The World of UV Phototherapy

Posts Tagged ‘UVB’

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.

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 »

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.”

TITLE: Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo

Link to full article <Click Here>
PDF of Article <Click Here>

AUTHORS: Y Hari Kishan Kumar¹, G Raghu Rama Rao¹, K.V.T Gopal, G Shanti, K Veerabhadra Rao

Background: Very few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in Indian patients with vitiligo and are of small sample size.

Aims: The purpose of this study is to know the efficacy and safety of NBUVB in 150 vitiligo patients of various age groups.

Methods: One hundred fifty patients (69 males, 81 females), aged 3-70 years, with vitiligo were treated twice weekly with NBUVB. The starting dose was 250 mJ/cm 2 in adults and 150 mJ/cm 2 in children, with 20% dose increments at each subsequent visit given for a maximum period of 1 year and were followed-up for 6 months for stability of repigmentation. Statistical methods were employed to establish the relation between the response and the number of exposures, duration of treatment, cumulative dose and the compliance.

Results: Analysis of our study showed that a majority of our cases, about 73, achieved 25-75% repigmentation, with an average of 51 ± 19 exposures, 51 had <25% repigmentation, with an average of 19 ± 11 exposures and 26 had >75% repigmentation, with an average of 74 ± 24 exposures. Good response to therapy was directly associated with good compliance, more number of exposures and increasing cumulative dose, which was statistically significant (P < 0.01). Adverse effects were minimal. Only three patients developed depigmentation of repigmented sites during follow-up.

Conclusion: Our study proves that NBUVB therapy is an effective and safe tool in the management of vitiligo, with good stability of repigmentation and cosmetic appearance.

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.

Present status of eyelid phototherapy.
Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.

Prystowsky JH, Keen MS, Rabinowitz AD, Stevens AW, DeLeo VA.

Department of Dermatology, Columbia-Presbyterian Medical Center, New York, NY.

BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis.

OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment.

METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids.

RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients’ records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue.

CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.

PMID: 1597547 [PubMed - indexed for MEDLINE]

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.

Published 7 May 2009, doi:10.1136/bmj.b1542
Cite this as: BMJ 2009;338:b1542

Research

Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

Mayke B G Koek, research fellow¹, Erik Buskens, professor of medical technology assessment^2,3, Huib van Weelden, investigator photodermatology¹, Paul H A Steegmans, dermatologist⁴, Carla A F M Bruijnzeel-Koomen, professor of dermatology/allergology¹, Vigfús Sigurdsson, dermatologist¹

¹ Department of Dermatology/Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands, ² Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, ³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands, ⁴ Department of Dermatology, St Antonius Hospital, Nieuwegein, Netherlands

Correspondence to: M B G Koek author@koek.com

Objective To determine whether ultraviolet B phototherapy at home is equally safe and equally effective as ultraviolet B phototherapy in an outpatient setting for patients with psoriasis.

Design Pragmatic multicentre single blind randomised clinical trial (PLUTO study).

Setting Dermatology departments of 14 hospitals in the Netherlands.

Participants 196 patients with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy. The first 105 consecutive patients were also followed for one year after therapy.

Intervention Ultraviolet B phototherapy at home using a TL-01 home phototherapy unit compared with standard narrowband ultraviolet B phototherapy in an outpatient setting. Both therapies were done in a setting reflecting routine daily practice in the Netherlands.

Main outcome measures The main outcome measure was effectiveness as measured by the proportion of patients with a 50% or more reduction of the baseline psoriasis area and severity index (PASI) or self administered psoriasis area and severity index (SAPASI), called the PASI 50 and SAPASI 50 (relevant treatment effect). Another outcome of effectiveness was the percentage reduction in median scores on the PASI as well as SAPASI. Also the proportions of patients reaching the PASI 75 and SAPASI 75 (successful treatment effect), and the PASI 90 and SAPASI 90 (almost complete clearance) were calculated. Other secondary outcomes were quality of life (SF-36, psoriasis disability index), burden of treatment (questionnaire), patients’ preferences and satisfaction (questionnaire), and dosimetry and short term side effects (diary).

