Phototherapy home ultra violet UV treatment

Is UV in phototherapy Carcinogenic?

Ben Lebwohl, Harvard College, and John Y. M. Koo, M.D. University of California phototherapy Ultraviolet light B, which is recognized as a carcinogen (a cancer-causing agent) in sunlight, consists of wavelengths similar to those administered in UVB phototherapy. Does UVB treatment increase one's risk of developing malignant melanoma or other skin cancers?

"The answer appears to be no"

phototherapy studies performed over the last two decades have consistently shown that the incidence of skin cancer in patients receiving UVB phototherapy is not increased above the incidence in the general population. These findings include the investigation of UVB treatment alone, in addition to UVB supplemented by another known carcinogen, topical coal tar, in the Goeckerman regimen (a day-treatment program in which patients receive tar and light treatments).

Goeckerman patients studied in one of the most comprehensive studies of this subject, Mark Pittelkow, M.D., and co-authors at the Mayo Clinic retrospectively reviewed 280 psoriasis patients in a 25-year follow-up. All of the patients had been hospitalized and treated with crude coal tar and ultraviolet light. The incidence of skin cancer in those patients was not increased over the expected incidence.

In a second study of skin cancers in patients with atopic dermatitis who were treated with Goeckerman regimen, Willard Maughan and co-authors completed a 25-year follow-up study of 426 patients and again found no significant increase in the incidence of skin cancer.

Results surprising.

These results are surprising, considering the established carcinogenic properties of UVB light found in natural sun light. Yet study after study has consistently proven that UVB treatment does not pose as much risk as PUVA (psoralen plus ultraviolet light A).

At 1982 a study was set out to determine the carcinogenic risks of UVB by studying 85 psoriasis patients who had received more than 100 UVB treatments over a long period of time. This population was compared to a control group with regard to precancerous and cancerous skin lesions. While the percentage of these lesions in the control population was 10.1%. in the UVB-treated psoriasis patients it was 5.9%.

Because of studies such as these, some investigators at the time even suggested that patients with psoriasis carried a lower risk of developing skin cancer, thought this has not proven to be true, especially in light of the recent long-term PUVA study conducted by Robert Stern, M.D., of Harvard Medical School (see "Long-term PUVA study emphasizes need for regular skin examinations," May/June 1997 Bulletin Dr. Stern's investigation linking PUVA treatments to squamous cell carcinoma also demonstrated that long-term UVB treatment poses minimal risk of skin cancer except in male genitalia. It is because of this increased risk male genitals are shielded during standard phototherapy treatment.

Sunburn is worse.

The surprisingly low carcinogenic risk associated with UVB phototherapy is not completely understood, but can be explained in terms of low amounts of UVB dosage involved in typical phototherapy.

Even an aggressive phototherapy regimen subjects patients to much lower UVB than a bad, blistering sunburn. Moreover, it is possible that low dosage UVB treatments that are gradually increased result in a thickening of the outermost layer of skin that might play a protective role against skin cancer as it does in sunburn.

phototherapy units have very little output in the wavelength attributed to UVB-induced cancer. It is possible that the ratio of therapeutic UVB to carcinogenic UVB is more favourable in phototherapy units than in sunlight.

Saving face.

Finally, it is well known that psoriasis tends to spare the face. Therefore, it is common practice in phototherapy to routinely shield the faces of patients with no facial lesions. Since skin cancer risk is greatest on the face because of lifetime cumulative sun exposure, it is possible that UVB to the parts of the body that are usually protected from sunlight such as the elbows, knees, and lower back may never get the total exposure the face receives. This also may account for the fact that no increase in skin cancer of any type has been attributed to UVB for psoriasis.

UVB remains one of the safest effective psoriasis treatments currently available.

Units Treat psoriasis at Home. Australian Doctor Magazine June 2003. Home-use UVB light units are a new option for patients with psoriasis who find regular hospital or specialist clinic visits inconvenient. The narrow-band UVB units - some as small as a hairdryer - can be bought or rented, saving patients from travelling long distances for treatment at major centres.

Nick Balgowan, whose company supplies such units in Australia, said the problem with UV treatment was that most patients needed it every day or 4-5 times a week, and even if the fee for treatment in hospitals or specialist clinics was covered by Medicare, there was a significant extra cost in terms of travel and time.

Leading dermatologist Dr Chris Baker, from Melbourne's St. Vincent's Hospital, said narrow-band UVB treatment used only a fraction of the UVB spectrum, corresponding to the most "biologically effective" wavelengths for treating psoriasis. Dr. Baker said this could reduce the risk of side effects such as sunburn. UVB had the added advantage of not requiring patients to take psoralen tablets (with known side effects,) unlike UVA phototherapy.

