Phototherapy Centers Q&A

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Category: Light For Hope

Published on Tuesday, 06 December 2011 09:32

Written by Super User

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1. What is Phototherapy?

Present in natural sunlight, UVB (Ultra Violet Bandwith) is an effective treatment for psoriasis. UVB penetrates the skin and slows the growth of affected skin cells. Treatment involves exposing the skin to an artificial UVB light source for a set length of time and on a regular schedule.  

Most past research conclude that narrow band Phototherapy should be the first-line of approach in children, adolescent and in adults with extensive moderate psoriasis involving small superficial plaques. It may also be used in pregnant or breastfeeding women and in patients with renal or hepatic insufficiency.

In addition, it is the preferable option for HIV-positive subjects. Narrow-spectrum UVB Phototherapy is an excellent alternative to PUVA therapy since concomitant psoralen is not required, there is less risk of a drug-induced photo sensitization, and there is no need for skin or ocular photo protection after sessions.

There are two types of UVB treatment, broad band (290-320 nm) and narrow band (311 -313 nm). The major difference between them is that narrow band UVB light bulbs release a smaller range of ultraviolet light. Narrow band UVB is similar to broad band UVB in many ways.

Several studies indicate that narrow band UVB clears psoriasis faster and produces longer remissions than broad band UVB. It also may be effective with fewer treatments per week than broad-band UVB. 

Therapy with UVB light in a dermatologists office at our centers or at home, is generally a very effective method for treating moderate to severe psoriasis.  

We use exclusively narrow band therapy and it has proven to be effective in these and other conditions:

Atopic dermatitis

Childhood Schamberg's disease 

Indolent Systemic Mastocytosis 

Lichen Planus 

Folliculitis

Pityriasis Rosea

Progressive Macular Hypomelanosis

Psoriasis

Solar urticaria

Vitiligo

 

2. Is Phototherapy Safe?

Ultraviolet light (UV) is one of the standard psoriasis treatments. 

Whether it comes from the sun or from UVB cabinets, it will, for the majority of psoriatics, have a good effect, as UVB suppresses the immune system in the first few layers of the skin as well as it helps create Vitamin D analogs.

However, certain risks do exist:

1. Patients that are photo-sensitivity cannot take this treatment.

2. Light therapy increases dryness in some patients and moisturizers should be used frequently.

3. Patients should be checked frequently, (twice a year) for early signs of skin damage.

4. Goggles should be worn to protect your eyes during treatment as to avoid cataracts and men need to shield their genitals to avoid an increased risk of genital cancer.

5. Some authors believe that while in the cubicle, it is essential to protect the face with a cloth  (except when the face shows lesions) Hönigsmann. 

This is especially true with seniors and all those with history of excessive sun exposure, prior cancerous condition or thin skin. 

Phototherapy is a serious treatment and UV radiations of all kinds will definitely make an existing pre-cancerous and cancerous condition much worst.

3. Is Phototherapy Effective?

Traditional broad band UVB radiation has been used for the treatment of Psoriasis for more than 75 years. In recent years Phototherapy has maintained its important role in the treatment of Psoriasis, either as monotherapy or in combination with topical or systemic agents.

Recent research has confirmed that clinical improvement of psoriasis by NB-UVB is linked to the suppression of Th17 and type I and type II IFN signaling pathways, which are critical in the pathogenesis of this disease. * (Effective Treatment of Psoriasis with Narrow-Band UVB Phototherapy Is Linked to Suppression of the IFN and Th17 Pathways)

In recent studies NB-UVB treated epidermis, several Psoriasis related molecules were significantly modified, such as p53, FABP5, miR-21 and miR-125b, however there TAp63 nor Np63 were significantly affected. *(Effect of Narrow-band Ultraviolet B Phototherapy on p63 and MicroRNA (miR-21 and miR-125b) Expression in Psoriatic Epidermis)

Early studies demonstrated the efficacy of BB-UVB monotherapy in psoriasis. One study reported resolution of psoriasis in 20 of 28 patients treated with erythemogenic doses of home-based UVB therapy whereas another study demonstrated efficacy in 18 of 20 patients treated with 3 times weekly outpatient UVB phototherapy with concomitant white petrolatum. 

Similar observations were made by Levine and Parrish when white petrolatum was combined with UV. Remission times were prolonged using maintenance therapy.  For more information on the effectiveness of Phototherapy visit the Phototherapy and the video area of our foundation website.

4. How Does Phototherapy Works?

UVB inhibits DNA synthesis, which may, in turn, inhibit the overgrowth of skin cells seen in psoriasis plaques.  It also promotes the self-destruction of T-lymphocytes, the immune cells that gather in psoriasis plaques and trigger the process of inflammation. 

UVB increases cellular production of several substances that reduce inflammation.  The combination of these mechanisms may explain how UVB exposure controls psoriasis.

