Kernel Medical Sub-website : www.kerneluvb.com
phototherapy treatment introduction
Type:Uv phototherapy Time:2016-08-10 9:12:14Narrowband UVB - now considered the
gold standard of treatment for vitiligo covering more than 20% of the
body. Narrowband UVB (NB) uses the portion of the UVB spectrum from
311-312 nm. This region has been determined to help stimulate pigment
cells to produce melanocytes in less time than it takes to burn the
skin. Any kind of light therapy has a suppressive effect on the immune
system, so it can possibly stop new areas from forming as well. NB can
be done in the doctor's office with a full-body cabinet or, with a
doctor's prescription, from home using a full-length panel or a handheld
device. The handhelds are very convenient for small areas of vitiligo
but are too tedious and cumbersome to use for larger percentages as they
cover a very small area at a time. NB is sometimes used in combination
with other topical treatments, but is effective for many on its own. NB
can be used on children old enough to stand still and keep goggles on.
Results are often seen beginning between 30 and 60 treatments, and
treatment is usually given 3 times a week. Potential side effects of NB
include burning if used for too long. If using a full-body panel or box,
the normal skin may tan, increasing the contrast. Only full sized body
units provide the immune suppression needed for stabilization that may
halt further pigment loss, as the handheld units only treat isolated
areas. As long as the patient is old enough to understand that they must
keep their eyes closed at all times, and has an annual eye exam,
research has shown that it is safe to expose the eyelid to NB-UVB light.
The exception to this would be if a psoralen had been used.
PUVA - "Psoralen" plus "UVA" light. Formerly the gold standard of
treatment, PUVA has mostly been surpassed by NB-UVB as NB-UVB is at
least as effective and has fewer side effects. The psoralens are
typically taken orally, but can also be used topically. A UVA light box
or sun may be used to provide the light component. Melaginina that is
available in countries outside the US is a psoralen and must be used
with caution and under a doctor's care. Treatments are usually given 3
times per week. Side effects of PUVA include burning, stomach upset,
liver issues, and cataracts. To prevent the possibility of cataract
formation you must wear sunglasses, which protect your eyes against UVA,
for 12- 24 hours after taking the tablets. Sunglasses labeled UV
400/UVB/UVA protection 100% are recommended. PUVA is used less often in
children because of the risk of side effects.
Narrow-Band UVB Comparison - Narrow Band Ultra Violet B Light is a
relatively new technology on the vitiligo front. In the past, most
doctors have used the PUVA system, which involved the use of Ultra
Violet A light exposure and the taking of Psoralen pills. However, side
effects for many people were unbearable. Narrow Band UVB light panels
and cabinets solve the problems of over-exposure to ultraviolet by
maximizing delivery of narrow-band UVB radiation (in the 311-312
nanometer range, the most beneficial component of natural sunlight)
while minimizing exposure to superfluous UV radiation.
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 B 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 eliminates 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.
Excimer laser - A targeted NB machine typically using the 308 nm
portion of the spectrum. Laser can be very effective for smaller areas
of stable vitiligo. As it treats a small area, it is inefficient for
larger areas or percentages. Results from laser treatments frequently
occur more quickly than with other treatments. Because laser treatments
are expensive, it is typically only used on stable vitiligo because when
the vitiligo is active there is a greater chance of pigment being lost
afterwards. Hands and feet are often not treated with laser because it
is less effective there. Treatments are generally 2-3 times per week.
Potential side effects include burning.
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