"The trend in recent years has been that narrow-band UVB is the first phototherapy that we use," Dr Baker said. Mr Balgowan said the units, which were available globally from www.beatpsoriasis.com come in a range of sizes.

psoriasis. An article in the August 1999 issue of The Chronicle of Skin Disease reports that it takes fewer treatments to clear psoriasis vulgaris with Narrow Band UVB than it does with conventional broadband UVB and that there is no statistically significant difference between the two lamps regarding photo toxicity. These results were reported by Dr. Lori Hobbs, clinical research fellow in Dermatology at Vancouver General Hospital, at the 74th annual meeting of the Canadian Dermatology Association in Vancouver.

psoriasis. Dr. Adrian Tanew of the Division of Special and Environmental Dermatology at the University of Vienna (Austria) found that Narrow Band UVB is nearly as effective as PUVA in treating plaque-type psoriasis. Reported in the Archives of Dermatology 135[5]:519-24, 1999, he states, "Our data demonstrate that in many patients, in particular those with moderate or moderate to severe psoriasis, narrow-band UVB is comparably as effective as PUVA, whereas in the more severely affected, PUVA is superior."

psoriasis. Dr. Henry W. Lim, chairman of dermatology at the Henry Ford Hospital in Detroit reported that "Narrow-band ultraviolet B light may carry no greater carcinogenic risk than broad-band UVB when used to treat psoriasis." "Animal studies have determined that narrow-band UVB is two to three times more carcinogenic per minimal erythemal dose (MED) than its broad-band counterpart. When compared with broad-band UVB, however, less MED-equivalents of narrow-band UVB are needed to clear psoriasis in humans." These remarks were made at the annual colloquium on clinical dermatology (sponsored by the Dermatology Foundation) and reported in the July 1998 issue of Skin & Allergy News.

psoriasis. photodermatol photoimmunol photomed: 1999:15:81-84 Charles L.G. Halasz, Department of Dermatology, College of physicians & Surgeons of Columbia University, New York, NY. "In summary, using a conservative fixed increment regimen, clearing of psoriasis is possible while minimizing the risk of serious erythema. It is the author s opinion that, compared to traditional broadband phototherapy, narrowband phototherapy leads to earlier clinical improvement resulting in enhanced compliance with treatment and lower drop-out rates."

psoriasis. Journal of the American Academy of Dermatology, 1999;40:893-900. In an article entitled "Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris", Dr. Ian B. Walters and others of the Laboratory for Investigative Dermatology, The Rockefeller University, reported that eleven patients were treated using a split-body approach for 6 weeks on a three-times-a week basis. Using suberythemal doses of narrow-band UVB, they were able to induce clinical clearing in 81.8% of patients after NB-UVB, but in only 9.1% of patients after BB-UVB. They concluded that NB-UVB is superior to UVB-BB in reversing psoriasis at suberythemogenic doses when given three times per week.

psoriasis. Archives of Dermatology, 1997;133:1514-1522. In an article entitled "Narrowband UV-B produces Superior Clinical and Histopathological Resolution of Moderate-to Severe psoriasis in patients Compared With Broadband UVB-B", Dr. Todd R. Coven and others of the Laboratory for Investigative Dermatology, The Rockefeller University concluded "that Narrowband UV-B offers a significant therapeutic advantage over BB UV-B in the treatment of psoriasis, with faster clearing and more complete disease resolution. The erythemal response to NB UV-B treatment was significantly more intense and persistent compared with BB UV-B.

psoriasis. Skin and Allergy News, reporting from the annual meeting of the West Virginia Dermatological Society, quoted Dr. Thomas Fitzpatrick, professor Emeritus of Dermatology at Harvard University: "Bulbs that emit a narrow band of ultraviolet light in the UVB range appear to be superior to traditional broad-band UVA for the treatment of psoriasis."

psoriasis. Journal of the American Academy of Dermatology 1997;36:577-81. D.A.R de Berker and others report in an article entitled "Comparison of psoralen-UVB and psoralen-UVA photochemotherapy in the treatment of psoriasis" that in a study of 100 patients with plaque-type psoriasis, "no significant difference was found between the two treatments [psoralen-UVB and psoralen-UVA] in the proportion of patients whose skin cleared during treatment or in the number of exposures required for clearance of psoriasis." "Side effects and disease status at 3 months after the end of treatment were similar for the two groups"

psoriasis. Skin and Allergy News, November 1997. Dr. Robert Rietschel, chairman of the department of dermatology at Oschner Clinic in New Orleans, reported at the annual meeting of the South Central Dermatological Congress, that "I've been very pleased with it [Narrow Band UVB] and highly recommend it. It may be the only light source you'll need." The article goes on to report that "Not only are the results as good with PUVA, but it obviates the nausea and cost associated with oral psoralen. It does not carry the same risks of photosensitivity, does not require eye protection except for during the treatment itself and does not require ophthalmologic check-ups. Pregnant women and children can be treated."