5. How Long Treatment Last?

More than anything the length of the treatment depends on the individual. There are a multitude of factors that influence this; such as genetics, skin type, age, prior sun exposure, actual occupation, severity of the disease, etc., etc.

But in general clearance can take a while. Most patients need 12 to 18 treatments to see a 50% reduction in psoriasis severity, which corresponds to 4 -7 weeks if following the typical three times per week treatment schedule.

6. Can My Condition Worsen?

During UVB treatment, and in few individuals (less than 10%) your Psoriasis may worsen temporarily before improving. The skin may redden and itch from exposure to the UVB light. 

To avoid further irritation, the amount of UVB administered may need to be reduced. Occasionally and in certain individuals temporary flares will occur when receiving low-level doses of UVB. These reactions tend to resolve with continued treatment.

7. How Can I Try Phototherapy?

If you are suffering from psoriasis you need to come by one of the phototherapy treatment center (PTC) near your area in order to register. Visit our PTCs section of our Foundation Website for locations. Keep in mind that you will have to travel that distance, depending on your condition, at least 3 times per week and for at least 14 weeks.

You may also register on our website to visit the dermatologist in your area. You will be notified of your appointment day and time by e-mail.

Before patients undertake light treatment, a complete body skin examination is done by a local dermatologist to evaluate the outspread the type and the severity of your Psoriasis. 

Emphasis during the exam will be to determine the existence of any preexisting pre-cancerous (actinic keratosis) or skin cancers that will make light treatment dangerous to your health.

Freezing or liquid nitrogen cryosurgery will be undertake for any discovered pre-cancerous condition, and skin biopsies may be performed for any suspected skin cancers. 

If basal cell carcinoma, squamous cell carcinoma, or melanoma is confirmed, you will be referred for surgical treatment before initiation of the Phototherapy for Psoriasis.

Because sometimes pre-cancerous lesions or superficial skin cancers are hidden within the psoriasis plaque, and these are later revealed when the psoriasis lesions disappear, a follow up skin cancer check is done every six months while monitoring the responsiveness of the psoriasis lesions to the ultraviolet light.

Your physician will make the determination if you have psoriasis or any other condition that will benefit by Phototherapy.

If he or she determines that you are a candidate for Phototherapy you will be given a  prescription to bring to us.

8. Is a Prescription Required?

Absolutely.

Phototherapy remains an essential option for patients with moderate to severe Psoriasis or when topical measures alone are insufficient but your dermatologist is the only that can asserted if you are suffering from psoriasis and if so, what type.

The action mechanism of Phototherapy is through anti-proliferative, antiinflammatory and immunosuppressant activity. 

Different forms of psoriasis may be treated with this method, but the best indication is for moderate to severe psoriasis, with predominance of fine plaques. UVB radiation is highly effective also for the treatment of plaque and guttate psoriasis.

Patients with pustular or erythrodermic psoriasis should not be submitted to Phototherapy or even long sun exposure, owing to the risk of worsening and vasodilation.

Before beginning treatment, all patients are evaluated to determine the maximum amount of light they can tolerate without developing erythema, or reddening of the skin (the Minimal Erythema Dose (MED). 

Ultra Violet rays are burning rays and UV lights narrow band or otherwise can burn your skin when improperly applied.  Receiving UV rays without eye protection can cause severe conjunctivitis. 

Proper therapy with UVB requires slowly incremental doses to maintain the exposure just below the point of causing a burn. 

Patients that have health insurance that covers light treatments for your condition will be required a Phototherapy prescription from their dermatologist even when the insurance provider is an sponsor of the Light for Hope Foundation ®.

Patients that are uninsured will be referred to the Light for Hope ® preferred dermatologist and after a complete dermatological exam a Phototherapy prescription will be issued.

9. How Much Will This Initial Doctor Visit Cost Me?

Examinations are provided free of charge for all uninsured, and those underinsured (insurance that do not cover a dermatologist visit) as well as for all Medicaid patients.

If you have health insurance coverage, visit a dermatologist in your area that is affiliated with your insurance plan. Inform your doctor that you are about to begin Phototherapy with us and that you need a prescription for it.

f you feel you need a dermatologist with experience in Phototherapy, we will be happy to recommend one in your area. 

10. Are Treatments Free?

Phototherapy treatments at Light for Hope® centers are completely free for those patients uninsured as well as Medicaid patients. Proof of income is required. 

Patients insured with Insurance companies that serve as sponsors of The Light for Hope Foundation® also qualify for free Phototherapy treatments. 

Insured patients are also able to receive treatments at Light for Hope® centers without required insurance co-payment (deductible).  If your insurance company is not an sponsor of the Light for Hope® Centers or you are a Medicare recipient, we will bill your insurance for you.

Patients time, volunteering services or monetary donations are always welcome.

