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.

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).

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.

This allows patients to receive photo-therapy treatments with less risk of severe burning or pathogenic exposure to UV in harmful ranges. (It also avoids the adverse side effects of the psoralens used in conventional PUVA therapy, since UVB treatment requires no supplemental drugs.) These benefits have made Narrow Band UVB systems increasingly popular with vitiligo patients and their doctors.

Even better is that Narrow Band UVB light systems are available in home-sized panel systems and cabinets, which many are finding far more convenient than frequent trips to their dermatologist’s office. Though many people buy complete surrounding cabinets, some doctors suggest that panels are actually more effective, and that the optimum distance from the bulbs for the area being treated is about 7 inches. Time exposures should be discussed with your dermatologist prior to using a light panel or cabinet, as the exposure times vary greatly depending on how long you have been treating, and your skin tone.

Narrow band UVB reduces superfluous and harmful UV by emitting only wavelengths of 311-312 nanometers. Conventional broad band UVB lamps emit a variety of wavelengths ranging from 280-330 nm. Clinical studies show the peak therapeutic effectiveness of UVB to be within the range of 295-313 nm, but wavelengths below 300 nm can cause erythema or severe burning and increase the risk of skin cancer. The 311-312 range is considered by many to afford optimum safety.

Edited and copied from www.HomePhotoTherapy.com

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.”

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.

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.

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]

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.