Thursday, August 11, 2022

How Does Phototherapy Work For Psoriasis

What Are The Possible Side Effects

PhotoTherapy For Psoriasis & Eczema

UV light therapy can have various side effects. For instance, the radiation can dry out your skin and cause itching. So people are advised to thoroughly moisturize their skin with a lipid-replenishing skin care product immediately after the treatment. Light therapy also often causes sunburn-like skin reactions. In rare cases, blistering burns may occur.

In people who tend to get cold sores on their lips, light therapy might make cold sores more likely. Applying sunscreen to your lips before the treatment can help prevent cold sores. Taking psoralen for PUVA therapy can cause nausea and vomiting. These side effects don’t occur when psoralen is used as a bath solution.

Other, less common, side effects include raised red patches that go away again after a few days and hair follicle infections.

In order to limit side effects as much as possible, it’s important to avoid natural sunlight on the day of treatment, or protect yourself when outdoors by wearing appropriate clothing, sunglasses and sunscreen. It is particularly important to avoid further exposure to sunlight after PUVA therapy.

Another disadvantage of UV light therapy is that it involves a lot of doctors’ appointments and takes up a lot of time overall. So people who are busy, for instance with their work and family, might find it hard to stick to this treatment in everyday life.

Light Therapy For Psoriasis

An NYU Langone dermatologist may recommend using light therapy as part of your treatment for psoriasis. Controlled exposure to strong ultraviolet light can help to reduce the number and size of psoriasis lesions and prevent new ones from forming.

These treatments can be administered on-site at NYU Langone or in your home. Your doctor may recommend using topical or oral medications in combination with light therapy to relieve symptoms such as itching.

How Does Phototherapy Work Against Psoriasis

The light therapy is based on the use of ultraviolet radiation of spectrum A and B. The healthcare providers use it widely to deal with several dermatological diseases including psoriasis. Phototherapy has an immunomodulatory and anti-inflammatory effect. The UV light helps to restore the balance between the inflammatory and anti-inflammatory factors in the affected skin.

It also slows down the excessive division of skin cells, which is a natural process for psoriasis. This way rashes gradually become pale and less dense, and scaliness disappears. There is also an anti-itching effect. The main methods of phototherapy for psoriasis include

  • selective phototherapy based on the combined use of medium-wave and long-wave ultraviolet radiation
  • a narrow-band UVB light therapy for psoriasis
  • a PUVA-therapy .

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What Dose Of The Uvb Light Should A Patient Start With

Once a patient decides on a home-based UVB phototherapy, he should contact a physician for a medical examination and prescription. The initial dose of UV light is prescribed based on the individual sensitivity of the patient to phototherapy, their skin type , and the degree of tanning.

Note that any health-care consumer cannot start treatment with a high dose of ultraviolet light. Even though narrow-band ultraviolet light is generally safe for the human body, the large and uncontrolled dose can cause burns and irritation on the skin as well. Therefore, you should start your phototherapy with a small dose of UV and slightly increase this dose with each procedure.

Can Anyone Who Has Psoriasis Use Phototherapy

Phototherapy for Psoriasis: Types, Home Therapy, Cost &  More

While dermatologists prescribe phototherapy for many people, it is not recommended for anyone who has:

  • Had a melanoma or any other type of skin cancer

  • A medical condition that makes you more likely to develop skin cancer, such as Gorlin syndrome or xeroderma pigmentosum

  • A medical condition that makes you sensitive to UV light, such as lupus or porphyria

  • To take medicine that makes them more sensitive to UV light, such as some antibiotics, diuretics, and antifungals

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A Guide To Using Light Therapy For Psoriasis

How this underused treatment can help

When ultraviolet light hits skin, it does all kinds of things, says Steven Feldman, MD, PhD, a professor of dermatology at the Wake Forest University School of Medicine in Winston-Salem, N.C. Ultraviolet light kills the immune cells in the skin that contribute to psoriasis, and research suggests that UV light may also disrupt the faulty signals between immune cells and skin cells that lead to psoriasis lesions.

With relatively few side effects, phototherapy is an effectiveyet underusedtreatment, experts say. Phototherapy is a great treatment to start with, says Kathy Kavlick, RN, community outreach nurse for the Murdough Family Center for Psoriasis in Cleveland. Some people get really good results from it.

What Are The Side Effects Of Light Therapy For Psoriasis

Because light therapy doesnt involve any kind of surgical procedure or ingesting medications, its considered very safe with few side effects. Light therapy can be a good option for pregnant women, who cant take systemic treatments, such as methotrexate or biologic medications, Kaffenberger says. This is because some of the systemic treatments can cause serious side effects that could harm the fetus. But with light therapy, the side effects are fewer and limited to the skin.

But there are some drawbacks. Gelfand says light therapy tends to work best on guttate and plaque psoriasis, but it doesnt usually help much when dealing with psoriasis lesions on certain parts of the body, and its not the right answer for all patients. It doesnt work well in the scalp because its covered by hair, making it difficult for the light rays to penetrate. And if you have psoriasis in the genital area, that can be a tricky area to treat. You have to protect the genitals because theyre sensitive to burns and skin cancers, Gelfand says. Therefore, the ideal candidate is someone who has plaque or guttate psoriasis on the arms, legs and trunk. Kaffenberger adds that in some patients, it can actually worsen psoriasis, and theres no easy way to discern ahead of time who will see a worsening of symptoms or an improvement.

