The World of UV Phototherapy

Posts Tagged ‘UVA’

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.

Since the Industrial Revolution, we’ve known about Rickets and other diseases and problems caused by the lack of sunlight as we as a people moved indoors. The lack of Calcium may also lead to Ricketsand other bone problems. I leave it to the diet bloggers to discuss the lack of Calcium in our diet, perhaps because of too many soft drinks and not enough milk.

Here’s a link to an article on Vitamin D Deficiency that you might want to read.

Research has shown that it is the UV (Ultraviolet) portion of the spectrum that helps the body create Vitamin D . This is one of the known benefits of UV. The use of sun-screens, hiding indoors from the sun as we worry about skin cancers and the like is now perhaps one of the causes of Vitamin D deficiencies in some of our population.

Dr. Michael F. Holick, author of The UV Advantage is one of the world’s experts on Vitamin D runs a website/blog called www.VitaminDHealth.org. I met Dr. Holick at Boston University many years ago along with Jim Shepherd of KBD. Jim and I were looking into the marketability of a product that Jim’s company now makes. This is a Vitamin D UV Lamp. It is not being sold as a medical device and from what I see on his website  there is no FDA approval (for Vitamin D) on the device(s) that KBD (Sperti) is selling. I am making you aware of this product only, I do not recommend its use. Please check our DISCLAIMER page on this blog.

There are many sites that recommend exposure to UV light to help with Vitamin D production in our bodies. The problem that I see is that there are no guidelines as to which wavelength(s) of UV are most effective, what energy levels are recommended or treatment/dosage times. This leads to anarchy in the field. Some are recommending UVA, some UVB but none that I see give treatment guidelines.

Our firm (www.amjo.net and www.HomePhotoTherapy.com) has avoided offering UV products for Vitamin D production as there are no clear treatment guidlines. I personally recommend that you buy a sports car, drive top down for fun in the sun. This seems to work for me.

Some sites you might want to visit:

• The UV Foundation - www.uvfoundation.org
• The UV Advantage - www.uvadvantage.org
• SUNARC - www.sunarc.org
• Explore Vitamins - www.explorevitamins.co.uk
• Wikipedia - http://en.wikipedia.org/wiki/Vitamin_D 
• Mayo Clinic - www.mayoclinic.com/health/vitamin-d/NS_patient-vitamind

Send me an email or perhaps comment below.

Narrowband UVB was safer and more effective than PUVA for vitiligo therapy.

Phototherapy employing sunlight and plants that contain natural psoralens was first used for vitiligo thousands of years ago, and it continues to be a first-line treatment today. Investigators conducted a randomized, double-blind trial to compare two of the most popular forms of phototherapy for vitiligo in 50 patients with nonsegmental vitiligo who received either PUVA or narrowband UVB (NB-UVB) therapy (25 patients in each group).

After treatment (maximum, 144 sessions), subjects in both groups had significant reductions in the extent of vitiligo-involved body surface area. Although between-group differences were not statistically significant, improvement occurred more rapidly and tended to be greater with NB-UVB. After 48 treatments in patients who received that many sessions, the median percentage of improvement in affected body-surface area was slightly more than 20% in the PUVA-treated patients and more than 50% in the narrowband-treated group. The color of the repigmented skin matched excellently the color of uninvolved skin in all NB-UVB recipients but in only 44% of PUVA recipients. Erythema occurred more often with PUVA phototherapy than with NB-UVB therapy (in 96% vs. 68%, respectively). The PUVA recipients received a median of 47 treatments and the narrowband UVB patients, a median of 97; the authors suggest that this is because of the greater efficacy and fewer adverse effects experienced by NB-UVB recipients.

Comment: This study clearly demonstrates that for vitiligo repigmentation, NB-UVB is safer and more effective than PUVA. Other randomized, controlled trials have shown at least some efficacy with targeted phototherapy, topical and systemic steroids, topical calcineurin inhibitors, and calcipotriene combined with PUVA. A number of reports show success with surgical repigmentation procedures, as well. Although we are making progress in treating this vexing disease (especially with calcineurin inhibitors and phototherapy), we still have a long way to go. At best, 75% of patients respond, and in most instances, this response is only partial. A breakthrough in the management of this disease would be greatly welcomed by both patients and doctors. An accompanying editorial provides a nice evidence-based review of existing therapies for vitiligo.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology June 1, 2007

Link to entire 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.

