) to treat psoriasis in many centres, particularly in continental Europe. No previously published controlled study has assessed DS salt + NB-UVB balneophototherapy.

Objectives: To compare DS salt balneophototherapy with NB-UVB monotherapy for chronic plaque psoriasis. Methods Sixty patients with chronic plaque psoriasis participated in this paired, controlled study, with pretreatment DS salt soaks randomly allocated to each participant’s right or left study limb. Psoriasis severity was assessed with a Scaling, Erythema and Induration score by a blinded observer. Assessments were weekly during the therapy course, and thereafter 8-weekly until relapse or for up to 1 year after clearance.

Results: The mean area under the psoriasis severity-time curves during treatment was not detectably lower with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.099). The psoriasis severity score fell slightly more from beginning to end of courses with DS salt balneophototherapy than with NB-UVB monotherapy (P = 0.019). There was no detectable difference in times to relapse.

Conclusion: In this population the addition of pretreatment DS salt soaks to NB-UVB did not result in a clinically important improvement in clearance of psoriasis.

Other reading

1. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2678696
2. http://pt.wkhealth.com/pt/re/bjdr/abstract.00002300-200509000-00024.htm;jsessionid=K9QJPTxdckT2wddJJJx3CxndDt51Qyzryl6b0M110nXVB9LTPlst!331639832!181195628!8091!-1
3. http://www.ncbi.nlm.nih.gov/pubmed/10792225

I think you’ll draw the same conclusion or maybe not if you read the article at Click Here where the author says  “The ultraviolet radiation at the Dead Sea is attenuated relative to Beer Sheva as a result of the increased optical path length and consequent enhanced scattering. The UVB radiation is attenuated to a greater extent than UVA and the shorter erythema UVB spectral range decreased significantly compared with the longer therapeutic UVB wavelengths” - Life sure is complex!

We receive the occasional query regarding the use of Ultraviolet Light for the treatment of acne. Generally speaking dermatologists do not prescribe UV light for the treatment of acne. From discussions I’ve had with derms, UV Light does treat the SYMPTOMS of Acne and dries up the comedones but it does not clear the underlying root cause. Blue light is used as the anti–bacterial light and the red is anti-inflammatory.

The common light treatment for Acne is the use of Red/Blue Light. See www.lightsforhealth.com, another www.amjo.net website, for some background on this technology.  

See http://www.lightsforhealth.com/csb-rb_red_blue_science.htm for some of the science of using Red/Blue light in the treatment of Acne.

Chris

The breakthrough came after 1988 when narrow-band UVB (NB-UVB) phototherapy was introduced for the treatment of psoriasis…

Narrow band UVB phototherapy in dermatology

AUTHORS: Sunil Dogra, Amrinder Jit Kanwar
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Full Article < Click Here >

The first report of the use of ‘phototherapy’ in the treatment of skin disorders dates from 1400 BC from India when patients with vitiligo were given certain plant extracts (whose active ingredients included psoralens) and then exposed to the sun. The real interest in the use of ultraviolet (UV) irradiation in the treatment of various skin diseases started in the 19th century when Niels Finsen received the Nobel Prize (1903) for his therapeutic results with UV irradiation in lupus vulgaris, the only dermatologist ever to be awarded one. This marked the start of modern phototherapy. It was used in thermal stations for the treatment of tuberculosis, in the treatment of leg ulcers in wartime, and various other skin diseases. It was a very long journey from the use of plant extracts and sun exposure to treat vitiligo to the use of oral psoralens and total body UVA-irradiation cabins (PUVA) to treat various skin diseases. In a landmark development, in 1974 Parrish et al reported the useful role of high intensity UVA tubes in combination with oral psoralens in the treatment of psoriasis leading to what is now known as PUVA therapy.

The history of UVB phototherapy is not as old as the history of photochemotherapy. Wiskemann introduced irradiation cabin with broad band UVB tubes in 1978 for the treatment of psoriasis and uremic pruritus. However, broad band UVB phototherapy was less efficient for treating psoriasis than PUVA and so never achieved popularity. The breakthrough came after 1988 when narrow-band UVB (NB-UVB) phototherapy was introduced for the treatment of psoriasis by van Weelden et al and Green et al.