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.

Volume 16, Number 2
February 2010

A review of home phototherapy for psoriasis�
Bridgit V Nolan1, Brad A Yentzer MD2, Steven R Feldman MD PhD2
Dermatology Online Journal 16 (2): 1

Abstract

Background: Phototherapy is a mainstay in the treatment of psoriasis and other photoresponsive dermatoses and home phototherapy has broadened therapeutic options.

Purpose: To describe the history of home phototherapy, the technological advances in the safety and efficacy of the equipment available, and the associated issues of cost, convenience, adherence, and quality of life.

Methods: We conducted a literature review of home phototherapy, broad-band UVB, narrow-band UVB, and PUVA phototherapy using PUBMED. A Google search of home phototherapy equipment and technology was also undertaken.

Results: Technological advances in home phototherapy equipment have allowed for more treatment options and improvements in safety and efficacy. One randomized, controlled trial found results comparable to office-based phototherapy. Home phototherapy is convenient, cost-effective, and associated with better quality of life compared to outpatient phototherapy treatment. One trial found that adherence to home phototherapy regimens was better than to oral retinoids.

Conclusions: Home phototherapy is a well-tolerated, efficacious, economical and patient friendly therapeutic option. Advantages of home phototherapy include improved quality of life, greater convenience, lower cost, and less time lost from work and social activities. Dermatologists should strongly consider home phototherapy as a first-line treatment option for appropriately selected psoriasis patients.

UVA (PUVA) Comparison with UVB Narrow Band

Comparisons using the split-body approach have been made to assess the relative efficacy of trimethylpsoralen bath PUVA and NB-UVB in patients with chronic plaque psoriasis [21, 22]. The decrease in Psoriasis Area and Severity Index (PASI) score was greater on the NB-UVB side compared with topical PUVA, and this difference occurred earlier during the course of treatment on the NB-UVB treated side. Additionally, NB-UVB treatment was associated with fewer side effects and better tolerability. These results suggest that NB-UVB is more effective, efficient, and better tolerated compared to topical PUVA in the treatment of chronic plaque psoriasis psoriasis [22]. Comparisons of PUVA with oral psoralen versus NB-UVB phototherapy demonstrate that PUVA is more effective and efficient in clearing and maintaining remission in patients with chronic plaque psoriasis (n=93). Clearance was achieved in 84 percent of patients treated with PUVA, after an average of 17 treatments compared to NB-UVB treatment, which resulted in clearance for 65 percent of patients after an average of 28.5 sessions (n=93). Remission at six months was 68 percent in the PUVA group versus 35 percent in the NB-UVB group. However, the side effects associated with PUVA were greater, with 49 percent reporting erythema in the PUVA group compared to only 22 percent in patients undergoing NB-UVB [23]. It should also be noted that this study used twice-weekly dosing with NB-UVB versus the standard 3-5 times per week of UVB phototherapy. Because PUVA is also associated with potential systemic side effects (erythema, pruritus, nausea, ocular damage, and increased risk of skin cancer) as well as death from accidental overexposure, it is generally not recommended as an option for home phototherapy.

Home Phototherapy

Over the years, there have been numerous studies to determine the efficacy of home phototherapy, including a simple evaluation of home phototherapy with and without the concurrent use of topical treatment, home phototherapy in addition to systemic therapy, and a pragmatic, randomized controlled trial comparing home versus outpatient phototherapy (Table 1). The efficacy of home phototherapy was demonstrated by complete remission of psoriatic lesions in 20 of 28 (71.4%) patients with long-standing, severe psoriasis after 45 exposures to high-dose BB-UVB home phototherapy as a sole therapeutic intervention. Of note, the subjects underwent MED determination and were closely monitored for response to treatment with weekly visits. This arrangement constitutes more supervision than many home phototherapy regimens. The need for adequate monitoring of response to treatment and incidences of adverse events is a major consideration in prescribing home phototherapy as a therapeutic intervention. This consideration underscores the importance of using home phototherapy units equipped with prescription controlled timers to limit the number of treatments between office visits. Additionally, patients with extensive, recalcitrant psoriasis showed clearance of psoriatic lesions in 55 of 56 (98.2%) patients after 8 weeks of BB-UVB treatment in suberythrogenic dose with concurrent use of topical coal tar [28]. In patients with patch and early plaque stage mycosis fungoides, home phototherapy consisting of erythemogenic doses of UVB resulted in clinical and histopathological clearance and prolonged remission in 7 of 31 patients. A comparison of the efficacy of high output UVB at home and at physician offices in patients with recalcitrant hand eczema demonstrated much improvement in 7 of 11 (63.6%) patients in the home group and 11 of 13 (84.6%) patients in the outpatient group [30]. Eighteen of 23 psoriasis patients demonstrated complete clearance with an additional 3 showing marked improvement with the use of NB-UVB. NB-UVB was also shown to be effective in a variety of other photoresponsive dermatoses (Table 1). Home phototherapy in conjunction with oral acitretin for 12 weeks in patients with moderate-to-severe plaque psoriasis reduced PASI score by 22 percent and was clinically significant as demonstrated by an associated improvement in quality of life (as measured by DLQI).

