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.

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

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

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

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).

The new Dermalume 2X uses the National Biological Corp CPT or Controlled Prescription Timer to help the doctor and the patient work together for optimal treatment.

It’s interesting to see the sales of our Dermalight 80 drop slightly as our sales of the Dermalume ramp up.

The Dermalume 2X arrives ready for use in a handy briefcase type case allowing the user to easily pack it away between treatments and carry it with them while traveling.

The unit allows the user to treat only affected areas – and use comb to maintain consistent distance from skin or separate hairs for scalp psoriasis treatment.

The clever hinge allows multiple wand positions can be held where you want while the two lamps with the large output window allow for faster treatment. The DermaLume is shipped fully assembled with an optional comb attachment (includes) , goggles, and carrying case.

You can learn more about the Dermalume 2X at our website. Please visit http://www.homephototherapy.com/dermalume2X.htm for more information.

Best thing to do is email us (support@amjo.net) or give us a call 513-942-2770 and we can get the ball rolling for you.

Abstract: