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Ultraviolet Light Phototherapy – Narrow Band UVB

This is a form of therapy that is primarily used for psoriasis.  It is also used for some forms of eczema-dermatitis and other, less common skin diseases.  It entails the use of one wavelength of UVB which is the major ultraviolet constituent of natural sunlight. This particular machine has been engineered to minimise the burning UVB. A computer is installed that keeps a record of your individual treatment.

How does it work?

This is not entirely clear, but is based on the fact that round 90% of psoriatics improve with natural sunlight and many patients with eczema-dermatitis and other conditions also do well in summer. It is generally combined with the use of creams, as the action of the two combine to give a more rapid effect.

What are the relative contra-indications to UVB?

  1. Previous skin cancer or melanoma
  2. Very fair skin, which burns with only minimal sun exposure
  3. Small children
  4. Medical problems which increase the susceptibility to sunburn – eg. Lupus
  5. Claustrophobia
  6. Some medications used to treat other medical problems may increase the risk of burning, for example sulphonamide, retinoids, tricyclic antidepressants, some antihistamines, thiazide diuretics, antibiotics and other drugs. We may need to modify the drug or the UVL treatment. You must tell the doctor/nurse of all your medications and every time these medications change.

What is involved in this treatment?

The treatments are given at a minimum of 3 times per week and involve standing in a light cabinet which gives out a measured and controlled dose of narrow band UVB. Each time you receive a treatment the amount of UVB is increased, thus the length of time you spend in the machine also increases.

What special precautions need to be taken during treatment?

It is essential to limit sun exposure whilst on treatment. Prolonged sun bathing or solarium use should be avoided.

It is most important that goggles or a full face mask are worn to protect the eyes.

Males should keep their genitals covered.

Sunscreen to:

– Nipples – put exactly on the nipple/areola as directed, not on your normal skin in this area.
– Back of hands – use sunscreen or white cotton gloves once this area has cleared.

AREAS WHICH ARE NOT INVOLVED SHOULD BE COVERED IF PRACTICAL

If you are asked to wear shirt, shorts or underwear, then the identical item of clothing should be worn each treatment. Any difference in the cut or shape of a piece of clothing will often result in a blistering burn in the area.  (eg changing the cut/shape of underwear).

No perfumed products (eg cologne, aftershave, perfume) to be worn.

What additional therapy is required?

Generally UVB is combined with other topical treatment – usually tar creams, or Dithranol in psoriasis. Other treatments may also be safely combined with UVB although it is best not to apply cream immediately before treatment.

How long does treatment need to continue for?

Until the rash has virtually cleared. This usually takes 20-30 treatments, but sometimes may take longer.

What if it doesn’t work?

The success rate with UVB is 50-90%. However, if problems arise, other forms of treatment are available.

What are the side-effects of treatment?

  1. The commonest side effect is sunburn. You must tell the nurse whether you have been burnt or even if you developed any redness following the last treatment. You will become tanned with treatment. It is very important that you limit sun exposure during the period that you are being treated. It is quite common for the skin to get red and occasionally painful after treatment.  Rarely blisters can occur. If the skin becomes red, often the rash will clear faster and fewer treatments will be necessary.
  2. The rash may rarely worsen with this treatment. This can result from a burn with treatment or unpredictable photosensitivity.
  3. A review of the medical literature showed no increased skin cancer risk with UVB phototherapy. Short term treatments do not seem to entail any more sunlight hazard than a similar amount of sun exposure.

WHEN BEING TREATED

    1. Don’t engage in prolonged sun-bathing or have treatments at solariums.
    2. Don’t take any new medications, vitamins or health food extracts without discussing this with your doctor.
    3. Do mention any reactions.  eg.  redness, sunburn.
    4. You must attend regularly.  Sporadic attendance increases the risk of burning and reduces the effectiveness of the treatment.
    5. BE AWARE OF HOW LONG EACH TREATMENT SHOULD LAST.  If you are concerned that you have been in the “UVB Treatment Unit” for too long, open the door to stop the treatment and ask the therapist.
    6. If you feel anxious or too hot, push the door open, leave the booth until you feel better. When you return to the booth and shut the door, the treatment will continue. It will not start all over again.
    7. TREATMENTS MUST BE A MINIMUM OF 24 HOURS APART. (ie) Cannot come Monday afternoon and then Tuesday morning. If treatment Monday afternoon then Tuesday’s treatment must also be in the afternoon.
    8. FOLLOW UP APPOINTMENTS MUST BE ATTENDED EVERY SIX WEEKS WITH YOUR DERMATOLOGIST OR YOUR UVB TREATMENT MAY BE DISCONTINUED.
    9. We are unable to take responsibility for children during a parents UVB treatment. We would appreciate it if arrangements could be made for younger children’s supervision during your treatment.

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Drummoyne Dermatology is a long established and well regarded dynamic dermatology centre which has provided state-of-the-art dermatology care in Sydney for over a decade. Our expertise is in the early detection and treatment of skin cancer and in the accurate diagnosis and optimal management of other diseases of the skin.
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