The World of UV Phototherapy

The full article publication is entitled “Efficacy of narrowband UVB vs. PUVA in patients with early-stage mycosis fungoides.” prepared by Ponte P, Serrão V, Apetato M. at the Department of Dermatology, Hospital dos Capuchos, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.

Abstract:

The article concludes “Besides topical and systemic therapy, UVA1 radiation is a good option of treatment in various skin diseases. It is one of the first-line treatments for several sclerotic diseases and it often improves pruritus considerably.”

I came across this study during an internet search when a customer called me about the use of UVA1. I have to admit I was surprise by the fact that the use of UVA1 has shown some good results with atopic eczema, scleroderma and other challenges.

The authors say

One of the realities we live with at Amjo is that many derms look at UV Phototherapy as a last resort. The typical derm would prefer to prescribe biologics and other ointments and salves, many of which expose the patient to higher risks than UVB Narrowband Phototherapy. The article below is one of the few that I’ve come across recommending UV Phototherapy.

The American Academy of Dermatology’s latest guidelines on the management of psoriasis and psoriatic arthritis focus on phototherapy.

Despite therapeutic advances in recent years, phototherapy remains an important treatment option for patients with psoriasis, according to Dr. Alan Menter, chairman of the division of dermatology at Baylor University Medical Center in Dallas, and his associates.

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Dr. James Nordlund

Today I was reading the Winter Newsletter from Vitiligo Support International and one of the articles was edited and vetted by Dr. James Nordlund here in Cincinnati.

An often-expressed concern of both vitiligo patients and dermatologists is whether having vitiligo increases one’s risk for non-melanoma and/or melanoma skin cancer and if ultraviolet light therapy is a safe treatment. Though there are limited, but growing data, on this subject, key observations have been made which can help both the individual with vitiligo and dermatologist to better assess this risk. To effectively address the question, the information has been separated into these categories.

• Do vitiligo patients in general have an increased incidence of skin cancer?
• Do vitiligo patients have an increased risk of non melanoma skin cancer (NMSC) in their depigmented lesions?
• Do vitiligo patients have an increased risk of melanoma and/or NMSC in their “normal” skin?

Melanin is the substance that gives the skin its color, with darker skin having higher melanin levels. Melanin acts as a sunscreen and protects the skin from ultraviolet light which helps prevent sunburn damage that could result in DNA changes and, subsequently, melanoma. The assumption by many has been that that because the depigmented skin affected by vitiligo has no melanin, that the patient would be more susceptible to some types of skin cancer.

Because there are no melanocytes in depigmented skin, it would be biologically impossible to develop in depigmented skin a melanoma the most serious type of skin cancer. The other forms, the so called basal epithelioma, could develop but are easily treated and are not life threatening.

Unfortunately there are no great statistical studies on cancer in vitiligo. However most research and/or observations indicate that while non melanoma skin cancers do occur in vitiligo patients, they are very rare and melanomas in the normal skin occur at most, in no greater incidence than within the normal population.
An interesting observation on this subject was reported in the book Vitiligo: A Monograph on the Basic and Clinical Science, by Seung-Kyung Hann and James J. Nordlund. Dr. Nordlund observed that in East African countries near the equator, where few work indoors and sunscreen is unavailable, that people with vitiligo not only do not appear to get skin cancer, they exhibit little sun damage to their skin. Other studies also agree that vitiligo patients generally do not demonstrate sun-induced skin damage, despite the lack of protective melanin in the skin.

Ultraviolet light, both natural sunlight and artificial light in PUVA, Excimer laser and narrowband UVB, is an important therapeutic tool for vitiligo. To date, most studies agree that light used in accordance with a supervised treatment plan is a safe, effective method for treating vitiligo. More long term studies will be needed to further assess any skin cancer risk from these treatments.

VSI would like to thank Dr. James J. Nordlund, Professor of Dermatology, Group Health Associates, Cincinnati, OH and Wright State School of Medicine, for his significant contributions to, and medical review of this article.

This is from an article written by Damian McNamara of Skin and Allergy News in an article published in February of 2008.

TORONTO — Narrowband ultraviolet B treatment is effective for repigmentation of vitiligo lesions, according to ratings from 50 patients and their physicians. The technique was particularly successful for lesions on the face and body and less helpful on the hands and feet.

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As I wander around the internet, from time to time I find articles that I hope my readers find of some value. This article from the December 2009 issue of Skin and Allergy News is one of the first articles I have come across linking Vitamin D production with UVB Narrow Band. This article was written by Bruce Jancin.

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UVB NB Systems are available from off-shore vendors in Israel, Europe and Australia.

I do recommend that you be very cautious for several reasons:

The offshore vendor may be (usually is) offering product(s) that are not approved for use or sale in the USA.

• Products from these vendors are sometimes stopped by US Customs and or the FDA and are typically rejected and you are out of cash!
  • If there are are any warranty issues, returning products for testing/repair can be very very expensive!
• If there are any legal issues then dealing with foreign vendors can be a problem.
• If you are foolhardy enough to purchase overseas then always use a credit card so that if necessary you can try to get any payment or part of a payment reversed by your credit card company.
• Some of these companies say “No Prescription Needed” - This should be a red-flag to you! All UV Ultraviolet systems require a prescription in the USA. If you purchase a non-FDA certified product then you may be in breech of sevreal laws.
• Just because the lamps used are possibly FDA Certified, this does not mean that the system or final product is.
• Check the voltage and frequency. Here in the USA we use 115V 60 Hz. A lot of offshore products operate at 220V/50Hz

There are several vendors/manufacturers here in the USA and we all sell devices that are 510K Certified by the FDA.