Home phototherapy had similar efficacy to outpatient phototherapy in a large, randomized, well-controlled trial (n=195). For patients undergoing home phototherapy, 82 percent and 70 percent reached Self-Administered Psoriasis Area and Severity Index (SAPASI) 50 and PASI 50, respectively, compared with 79 percent and 73 percent of the patients receiving outpatient treatment. Additionally, the median SAPASI and PASI scores for patients receiving home phototherapy decreased by 82 percent and 74 percent, respectively, compared with 79 percent and 70 percent decreases in the outpatient group. The overall treatment effect, as assessed by the mean reduction in PSAI and SAPASI, and the increase in quality of life was significant and similar between the two groups. As used in this study, home phototherapy was similar in efficacy to standard outpatient phototherapy.

Safety of home phototherapy devices

Adverse effects associated with phototherapy include both acute adverse effects and cumulative, dose-related effects that occur with prolonged use. Early adverse effects associated with BB- and NB-UVB phototherapy are typically limited to erythema and drying of the skin, with maximal erythema occurring between 8 and 24 hours following exposure. Blistering represents a severe acute adverse event more commonly associated with exposure to BB-UVB phototherapy compared to NB-UVB, due to the lower erythemogenicity of NB-UVB. Concerns about the possible increased risk of acute adverse events in the home setting has raised questions about the appropriateness and safety of home phototherapy. Side effects of home phototherapy are common with 44 percent of patients reporting adverse effects, but the reported side effects are mild and include erythema (36%), blisters (1%), pruritus (8%), and dryness (1%). In a comparison to home versus outpatient phototherapy, there was mild erythema in 87 percent of subjects, burning sensation in 56 percent, severe erythema in 36 percent, and blistering in 6 percent, with no difference in incidence of acute adverse events between the two groups. Thus, acute adverse effects appear to be mild and well-tolerated, with severe reactions occurring in low incidence. Late adverse effects result from the cumulative UVB dose, which leads to aesthetic changes, including premature aging (photoaging), wrinkling, and leathery appearance, increased fragility of the skin, and increased risk of photocarginogenesis. Such late adverse effects correlate directly with the total cumulative dose and the incidence of acute adverse events. Data investigating the carcinogenetic risk associated with exposure to BB- versus NB-UVB do not demonstrate a significant difference. Because photocarginogenesis is directly related to the cumulative dose of UV light and to the incidence of acute adverse events, the presumed long-term risk associated with home phototherapy may be similar to that associated with outpatient treatment. Whereas there are good data demonstrating the long-term safety of physician-administered phototherapy, no such data are available for home treatment. However, the existing data demonstrates no differences in acute adverse events or total cumulative ultraviolet dose and there are no data suggesting that home phototherapy is less safe than standard outpatient treatment [33].

Improved technology has allowed for the evolution of safer home phototherapy devices. Innovative safety features in newer units include a key-locked ON/OFF switch to prevent unauthorized use, a built-in controlled prescription timer (CPT), and a failsafe feature that disables the unit in the event of malfunction [38-45]. The controlled prescription timer (CPT) ensures that the equipment can only be used for a certain number of treatments as prescribed by the doctor between office visits. Such innovations make phototherapy safer and more appropriate for home use by allowing greater monitoring for appropriate response to treatment and for incidence of adverse events. Additionally, these features decrease the possibility of unauthorized use or inappropriate use and thus reduce physician and patient worry about potential side-effects, lack of follow up, or abuse.

 Advantages of home phototherapy

The advantages of home phototherapy to both doctor and patient are numerous and include convenience, lower cost, better adherence to treatment, and improved quality of life [55]. In terms of treatment effectiveness, adherence is one of the most important factors in determining clinical outcomes. Patients’ adherence to home phototherapy regimens is high and may be even better than to oral psoriasis treatment [32]. Furthermore, improved quality of life, which is attributable to a certain form of treatment, is likely to foster better adherence to that treatment.

Convenience

Repeated journeys to the hospital or outpatient offices for phototherapy pose an obvious inconvenience and expense. Geographic, work, and economic constraints compound the difficulty for patients to maintain an adequate treatment schedule. Treatment plans which are too complicated, costly, or time-consuming may increase the burden of chronic disease. Convenience factors played a major role in patients’ decisions regarding mode of treatment and adherence to treatment. In a survey of patients undergoing home phototherapy, forty percent of users identified “time” as their reason for selecting home phototherapy and an additional seventeen percent chose it due to “difficulty with work schedule”. Other reasons relating to convenience included “convenience of being at home” and “moving from the city” [4]. In another survey, 42 percent of patients undergoing outpatient phototherapy described this method as “inconvenient” and 75 percent indicated that home phototherapy would be helpful. The importance of convenience factors and the relationship between convenience and adherence has been emphasized in the dermatology literature. Additionally, technological advances in equipment design have made home phototherapy units more convenient. Home phototherapy units now operate on standard house electrical current. Many have convenience features, such as casters, which allow for easy moving; adjustable wheels that ease movement on any type of floor surface; and wings or doors, which can be closed or folded away for easy storage (Table 2).

Since the publishing of the article on May 7th by the British Medical Journal on the effectiveness of UVB Treatment in the home, the Internet has been buzzing with articles written by a host of reviewers on the subject. Most are simply referring to the original article but many are commenting. Most if not all of the postings I’ve seen on various blogs and publications show strong support for the use of UVB Narrowband Therapy in the home.

This of course is like music to my ears. Many of you know that I run a business offering UV Phototherapy Products for use in the home. See www.HomePhotoTherapy.com. So of course I’m a little biased.

The actual heading of the article is “Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)”

The finding by the researchers who followed 196 patients was “Ultraviolet B phototherapy administered at home is equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting. Furthermore, ultraviolet B phototherapy at home resulted in a lower burden of treatment and led to greater patients’ satisfaction. “

This statement flies in the face of many dermatologists that say that they believe that treatment at home is the wrong approach because they believe that patients will not be compliant at home. It’s interesting to note that many of the derms who make such ridiculous statements have phototherapy systems in their offices or clinic and they draw some of their income for the sale of time in their own phototherapy systems. I guess it shows that even doctors like to make a dollar.

Treatment at home is ultimately much less expensive to the patient and the insurance company than in-clinic treatment. Typical home equipment can range from $600.00 to $7000.00 with most folks spending perhaps $2500.00 on a home system. In clinic rates can vary from a low of $25.00 to a high of $90.00 PER TREATMENT. I we take an average of let’s say $40.00/treatment with three treatments a week then that’s $120.00/week and in 20 weeks ($2400.00), the typical home system would be paid for. That does not include the costs of parking, car mileage, time of work.

Visit www.HomePhotoTherapy.com to see some home systems. Remember most folks over a lifetime require treatment sometimes several times a year, perhaps for a lifetime.

The absolute best way to have UV Treatment is in the home.

<Link to original article>

The following is a typical treatment protocol to determine how to find the correct treatment time for a user at home. Remember that you should review this protocol with your doctor before starting any treatment!

Always wear UV Blocking Eyewear (Click Here).

You and others in the room need to be aware that eyes are very sensitive
to UV light and your eyes must be protected at all costs.

One needs to recognize that each of us will require treatment times that are unique. Amongst others, some of the items that can affect treatment times include our individual skin type and our prior exposure to UV (Ultraviolet) light from the sun and or other sources. To some extent our diet and/or other drugs we may be taking can affect our skin’s sensitivity to UV.

To determine optimal treatment time for the home user, one can learn to self regulate or self medicate by following a fairly simple protocol. First we need to determine at what point our skin develops what’s called an erythemal response or mild sun burn.

Let’s begin safely by starting with a very low dose and then increasing that dose a little at a time every 24 hours for several days. During this initial phase you will need to take notes and do an exposure every day at approximately the same time. Never repeat an exposure in less than twelve hours. It’s best to do your treatments at the same time each day 24 hours apart. NEVER DO A TREATMENT AT BED TIME AND THEN AGAIN THE NEXT MORNING!

Start with 10 to 15 seconds on day one. If you have very fair skin then increase your dosage each day by 10 seconds per day until you get a mild sunburn or erythemal response. This usually occurs 8 to 24 hours after an exposure. If you have darker skin then increasing by 15 to 20 seconds per day is probably very safe. Keep notes each day and on the day you do turn a little pink then begin to follow the regimen outlined by your doctor. It is likely that your doctor will recommend treatment every second day or perhaps three days per week once the correct treatment time has been determined.

