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What is UVB treatment?

B-band ultraviolet (UVB) phototherapy is the treatment of psoriasis by exposing the skin to ultraviolet light of a specific wavelength. UVB is found in natural sunlight, which is the most biologically active band of ultraviolet radiation and has the potential to cause sunburn. Artificially producing UVB through a phototherapy light box can be used to treat psoriasis.

UVB treatment needs to be guided by a doctor in the medical department. The UVB device used by the doctor can produce a strong therapeutic effect. UVB devices designed for medical use are often different from household devices. And it is different from the equipment in the sunbathing beauty salon (see "What is the difference between UVB and UVA?" at the end of this manual).

In this manual, the term "UVB" refers to the most common type of UVB phototherapy in the United States. There is another type of UVB treatment called "narrowband UVB"

You can ask NPF for the ��Home Phototherapy�� and ��Psoriasis and Daylight�� manuals to learn more about phototherapy.

l Who is suitable for UVB treatment?

UVB treatment can be used in adults and children. UVB can be used for at least two-thirds of patients with the following indications:

1. Thin plaques (reducing scale formation);

2. The condition is severe to severe;

3. Responsive to natural sunlight.

UVB can be considered when topical treatment is ineffective. It can be used alone or in combination with topical treatment (corticosteroids, eucalyptus, coal tar) or systemic drugs (oral retinal or methotrexate).

UVB is the standard treatment for moderate to severe psoriasis. Moderate to severe psoriasis can affect skin from anywhere from 2% to 100% of the body (the palm is roughly equivalent to 1% of the total body surface area).

UVB takes a considerable amount of time. Only when patients follow the appointment and follow the instructions can they get the best results. Like all therapies, UVB requires time and effort.

l How to treat UVB?

The patient is standing in a treatment light box with a special UVB lamp, or surrounded by one or more rows of lights. Some doctors have small devices for treating limited areas such as the palms and soles.

Patients are usually treated three times a week. It takes an average of 30 treatments to remove psoriasis lesions. The patient takes off his clothes and exposes all affected areas to ultraviolet light. But the following things need to be noted:

1. Protect the male reproductive (groin) area with cloth, paper or sports pads:

If the reproductive area is involved, the area is allowed to be exposed for short-term UVB. Other methods can also be used to treat psoriasis in the male genital area. Female genitalia does not require special protection.

2. Protect your eyes:

Goggles, gogglets and special sunglasses that cover the eyes and are designed to block UVB lines provide the best protection. When using ordinary sunglasses, some of the light can still reach the eyes.

l What is UVB treatment like?

The first light exposure is usually very short and lasts for as little as a few seconds. The exposure time depends on the type of skin of the patient (see Figure 1) and the intensity of light emitted by the bulb used. The lighter the skin color, the more sensitive it is to UVB. They started to expose less than dark-skinned people.

In general, the number of treatments should be gradually increased until the lesion begins to clear unless the final interval produces itchy and/or tender skin. Because UVB phototherapy is not able to make accurate quantification, the response of each patient is not fully predictable. The subsequent treatment plan should be appropriately adjusted according to the response of each patient.

 

Skin type

The six skin types recognized by the FDA and the American Academy of Dermatology:

Type I - skin that is always prone to burns, never sunburned, extremely sensitive to sunlight; red-haired, freckled, Celtic Irish-Scottish.

Type II - skin that is always prone to burns, can be slightly tanned, very sensitive to sunlight; white skin with white skin and blue eyes.

Type III - sometimes easy to burn, can gradually turn tan to brown; sun-sensitive skin, normal skin.

Type IV - can be slightly burned, always easy to tan and turn into light brown; mildly sensitive to sunlight, the skin type of the Mediterranean nation, white.

Type V - rarely burned, sun-dark, sun-sensitive skin; people in the Middle East, some Spaniards, some blacks.

Type VI - never burned, severely pigmented; skin that is not sensitive to sunlight, blacks.

 

Some treatments can be combined with UVB. Topical treatments such as eucalyptus and vitamin D3 derivatives (Dars, Dovonex) and vitamin A derivatives (Tazorac), in combination with UVB are effective in some patients. In addition, UVB can increase the response to UVB when used in combination with some systemic treatments including methotrexate and oral retinal (Avi A).

Many doctors use topical corticosteroids in combination with UVB, but there is evidence that topical steroids in combination with UVB may result in a shortened interval. Discuss with your doctor about the psoriasis condition and whether this combination therapy is appropriate.

The doctor should ask the patient to complete one or more of the following tasks before UVB treatment:

1. Tell the medical staff about the drugs you have used or are using, both topical and oral;

2. Soak in warm water for 30 minutes to remove psoriasis scales;

3. Use sunscreen to protect the skin in clean areas (such as the dark pigmentation areas of the back of the hands, neck, lips, nipples and breasts);

4. Cover the unaffected parts of the body, such as the face, with paper, cloth or sunscreen to avoid unnecessary light exposure;

5. Pre-use tar one night before treatment and rinse them off on the morning of treatment.

Some studies have shown that mineral oil or petroleum jelly is as effective as tar or eucalyptus when used in combination with UVB. Mineral oil or petroleum jelly is applied a thin layer before treatment to increase the ability of light to penetrate the skin.

Any other topical items that remain on the skin may block some or all of the UVB light, thereby reducing the effectiveness of the treatment. This is especially true for tar, salicylic acid and thick wetting agents.

l What is the efficacy of UVB?

If used correctly, UVB is usually very effective, and most patients can clear the skin lesions and get a noticeable improvement. In one study, lesions were completely cleared in more than 90% of patients. However, the key to achieving maximum efficacy is patient compliance: only get all appointments on time (usually at least three times a week) and follow the treatment guidelines to get the best results.

l What to do when the lesion is cleared?

Once the lesion is cleared, the treatment can be stopped. They can start again when the lesions recur. UVB treatment can sometimes be continued with maintenance. Studies have shown that UVB maintenance therapy can prolong the remission period. One study showed that maintenance therapy as low as every Saturday can be extended by at least six weeks. Most patients require maintenance treatment eight times a week to extend the remission period, but it varies from person to person.

When the psoriatic lesions recur, the patient may need to increase the number of treatments. Sometimes it can be replaced with other treatments. The altered treatment gives the skin a UVB intermittent period that reduces the side effects of long-term UVB exposure. And those who require prolonged exposure can reduce the number of treatments after a period of UVB.

Most maintenance treatments need to be done in the doctor's office, but for those patients who are inconvenient to see a doctor often, home UVB devices can be prescribed. NPF's "Home Phototherapy" manual describes the benefits and limitations of home treatments and lists the manufacturers of various home phototherapy devices. These devices range from desktop models to whole body treatment kits.

What are the side effects of UVB?

During treatment, psoriasis may be exacerbated before improvement is achieved. Due to UVB exposure, the skin may appear itching and redness. To avoid further irritation, the amount of UVB exposure should be reduced. Occasionally, a puncture episode of psoriasis may occur with an exposure that does not cause burns. These reactions can be eliminated by continued treatment with UVB.

If tar is used in combination with UVB, the pores of the skin may clog and a small sputum-like papule (folliculitis) may appear. These rashes are caused by improper use of tar. The use of tar should follow the direction of hair growth. Folliculitis does not persist, but occasionally it is necessary to stop using tar.

Natural light exposure should be avoided during UVB treatment. Excessive UV exposure can cause severe burns. It is recommended to wear clothes or use sunscreen. UVB cannot pass through the glass of the window.

l What are the long-term risks of UVB?

The long-term risks of UVB in sunlight include premature skin aging and skin cancer. UVB that is exposed to sunlight for a long period of time may also cause spots, loss of skin elasticity, and wrinkles. Some of these symptoms are partially reversible.

The exact risk of skin cancer due to long-term exposure to UVB treatment is unclear. UVB is a certain carcinogen (a substance or drug that produces cancer) to the human body, but long-term studies have shown little risk in UVB phototherapy. Some studies have shown that patients treated with UVB do not have an increased risk of developing skin cancer compared to the normal population. However, this treatment should still be used with caution to avoid other effects on the skin.

When assessing risk, it should be noted that if skin cancer can be detected early, it is generally easy to remove. It is important to have your doctor check your skin regularly.

Some doctors recommend using sunscreens on unaffected skin as a way to reduce UVB exposure. For example, the face is often exposed to a large amount of natural sunlight. If there is no psoriasis on the face, UVB exposure should be avoided. If there is widespread psoriasis, it is impractical to use sunscreens, but it is a useful precaution for moderate or localized skin lesions.

l symptoms of skin cancer

1. The skin's new organisms increase in volume and appear as pearl-like, translucent, tan, brown, black or multi-colored;

2. The color of the cockroach, birthmark or beauty is changed, the volume is increased or thickened, the texture is changed, and the outline is irregular.

3. A spot or new creature continues to itch, tingling, hardening, crusting, corrosion or bleeding;

4. An open ulcer or wound on the skin does not heal or lasts for more than four weeks, or recurs after healing.

If you have any of these symptoms, please go to the doctor right away.

l Goeckerman therapy

Some people need to recommend hospitalization or a day treatment program for their UVB and coal tar intensive treatment. Coal tar (a prescription tar) and UVB treatment are required daily for three to four weeks. This is called Goeckerman [Gek-er-man] therapy. Since the 1920s it has become the mainstream treatment for severe and difficult to control psoriasis.

Regardless of hospitalization or day treatment, Goeckerman therapy requires the use of natural tar on the skin. Excess tar is removed once or twice a day and the whole body is exposed to UVB. Then wash the bath or shower once to remove residual tar and scales and use new tar.

The therapy aids in the treatment of steroid drugs and keratolytic agents (drugs that remove thick scaly), especially in the early stages of treatment. In a modified Goeckerman therapy, a potent topical eucalyptus is used instead of tar (this is called Ingram therapy).

Although the degree of remission is different, it has been reported that the average remission period is six to twelve months. The remission time and relative safety of Goeckerman therapy is the main reason why it is often used to treat moderate to severe psoriasis.

Low-intensity tar and UVB treatments used in doctors' offices are often used as a modified Goeckerman therapy.

l Day treatment or hospitalization?

Sometimes psoriasis is too broad to be effectively treated in the doctor's office, but hospitalization is not necessary. The psoriasis day treatment program provides an intermediate solution. Patients who want to be included in a day treatment regimen must:

1. Being able to walk without help;

2. There are no health problems that may complicate treatment;

3. Be able to go to the treatment center every day for three to five weeks;

4. Go home at night and on weekends or go to other boarding houses.

There are a few psoriasis day treatments in the United States. The best way to get this option and service is to request NPF's Physician Resource Directory to find a doctor who can provide tar and UV treatment in your area.

However, even if a day-to-day treatment regimen is available, it is necessary for some people to have intensive inpatient (hospitalization) Goeckerman treatment. Sometimes the patient's mood needs medical control just like the physical condition. Resting on the bed and removing stress from everyday life are important complementary elements of hospitalized Goeckerman treatment.

l narrow band UVB

This type of UVB device is similar in many respects to a "wideband" UVB device, which has been used as a primary representative in this manual because it is more commonly used in the United States. The main difference between the broad band and the narrow band is that they emit different wavelengths of ultraviolet light; the concentrated band of narrow band units is considered to be the most therapeutic for psoriasis in the UVB spectrum.

Several studies have shown that narrow-band UVB can remove psoriasis more quickly and has a longer remission period than broadband UVB. It is effective to treat three times a week, and in some cases it is effective to increase the number of broadband UVBs. The narrow-band UVB has also been developed as an alternative to PUVA (light-sensitive drug psoralen plus UVA exposure). Although not as effective as PUVA, narrow-band UVB is more acceptable to people and seems to be less dangerous in the long run.

In Europe, narrow-band UVB is the most widely used type of phototherapy, but it remains to be seen by doctors in the United States. As doctors and patients learn more about its effectiveness, usage, and safety, and as device costs decrease, the use of narrow-band UVBs will gradually increase.

 

l UVB and UVA: What is the difference?

Many people ask about the difference between UVB (a type of light typically used for phototherapy) and ultraviolet A (UVA). Because UVA is used not only in doctor's offices, but also in commercial tanning salons, it has a natural curiosity about its possible role in treating skin diseases such as psoriasis.

UVA itself is not used as a routine treatment to remove psoriasis unless the patient uses a light-sensitive drug at the same time