psoriasis. photodermatol photoimmunol photomed 1997: 13: 82-84. In an article entitled "Narrow-band (311 nm) UVB phototherapy: an audit of the first years experience at the Massachusetts General Hospital" MBT Alora and CR Taylor, both from the phototherapy Unit, Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA, state: "In summary, published reports of controlled narrow-band studies have all shown superior clinical results with minimal risk of burning. Our preliminary findings suggest that caution must be exercised in using this modality, especially when patients miss treatments or the irradiation protocols are aggressive. Careful attention to dosimetry is essential and patients should be encouraged to express any, even minor symptoms, which may result from their last treatment as we have seen a clear threshold phenomenon even with strict adherence to standard protocols."

psoriasis, Scalp. Private communication written by Edmond I, Griffin, M.D. and others, from Atlanta, Georgia, USA. " The Dermalight psora-Comb was used in a group of 13 patients with moderate to severe scalp psoriasis. Also included was 1 patient with chronic persistent seborrhea. The group of 14 patients all received scalp phototherapy as part of an intensive scalp therapy program." " In this group, the average treatment time at clearing was 9 minutes and 20 seconds. The average number of treatments needed to provide clearance was 20, with the highest being 32 and lowest being 10. Periods of remission were reported in the group, with 57% experiencing remissions for 1-16 months, while the remaining 43% were lost to follow up or discontinued treatment altogether." "In conclusion, we have found the psora-Comb to be an effective instrument in our scalp therapy program, especially when used with short contact anthralin therapy or psoralens either together or separately."

psoriasis, Scalp. G Ital Dermatol Venereol, 1989;124:LXI-LXV. In an article published in Italy entitled "Fototerapia della psoriasis del cuoio capelluto" by Dr. M. Caccialanza and others at the University of Milan, they state, "The presence of hair hampers the performance of photo-and photochemotherapy and blocks the efficacy of exposure to sunlight in patients affected by scalp psoriasis. A portable source of ultra-violet rays was tested on 21 patients: the device is equipped with a special comb which, by separating the hair, partially overcomes the protective shield formed by the latter." They further report that "A complete remission of dermatosis was achieved in 6 cases, a marked improvement in 11 (50-95%), and a slight improvement in 4 (20-30%). The source used was found to be efficacious especially in those forms of slight to medium psoriasis of the capillitium; it was handy and easy to use making it suitable for home use."

Atopic Dermatitis. The Skin and Allergy News, May 1999 reports that "Narrow-Band UVB May Benefit Atopic Dermatitis." Dr. Craig A. Elmets of the University of Alabama at Birmingham stated at the colloquium on clinical dermatology that "The single-frequency, 311-nm light source is nearly as effective as PUVA in atopic Dermatitis patients, with potentially fewer side effects ??[but] still has an unproven safety record."

Atopic Dermatitis. The British Journal of Dermatology (1993) 128, 49-56 reported in an article by Dr. S.A. George and others (photobiology Unit, Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK.) that a 12 week course of Narrow Band UVB resulted in a 68% reduction in atopic Dermatitis severity scores. The article concluded that "Narrow-band UVB (TL-01) phototherapy appears an effective, steroid-sparing treatment for chronic severe atopic Dermatitis, offering long-term benefits in the majority of those treated."

Mycosis Fungoides. An article in Skin and Allergy News reported on a presentation by Dr. Jane J. Kim of the Henry Ford Health System (Detroit) that "Narrow-band UVB phototherapy shows potential as a novel therapeutic option for patients with stage I mycosis fungoides ??" The article goes on to state that " ??three such patients each showed greater than 70% improvement after a mean of 18 narrow-band treatments, with clinical remission achieved after a mean of 30 treatments, or 14.5 weeks" which is quicker than broad-band UVB. The same article also presents information on positive results in Vitiligo and Atopic Dermatitis using Narrow Band UVB phototherapy therapy.

Phototherapy is the process of treating the human body with various wavelengths of light such as laser, ultra violet or infra-red. Different wavelengths and intensities offer medically proven treatment for chronic skin conditions.