After determining the correct dosage, expose yourself every second day or three days per week using that time. Each of us will have a different time. After several days you will probably notice that your skin will no longer turn mildly pink and at that point increase your exposure by 10 or 15 seconds. This will in all likelihood cause a minor sun burn again and then you will continue treatment at this new time until once again you no longer have a skin response.

ONE MAJOR CAUTION! If you interrupt treatment for a few days because of travel, vacation or any reason, when you resume treatment REDUCE your exposure significantly to reduce the possibility of a sun burn. It’s best to back off to very short exposure times and then, just as you did during the initial phase above, increase your time daily in small increments until you find the correct time again. It is always wiser to under expose than over expose. Nobody enjoys a sun burn.

Keep a treatment log to review with your doctor during your next scheduled visit and all subsequent visits. Your log should record the date, the length of each treatment and the effect you notice on your skin following treatment. After each treatment, record in your log, the date of treatment, the length of each exposure, the time of the day of the exposure and any other appropriate information, (e.g. forgot lip balm, put sunscreen on tender area of breast, etc.)

If you experience a sun burn then reduce or stop treatment for several days until your skin has healed and then cautiously return to treatment again following the guidelines above to determine the correct exposure time.

If after a treatment, a small area feels sunburned, you may protect that specific area with the sunscreen during several treatments until that area gets back to normal.  (Make a note in your log.)   You should see your physician regularly at the intervals he or she requests during periods when you are actively using the unit.  Always take your notebook with you when you see your physician.

Dicussion about Joules, Millijoules, Watts and Milliwatts << Click Here >>

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.

UVB Narrowband is as its name suggests a very narrow portion of the spectrum of ultraviolet. In this blog we will concern ourselves with the UV portion of the spectrum, specifically UVB.

UVB Narrowband is the a very specific spectrum at 311 nm (nano meters) or billionths of a meter.

Another clear advantage of narrowband UVB is that skin is most sensitive to erythemic response, (sun burning) at 297 nm, so narrow band phototherapy reduces this problem as shown in the chart below.

Image from http://www.homephototherapy.com/nbc-narrowband.htm

Looking at the image above, one should notice that

1) The red line is our skin’s sensitivity to UV light
2) The blue line is what we call UVB Broad Band
3) The green line is UVB Narrow Band

The unique properties of
UVB Narrow Band causes less sun burning or erythemal effect than other treatments such as UVB Broadband. The chart above shows that the skin’s erythemal (sun burning sensitivity) is at its max at around 297 nm and that UVB NB with it’s spectra centered around 311-313 nm generates very low erythemal response. This allows the user to have longer treatment times before “seeing” an erythemal response. UVB NB is fast becoming the recommended treatment to replace Broadband UVB and PUVA. Most of Amjo’s sales today are UVB Narrow Band units.

Clinical studies have shown that the peak therapeutic effectiveness of UVB to be between 295 to 313 nm and that wavelengths below (shorter) than roughly 300 nm are more likely to cause a strong erythemal response or severe burning. UVB Narrow Band is in the 311-313 nm range and causes less burning than shorter wavelengths.

For Psoriasis

• Now dermatologists can gain the advantage over persistent and chronic cases of psoriasis with UVB Narrow Band technology. Narrow Band UVB has been shown to provide faster clearing of psoriatic plaques when compared to traditional Broad Band UVB.

For Vitiligo

• Check out or Vitiligo Success Stories
• Today UVB Narrow Band technology is proving to be very useful in the treatment of Vitiligo. It is replacing traditional PUVA phototherapy treatment. UVB Narrow Band requires no photo-sensitizing agents. 

For Eczema

• Eczema is one of the more common applications of UVB Narrowband in the derm’s office and at home. Dermatologists can gain the advantage over persistent and chronic cases of eczema with UVB Narrow Band technology. Narrow Band UVB has been shown to provide faster clearing of eczema when compared to traditional Broad Band UVB or PUVA.

One can find UVB Narrow Band Bulbs in the following systems:

• Panosol II – UV Panels
• Foldalite-III – Full Body System
• Hand/Foot Unit – for localized treatment of the hands or feet.
• The Handisol NB – Hand Held Wand

It is said that  because the shorter wavelengths are eliminated and that exposure times can be increased.  The 311-313 nm range is less than 1% of the total range of wavelengths from sunlight, it is a powerful and targeted treatment.