Results 82% of the patients treated at home compared with 79% of the patients treated in an outpatient setting reached the SAPASI 50 (difference 2.8%, 95% confidence interval -8.6% to 14.2%), and 70% compared with 73% reached the PASI 50 (-2.3%, -15.7% to 11.1%). For patients treated at home the median SAPASI score decreased 82% (from 6.7 to 1.2) and the median PASI score decreased 74% (from 8.4 to 2.2), compared with 79% (from 7.0 to 1.4) and 70% (from 7.0 to 2.1) for patients treated in an outpatient setting. Treatment effect as defined by the mean decline in PASI and SAPASI scores was significant (P<0.001) and similar across groups (P>0.3). Total cumulative doses of ultraviolet B light were similar (51.5 v 46.1 J/cm², difference 5.4, 95% confidence interval -5.2 to 16.0), and the occurrence of short term side effects did not differ. The burden of undergoing ultraviolet B phototherapy was significantly lower for patients treated at home (differences 1.23 to 3.01, all P 0.001). Quality of life increased equally regardless of treatment, but patients treated at home more often rated their experience with the therapy as “excellent” (42%, 38/90) compared with patients treated in the outpatient department (23%, 20/88; P=0.001).

Conclusion 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.

^{<Original Article - Click Here>}

Published 7 May 2009, doi:10.1136/bmj.b607
Cite this as: BMJ 2009;338:b607

Editorials

Home UVB phototherapy for psoriasis

Is as safe and effective as outpatient treatment, but provision is poor Psoriasis is a common chronic inflammatory skin condition that causes substantial disability in affected people and their families. In the linked randomised controlled trial (doi:10.1136/bmj.b1542), Koek and colleagues assess whether home ultraviolet B (UVB) phototherapy is as safe and effective for psoriasis as conventional UVB phototherapy given in the outpatient department.¹

UVB has been used to treat psoriasis for more than 75 years, initially in combination with crude coal tar,² and later as monotherapy.³ UVB has been the phototherapy of choice for psoriasis since it was found to be less carcinogenic than PUVA (psoralen plus ultraviolet A phototherapy),⁴ and since the development in the late 1980s of a highly efficacious UVB lamp, termed “narrow band UVB.”⁵

Patients taking a course of UVB treatment usually attend their local dermatology unit three times each week for eight to 10 weeks. In many cases this leads to complete or almost complete . . . [Full text of this article]

Alex Anstey, professor

¹ Department of Dermatology, Royal Gwent Hospital, Newport NP20 2UB

alex.anstey@gwent.wales.nhs.uk

Sunshine can also beat back the chronic autoimmune disorder of the skin. But explaining light’s therapeutic effects has been difficult. “We know it works, but we want to know how,” says Michelle Lowes, an assistant professor of clinical investigation in the Laboratory for Investigative Dermatology at Rockefeller University. “Does it target the pathways that we think are important in the disease?”

A new clinical trial under way at the Center for Clinical and Translational Science in The Rockefeller University Hospital will literally shine light on the disease in hopes of finding out. Researchers, including Lowes and Clinical Research Nurse Practitioner Patricia Gilleaudeau, have recruited the first of what will be 20 patients who will visit the hospital three times a week for up to four months to receive narrowband ultraviolet light B (UVB) treatment. Patients will give skin and blood samples as the treatment takes its course, giving the scientists the possibility to study what is happening at the molecular level as the skin gets better.

UVB therapy is known to kill off T cells, which are partly to blame for the inflammation caused by the disease. For years, Lowes has been systematically accounting for the cell types and proteins involved in the disease. She is specifically interested in whether UVB targets a pathway involving two immune system proteins called cytokines, which she believes may disrupt certain types of T cells and another specialized group of immune-directing dendritic cells. “If we can define the mechanism of action we may potentially have new therapeutic targets for psoriasis and other diseases,” says Lowes, the recipient of a 2008 Doris Duke Charitable Foundation Clinical Scientist Development Award, which is supporting the study.

Doctors often recommend UVB therapy if standard ointment treatments fail and if patients would rather avoid a systemic immunosuppressive drug regimen that has been developed more recently. Patients receive the treatment, brief blasts of UVB, standing inside an upright cabinet whose inside is lined with fluorescent tube lights. The duration of the light exposure increases over the course of the treatment.

In addition to providing free treatment to the study participants, Gilleaudeau consults with the patients and their families and directs them to resources for getting the equipment they need to administer the treatment at home. “We try to help them continue with treatment after they leave whenever we can,” says Gilleaudeau, who will staff a table for The Rockefeller University Hospital May 3 at the National Psoriasis Walk for Awareness in the New York Botanical Garden. “We want to help.”

Lowes hopes to have some preliminary results in about a year. “We are excited about studying this commonly used therapy for psoriasis with modern methods, and hope that this will lead to a better understanding of this complicated and common skin disease,” she says.

http://www.rockefeller.edu/