Home UVB phototherapy for Psoriasis
Alex Anstey - professor - Royal Gwent Hospital, Newport NP20 2UB - alex.anstey@gwent.wales.nhs.uk - Research, doi:10.1136/bmj.b1542

Is as safe and effective as outpatient treatment, but provision is poor. Psoriasis is a common chronic inflammatory skin condition that causes substantial disability in affected people and their families. In the linked randomised controlled trial (doi:10.1136/bmj.b1542), Koek and colleagues assess whether home ultraviolet B (UVB) phototherapy is as safe and effective for psoriasis as conventional UVB phototherapy given in the outpatient department.

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TITLE: A randomized controlled study of low-dose UVA1, medium-dose UVA1, and narrowband UVB phototherapy in the treatment of localized scleroderma.
Kreuter A, Hyun J, Stücker M, Sommer A, Altmeyer P, Gambichler T.

Department of Dermatology and Allergology, Ruhr-University Bochum, Bochum, Germany.

BACKGROUND: In previous trials, UV therapy has been demonstrated to be effective in the treatment of localized scleroderma (LS). To date, a randomized comparison study to evaluate the efficacy and safety of different, commonly used phototherapeutic modalities in LS is still outstanding.

OBJECTIVE: The aim of this study was to compare the safety and efficacy of

• low-dose (LD) UVA1,
• medium-dose (MD) UVA1, and
• narrowband (NB) UVB phototherapy in the treatment of LS.

METHODS: Sixty four patients with LS were consecutively included in a prospective, open, randomized controlled 3-arm study. Severity of LS was determined by means of a clinical score, and clinical improvement was also monitored by histopathologic analysis and 20-MHz ultrasound.

RESULTS: A total of 27 patients were treated with LD UVA1 (20 J/cm2), 18 patients received MD UVA1 (50 J/cm2), and 19 patients were treated with NB UVB dependent on their skin type. Phototherapy was performed 5 times weekly for 8 weeks. Two of the 64 patients included in this trial discontinued therapy. Skin status significantly improved in all patients who finished the treatment protocol, resulting in a reduction of the clinical score in all groups (LD UVA1, 7.6-5.0 [P < .001, 95% confidence interval 1.6-3.4]; MD UVA1, 11.1-6.6 [P < .001, 95% confidence interval 2.5-6.2]; NB UVB, 7.3-4.9 [P < .001, 95% confidence interval 1.6-3.2]). The reduction of the score was accompanied by an improvement of the visual analog scale for itching and tightness, histologic score, and 20-MHz ultrasound. MD UVA1 was significantly more effective than NB UVB (P < .05). There were no significant differences between LD UVA1 and NB UVB and the former and MD UVA1 (P > .05).

LIMITATIONS: We had a relatively small study sample and nonblinded assessment of primary outcome.

CONCLUSION: Phototherapy, as previously reported in several noncontrolled trials, is an effective therapeutic option in LS, with a favorable risk/benefit ratio. UVA1 phototherapy should be considered among the first approaches in the management of LS.

Link to PubMed Article:  << Click Here >>

NOTE: Amjo does offer UVA-1 Products at www.HomePhotoTherapy.com

An older study (2003) highlights UVA-1 (340-400 nm) Ultraviolet Therapy.

The original work was completed by Dawe RS. at the: Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. r.s.dawe@dundee.ac.uk

Long-wavelength ultraviolet A (340-400 nm; UVA1) therapy is currently available in only a few dermatology departments. Equipment capable of delivering this waveband has been available since 1981, but it is only over the past decade that increasing numbers of studies assessing the potential of this as a therapy have been published. High-dose UVA1, which requires expensive and space-occupying apparatus, is effective as a monotherapy for acute flares of atopic dermatitis, but it has not yet been formally assessed as an adjunct, rather than as an alternative to conventional therapies including potent and very potent topical corticosteroids. Low-dose (which can be administered using a standard phototherapy cubicle fitted with appropriate lamps) and medium-dose UVA1 may be less effective for this indication. Another condition for which UVA1 is effective, and is particularly promising because we have no reliably effective treatment already, is localized scleroderma. It also appears to be effective in systemic lupus erythematosus (although it is not yet clear when it is indicated, and its safety needs to be assessed in more patients) and in polymorphic light eruption (although there have been no studies suggesting that UVA1 will have any advantages over standard prophylactic phototherapies). Open studies and case series suggest that UVA1 may prove beneficial for various other diseases, including cutaneous T-cell lymphoma, lichen sclerosus, keloids, systemic sclerosis and hand dermatitis. In the centres where it is available, UVA1 has already proved a useful addition to the range of phototherapies previously available. However, much more research is needed to confirm its efficacy for many of its potential indications, and to determine when and how it should be used.

Original Article << Click Here >>