Link to entire article << Click Here >>

Excerpted from an article by: Sunil Dogra, Amrinder Jit Kanwar, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh, India

Correspondence Address:
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education & Research, Chandigarh - 160102, India
ajkanwar@sify.com

One of the questions that arises from time to time is “Do I need a dosimeter in my home system?” My answer is No, so let’s talk about it.

OK, so what’s a dosimeter you ask? UV Phototherapy systems in clinicasl use (in a clinic, hospital or doctor’s office) absolutely require some form of dosimetry. A dosimeter is a device that measures the power of the UV light output from the lamps and determines the treatment time required for that particular treatment session based on the input from the clinician.

In home use, a dosimeter can add significant cost to a phototherapy system and offer no advantage to the home user. In a clinical environment, lamps age, patients might not be using the same phototherapy booth or panel or might go to a different clinic. For these reasons it is important that the treatment dosage, usually measured in Joules or Milli-Joules is known and recorded. Then, if the patient returns to a unit where bulbs have been replaced or perhaps a different booth the last treatment energy in Joules or Milli-Joules is known and can be used to set the dosage for the next treatment.

In the home, the user uses the same machine every day and unless new lamps are installed the power output from the lamps will be essentially the same as the output two days earlier during the prior treatment and the treatment time will usually be the same. Please see my posting on treatment times for the home user <CLICK HERE> 

A Joule is a measurement of ENERGY which is POWER delivered over time. OK so now it’s getting more complicated and for that I apologize. I have created a page called “Joules,

(Borrowed from National Biological Corp’s Website)

UV Phototherapy is a Safe, Effective, and Economical Vitiligo, Eczema and Psoriasis Treatment

How UV Phototherapy works

UV Phototherapy treatment works by exposing the skin to specific segments of UV light. UV phototherapy treatments are quick and painless. Only the affected areas are exposed. A doctor prescribes the form of ultraviolet light such as UVA, UVB, or narrowband UVB light, as well as length of phototherapy exposure time, number of sessions, and frequency of sessions.

UV Phototherapy is a Safe Treatment

Ultraviolet phototherapy, or UV light therapy, has been studied for over 100 years. The UV phototherapy safety record has been proven in children and for long-term use. Conversely, research into safety of oral, IV or IM medications is limited and a recent Mayo Clinic study suggests a link between new biologic treatments and cancer. Side effects are minimal, though you do need to follow your doctor’s prescription to avoid sunburn. All of our UVA, UVB, and narrowband UVB phototherapy units are equipped with numerous safety features including a controlled prescription timer, child-proof key lock switch and more.

UV Phototherapy is an Effective Treatment for Psoriasis and More

UV Phototherapy is often the most effective psoriasis treatment. While psoriasis treatment is the most common use, phototherapy is also highly effective in treating vitiligo, eczema, hair loss and over 25 other skin conditions. People typically see some improvement immediately and experience clearing with 20 to 25 treatments. Long term remission is experienced for 90 to 95% of cases. Success rates and remission rates are higher for UV phototherapy than for any oral medication or biologic on the market.

UV Phototherapy is an Economical Treatment

Many skin conditions are chronic, genetic diseases. Home phototherapy is often less costly than either long-term medication or regular office visits for UV phototherapy treatments. Insurance companies know this, so most reimburse our phototherapy equipment.

Side benefits of UV phototherapy!

With UV phototherapy, people often report that they enjoy relief from the anxiety caused by living with chronic discomfort. They obtain peace of mind, knowing that their episodes and pain are manageable and that less pain and fewer drugs means better mental health. And, since UV light is sunlight, the therapy itself often has a calming effect.

Typical Rectangular Woods Lamp Made by Waldmann

Perhaps a little off topic. The Black Light or the Woods Light is a low energy ultraviolet emitter  usually at 365 nm. All kinds of DNA based materials fluoresce when illuminated by a UV source. In fact one of the primary uses of a Woods Light is in the detection and determination of Vitiligo. Vitiligo is a skin condition where the skin becomes depigmented and turns white. The resulting white spots glow brightly in the presence of the light from a Woods Lamp.

