Phototherapy.
As the name indicates, phototherapy is a therapeutical method based on  the use of ultraviolet light. Phototherapy treats skin conditions, such as eczema, vitiligo, psoriasis, acne vulgaris and cutaneous T-cell lymphoma. Phototherapy uses either UVA or UVB with wavelengths 320 to 400 nm or 290 to 320 nm respectively. The light is produced by special appliances and focused on the treated skin areas. Phototherapy is applied under a doctor’s supervision, regardless if it takes place at a medical facility or at home. A light therapy course will be prescribed by a dermatologist considering the patient’s medical history, other previous treatments followed and the severity of the condition.
Phototherapy seems to be very effective in people, suffering from persistent skin conditions. Even in cases that light treatment cannot cure the problem, phototherapy provides longer periods of remission. Both UVA and UVB are included in the sunlight spectrum. Treatment with light requires patience and consistency on behalf of the patient, especially when the course is carried out at home. A doctor’s instructions must be followed faithfully and phototherapy sessions should not be missed neither extended beyond the prescribed duration. Otherwise, minimal or adverse results may occur and especially in cases of overexposure to light, unpleasant or dangerous side-effects are likely to occur. Skin ageing, burns, actinic keratosis and increased risk for skin cancer are the most common aftermaths.
Phototherapy can be combined with other treatments, such as topical application of corticosteroids, Vitamin A derivatives or retinoids and the intake of oral medications.
About PUVA.
This is a combined use of UVA topical or ingestible agents called psoralens. The latest are drugs derived from plants. The most common sources are the seeds of the ammi majus, heracleum candicans and psoralea corylifolia. Psoralens are photosensitizers. In other words, they have the ability to increase the skin sensitivity to sunlight and facilitate phototherapy, providing they are applied fifteen minutes earlier or taken one to two hours prior to light treatment.
PUVA seems to be more effective than bro\d band UVB light treatment, because UVA can deliver the therapeutic action deeper into the skin.
 Photosensitizers. Unlike the UVB, the UVA is not very drastic if used alone. Thus, a psoralen must be applied or taken prior to UVA phototherapy; in order the desired results to be achieved. Methoxalen (Oxsoralen) is one of these photosensitizers. It is available in 10mg pills and must be taken strictly, according to a physician’s instructions, because it is very potent and if misused, very serious side-effects may occur due to skin hyper photosensitivity. If you have been prescribed Oxsoralen, you can find a generic form of it by trying the
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Procedure of PUVA. PUVA is carried out at an organized medical facility, where the necessary equipment is operated by qualified staff. The duration of each session is critical for successful treatment and prevention of any complications. A typical PUVA course is consisted of twenty five sessions, unless more are required because of the severity of disease. The duration of the first sessions depends on the type of the treated skin but in general, it ranges between thirty seconds to a few minutes. Gradually, they can be extended up to twenty five minutes, according to a dermatologist’s instructions.
After the course is finished successfully, two or three monthly maintenance sessions may be required, in order remission to be sustained.
Side-effects of PUVA. These include nausea, headache, fatigue, burning, itching and redness but they usually settle down within a few days. Ginger supplementation taken at the same time with oral photosensitizers can prevent nausea. Capsaicin and antihistamines may ease itching.
UVB phototherapy.
UVB is light, having a short wavelength that is absorbed in the upper layer of the skin called epidermis. There are two categories of appliances used in UVB phototherapy. The UVB broadband ones produce radiation with 290-320 nm wavelengths, whereas the newer generation equipments emit radiation with 290-320 nm wavelengths. The UVB narrowband produces the part of the ultraviolet light spectrum band that is most helpful for psoriasis. This kind of treatment is superior to broadband UVB. However, the UVB narrowband phototherapy can result in more severe and longer lasting burns than broadband treatment. Over the last few years, UVB narrowband phototherapy has been gaining popularity, since it is considered more effective by some experts.
Typically, UVB phototherapy is used for relatively mild or moderate cases of eczema, vitiligo and guttate or plaque psoriasis resistant to topical treatment. Combination with other anti-psoriasis treatments, such as tars, topical calcipotriol and oral retinoids, such as Soriatane has been proven to be effective.
UVB phototherapy can be carried out either at a physician’s office or at home under medical supervision and specific instructions.
Precautions and contra-indications of phototherapy.
Phototherapy is not indicated for children, adolescents and pregnant or breastfeeding females, unless there is not any other option.
The light treatment should be avoided in people having a medical history of allergy to sunlight, melanoma, squamous cell carcinoma, actinic keratosis, aphakia, arsenic intake, lupus erythematosus, porphyria and liver conditions.
Phototherapy should be avoided or postponed in patients that have had a recent ionizing radiation treatment, such as Grenz ray or undergone x-ray diagnostic procedures.
During phototherapy sessions, only the treated skin areas must be exposed to light. The rest of the body should be protected with cloths or very high SPF sunscreens. Sunglasses are absolutely necessary to prevent eye conditions, such as cataract. Especially in PUVA cases, the glasses must be used as soon as oral psoralen is taken and until twelve hours after this moment, since the agent tends to remain in the eye for a while. It is important the sun glasses to be absolutely ultra violet light absorbent and must be worn wherever the sun shines, including indoors. We have to bear in mind that the UVB can come through the window glasses and can cause problems to photosensitive eyes.
During a phototherapy course, sun bathing must be done with extreme caution and only after a physician’s advice. Otherwise, perhaps it would be safer to be avoided for a while.
Certain medications obtained with prescription or over-the-counter may increase skin photosensitivity and the risk for serious side-effects. Thus, if taken, they must be reported to the specialist prior to phototherapy. These agents include antiparasitics, diuretics, oral contraceptives, antidepressants, antihistamines, topical retinoids, nonsteroidal anti-inflammatory drugs (Ibuprofen), crud coal tar preparations or medications for treating cancer, hypoglycemia and high blood pressure.
A patient’s medical state should be monitored before and after a phototherapy course. In cases that more than 150 sessions have been carried out, an annual check up for skin cancer is strongly recommended.
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