11. Will UV Lights Affect My Skin?

UVB phototherapy may produce a reaction similar to natural sunlight. The area treated may tan due to the absorbed UVB wavelengths just as your skin would tan with the sunlight. You will also experience skin Photosensitivity and will be recommended a limited exposure to natural sunlight following treatments.

The most common side effect of UVB therapy is erythema, a sometimes painful reddening of the skin similar to sunburn. 

The dosage of UVB that causes erythema varies from patient to patient. Determination of an acceptable UVB dose on an individual basis helps to minimize this side effect.

12. Will I get Skin Cancer?

We do not know, but if you do it will not be because of the light treatment. Phototherapy has been shown to be extremely safe and effective in controlling psoriasis. You and your dermatologist will need to discuss how to use UVB light to keep your skin and/or scalp in remission with minimal side effects. 

Several studies have shown that people who receive broad band UV Phototherapy have not demonstrated an increased rate of skin cancer when compared to the general population. 

A 2009 paper "Treatments for psoriasis and the risk of malignancy by Rita V. Patel, DA, Lily N. Clark, MD, Mark Lebwohl, MD, and Jeffrey M Weinberg, MD" stated: Review of studies on UVB, both narrow band and Broad band, do not indicate any increased risk of non-melanoma skin cancer or melanoma.

For the latest research in Phototherapy visit our Phototherapy Research areas of this website.

13. When Can I Begin?

As soon as you have a prescription you can make an appointment for your first visit.

During this first visit you will also be provided with a tentative schedule in accordance with your prescription. You will receive instructions in the operation of the light cabin that you will be using as to meet your prescribed requirements.

Treatment will begins at a lower exposure (50% MED, for example), and the exposure will be gradually raised.  

In your first visit we will also verify your lack of insurance or underinsured situation or your Medicaid status.  

14. What If I Only Have Scalp Psoriasis?

No problem, we also have available in our centers hands, feet and scalp UV narrow-band units.

15. What Do I Need To Prepare For Treatment?

If you suffer from plaque Psoriasis we recommend that you remove as much psoriatic scale as possible before UVB light treatment. The removal of loose, excess scales through gentle washing permits increased penetration of the UVB light during your treatment.  In order to accomplish this a gentle washing the affected area with salicylic acid shampoos is recommended.

Research has shown that to improve UVB light transmission, fragrance-free mineral oil should be applied to the affected area prior to treatment. One should avoid oil with fragrance or additional compounds as they will partially absorb UVB light.

16. How Does Lights Compare With Biologics?

Phototherapy typically requires 20 to 25 sessions to clear a psoriatic condition with long term remission in most cases for 80% of patients.  

On the other hand, the best Biologics achieve 75% PASI score clearance in 68% of patients but in average all Biologics produce 75% PASI score clearance in only 43% of patients.

The percentages favor phototherapy but if you don't mind injecting yourself the convinience is for Biologics hands down. But there is also the cost. Biologics course of therapy every 12 months may be as high as $20K.

Biologics after a prolonged treatment (1-2 years) in as much as 30% of patients create antibodies making necessary the switch to similar Biologic. Some times (in 3% patients) antibodies are produced as early as 4 to 6 months.

Biologics present a limited Safety Record when compared with 75 years use of Phototherapy. Narrow band UVB lamps have been available in Europe since 1988 and with the proper use and light exposure; they have shown minimal side effects.

Some Biologics commonly use in the treatment of Psoriasis in order of FDA approval are; Alefacept,  Efalizumab, Etanercept, Infliximab, Adalimumab, Ustekinumab.

Biologics suppresses part of your Immune System and is well known that immunosuppressive agents have the potential to increase the risk of malignancy.  Danger that increases with long-term administration.

The following conditions may develop with use of Biologic therapies: Pharyngitis, dizziness, increased cough, nausea, pruritus, myalgia, chills, injection site pain, injection site inflammation,  fever, nausea and muscle aches, back pain, joint pain and swelling of the arms and legs (peripheral edema). Rare cases of TB have been observed.

However thousands of patients with various diseases are finding that the Biologics are the right alternative for them.  As new Biologics are develop and alternation of them become more and more researched, the number of patients will continue to increase. 

And a last point. Many researchers are looking at the two therapies working together and it is looking extremely good.

17. What If Lights Do Not Work For Me?

It could happen.  Phototherapy at least as far as Psoriasis is concerned only work for approximately 80% of the patients and it will be highly effective for about 68% of users.

If you are one of those for which Phototherapy is ineffective we will work with you, your dermatologist and our sponsors to look for an effective treatment that helps you with the disease.

Again, if you are uninsured and with low income, we will do our level best, working with our sponsors and donors to provide you with free medication.

One thing is for sure. If you usually get better from your Psoriasis in the summer and if you drive (in the US) and your left arm is less affected by psoriasis than the right one or If you get better when at the beach, then chances are that Phototherapy is right for you.