Vitiligo on Hands

To see a selection of images where the skin fluoresces. Click here http://msp.rmit.edu.au/Article_01/14_gallery.html. Vitiligo is an equal opportunity  disease affecting 1% to 2% of the world’s population. We tend to notice it more in dark skinned people because of the greater contrast between the light and dark skin tones. Materials that fluoresce are materials that are affected by the UV light and they themselves emit light. If you’ve ever entered a bar with black lights over the dance floor, you’ve seen how some fabrics and other items glow in the presence of UVA / Black Light.

 Typical Applications for Woods Lamps or Woods Light are very diverse. In the medical field there are several applications. We also find them used in criminology (forensics), mineralogy and gemology to detect fluorescence in many minerals and gems.

We will attempt here to list some of the major applications of our woods lights or woods lamps.

Medical Uses

Several skin diseases/challenges such as vitiligo, acne and a host of others cause the skin (or the fluids on the skin) to fluoresce.

• Vitiligo
• Bacterial Infections
• Acne
• Porphyria
• Erythasma 
• Alopecia
• Tinea Versicolor
• Fungus & Fungal Infections
• Head Lice and their nits, fluoresce under black light.
• Ringworm
• Scabies
• Child abuse / bruising can often be discerned with a woods light.

Why is it useful to be examined with the Wood’s lamp? Normally your skin will not fluoresce, or shine, under the ultraviolet light. This test reveal different colors according to the type of skin disease, which may include:

• Golden Yellow (Tinea Versicolor)
• Pale Green (Trichophyton Schoenleini)
• Bright Yellowgreen (Microsporum Audouini or M. Canis)
• Aquagreen To Blue (Pseudomonas Aeruginosa)
• Pink To Pinkorange (Porphyria Cutanea Tarda)
• Ash-Leaf-Shaped Spot (Tuberous Sclerosis)
• Bluewhite (Leprosy)
• Pale White (Hypopigmentation)
• Purplebrown (Hyperpigmentation)
• Bright White, Or Bluewhite (Depigmentation, Vitiligo)
• Bright White (Albinism)

Ophthalmology

When used with sodium fluorescein or other fluorescing dyes, there are several applications for the world of the eye doctor.

• Foreign Particles in the Eye (glass and other hard to see particles)
• Eye Injury
• Scratches of the cornea
• Blocked Tear Ducts

Veterinary Applications

• Ringworm
• Urine Stains
• Eye challenges
• Lice and Nits
• Microsporum Canis
• Fungal Infections

Miscellaneous Uses

• Pets, small and large leave urine and feces in places that you would least expect. Feces, urine and other biological contaminants/materials can be detected easily with UVA Woods Lights.
• Hard water detection. Many “Culligan Men”, water softener sales people carry a UVA black light as many hardened mineral deposits on taps, sinks etc fluoresce with black light.
• Re-admittance inks. Fluorescent Ink detection. Some invisible inks such as those uses at some night clubs and amusement parks for re-entry stamps can ne seen under UV (Black Light)
• Rodent urine and traces fluoresce under black light. One can monitor/detect some forms of rodent activity with a simple woods lamp.
• Fraud detection. Some of our money has fluorescent dyes within.

UVA is the long wavelength portion of the UV Spectrum. The UV spectrum is defined as the wavelengths twixt 100 and 400 nm with UVA usually defined as the wavelengths between 315 nm (nano meter) and 400 nm as depicted below.

UVA light is used in conjuntion with a Psoralen for phototherapy. The term then becomes PUVA (”P” UVA). This technology was very common but over the last ten years or so there has been a migration towards the use of UVB Narrowband which is generally considered to be the equal of PUVA but without the side effects. See http://www.uvbnarrowband.com/?p=41 for some info on the undesirable effects of PUVA.

UVA light is the main component of the light from a tanning bed. UVA without the use of a Psoralen to sensitize the skin does little for the treatment of most skin problems. UVA penetrates deeply and can cause premature aging of the skin while passing through the upper layers of the skin where the skin challenges such as Psoriasis, Vitiligo and Eczema reside.

UVA (PUVA) is becoming less and less popular as a treatment modality for most skin challenges.

One interesting application of UVA is its use at low energy levels as a “Woods Light” for skin inspection and forensic work. Many chemicals and DNA based materials fluoresce in the presence of UV light. The Wood’s Light was invented by Dr. Robert Woods early in the twentieth century.