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Dermatology
Ultraviolet Therapy
Built from Dermatology, 5th Edition
What’s inside
6 sections · 94 slides
Overview
- Five phototherapy modalities
- What phototherapy is
Phototherapy with UVB
History, mechanism, dosing, and disease-by-disease use
- Milestones in UVB history
- Electromagnetic spectrum and the UV region
- How UVB damages and protects skin cells
- Immune effects of UVB
- Why UVB clears psoriasis
- The 'action spectrum' is the range of UV wavelengths that actually clear psoriasis.
- Broadband UVB (BB-UVB) lamps emit a wide range of UVB wavelengths (Philips TL12).
- Natural sunlight as therapy (heliotherapy)
- Examples of national phototherapy guidelines
- Finding a patient's safe starting dose
- How exposure time is calculated
- Recommended MED phototesting doses for UVB sources
- Building up the UVB dose
- Dose-adjustment schedule for broadband and narrowband UVB
- Maintenance treatment after clearing
- UVB for psoriasis
- Combining UVB with other treatments
- UVB and modern biologic drugs for psoriasis
- UVB for early-stage mycosis fungoides (skin lymphoma)
- UVB versus PUVA for mycosis fungoides
- Vitiligo is patchy loss of skin pigment where melanocytes (pigment cells) stop working.
- Dosing UVB carefully in vitiligo
- New add-on therapies for vitiligo
- UVB for atopic dermatitis (eczema)
- UVB 'hardening' for sun-triggered rashes (photodermatoses)
- UVB for other inflammatory and itchy conditions
- Overdosed UVB can cause a 'target-like' ring pattern around psoriatic plaques.
- Long-term cancer risk of UVB
308 nm Excimer Laser or Lamp
Focused UVB for localised, resistant disease
- A focused UVB beam
- Where the excimer laser fits in
Phototherapy with UVA1
Deep-penetrating UVA for dermal disease
- UVA (320-400 nm) is arbitrarily split into UVA2 (320-340 nm) and UVA1 (340-400 nm).
- How UVA1 works in deeper skin disease
- UVA1 helps moderate-to-severe atopic dermatitis, especially acute flares.
- UVA1 for other conditions
- Side effects of UVA1
Photochemotherapy with Psoralens (PUVA)
A light-sensitising drug plus UVA - stronger, and more side effects
- What PUVA is
- Ancient roots to a modern therapy
- PUVA-responsive diseases
- PUVA-responsive diseases (continued)
- Psoralens are natural plant chemicals (furocoumarins); some versions are made synthetically.
- How the body handles oral psoralen
- Topical and bath delivery of psoralen
- How psoralen and UVA damage DNA
- Psoralen-DNA adducts and cross-links
- Beyond DNA cross-linking
- The peak wavelength for psoralen-driven redness is 330-335 nm, matching its antipsoriatic action.
- The PUVA skin reaction: redness and tanning
- PUVA pigmentation
- Oral PUVA dosing
- Skin phototypes and initial UVA dose for PUVA therapy
- Bath and topical PUVA
- Dose-adjustment schedule for oral and bath PUVA
- Clearing phase and maintenance phase
- Does maintenance therapy actually help?
- Nearly all types of psoriasis respond to PUVA, though severe pustular forms are harder.
- Combining PUVA with other drugs
- RePUVA: retinoids plus PUVA
- PUVA was first used successfully for mycosis fungoides (MF) in the 1970s.
- PUVA in advanced skin lymphoma
- PUVA for vitiligo
- Practical points for PUVA in vitiligo
- PUVA for other named conditions
- PUVA for less common conditions
- PUVA to prevent sun-triggered rashes
- Short-term side effects of PUVA
- Eyes and internal organs
- Repeated PUVA exposure ages the skin much like chronic sun damage (dermatoheliosis).
- PUVA and skin cancer risk
- Genital cancer and melanoma with PUVA
- Is bath PUVA safer long-term?
- UVB and PUVA in HIV-infected patients
Extracorporeal Photochemotherapy (Photopheresis)
Treating blood with psoralen and UVA outside the body
- What extracorporeal photochemotherapy (ECP) is
- Who responds best to ECP
- How the ECP procedure works
- Why ECP might work
- ECP side effects and other uses
- Choosing between the phototherapy options
- Key takeaways
- References
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- Dermatology, 5th Edition (2-Volume Set)