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Narrowband Ultraviolet B Light Therapy

Narrowband ultraviolet B is the most common form of phototherapy. It can be used to treat plaque or guttate psoriasis.

NB-UVB lamps and light bulbs emit wavelengths of light between 311 and 313 nanometers , according to recent clinical guidelines on phototherapy.

Your starting dose will depend on your skin type and how easily you burn or tan.

However, NB-UVB light therapy is most effective when performed two or three times a week. An emollient such as petroleum jelly may be applied before each session.

According to a 2002 , people who had twice-weekly sessions saw their symptoms clear up in an average of 88 days. Those with sessions three times a week saw their symptoms clear up in an average of 58 days.

Once the skin is clear, maintenance sessions can be performed on a weekly basis.

A 2017study showed that around 75 percent of people receiving NB-UVB treatments found it cleared their psoriasis or led to minimal symptoms. They used fewer prescription creams for their condition, too.

NB-UVB treatments may prove more effective when combined with topical treatments, such as vitamin D analogues and corticosteroids.

What Are The Different Kinds Of Light Therapy

UVB Light Treatment for Psoriasis (before and after) – My Story

The type of light therapy that is generally used to treat psoriasis is known as narrow band UVB phototherapy. Here the skin is only exposed to UVB light wavelengths between 311 and 313 nanometers. The idea is that limiting the light spectrum in this way reduces the risk of side effects.

Another kind of light therapy is known as balneophototherapy. Here people bathe in warm water containing specific substances for about 20 minutes. Their skin is exposed to artificial UV light while bathing, or immediately afterwards. The bath often contains a solution made out of common salt or Dead Sea salt.

There is also another option called psoralen plus ultraviolet A therapy. It involves exposing the skin to UVA light and using a medication known as “psoralen” too. The medication makes the skin more responsive to UVA light, increasing its effect. Psoralen can be taken as a tablet, applied to the skin in the form of a gel or cream, or added to a bath.

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What You Should Know About The Procedure

Using UV therapy you should avoid:

  • Sunlight
  • Using medications increasing light sensitivity
  • Eating fruit rich in vitamin C
  • Using perfumes and aroma essential oils

Ambulatory care provides a testing radiation before the beginning of the course, to see the skin reaction to the ultraviolet. After consulting the doctor, you can proceed to deciding on the appointments schedule and setting the best time for the treatment.

Phototherapy is used for treating many diseases, like vitiligo, eczema, psoriasis etc. It helps to control the disease in winter, when aggravations are the most common. According to previous experience sometimes its not possible to cure diseases completely. But you can keep the conditions under control using a portable devices at home.

Cost And Health Insurance

The cost of phototherapy can vary by your location and the type of procedure performed. Health insurance may cover some of the cost of treatment, but almost invariably requires prior authorization.

Check with your insurance company to find if phototherapy is covered in your schedule of benefits and what your copay or coinsurance costs will be.

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What Are The Side Effects Of Puva

The phototherapist will carefully explain all of the possible side effects of phototherapy before a course begins. The most common immediate side effect of PUVA phototherapy is a mild sunburn reaction. This may be more likely if the individual has been using other medications or herbal supplements which can cause sensitivity to light, so it is important to tell the phototherapist of anything being taken. This sunburn reaction is usually not serious, and the phototherapist will adjust the dose of the next treatment or postpone treatments until the redness has settled. Some people report some itchiness in the early stages of treatment, but this should soon settle. People on tablet PUVA may feel a little sick after taking the tablets. This maybe only a mild inconvenience but if it is intolerable, an alternative tablet is available and may help. Taking the tablets will sensitise the eyes to UVA and exposure to the sun may increase the risk of cataract formation, so eyes must be protected from sunlight or other sources of UVA for 12 hours or until night-time. After taking the tablets, patients should wear sunglasses or other UV protective eyewear, or avoid exposure to sunlight altogether.

Giving Yourself Phototherapy At Home

Does Phototherapy Work For Psoriasis?
  • Dont put on lotion or moisturizer for 24 hours before each treatment.
  • For each treatment, you will need:
  • Protective goggles. You will get these from the company that supplies your phototherapy machine.
  • The home phototherapy machine.
  • If youre only getting phototherapy to certain areas of your body, make sure all other areas are covered. You can cover them with clothing or sunscreen. This keeps your skin from getting burned. If you have any questions about covering your body, ask your healthcare provider.
  • Wear protective goggles during every treatment, as instructed by your healthcare provider. Wearing goggles will help prevent damage to your eyesight.
  • If your eyelids are the area being treated, you dont need to wear the goggles but be sure to keep your eyes closed during your entire treatment.
  • The dose of phototherapy will be calibrated for you by the company that makes the machine.
  • Stay the correct distance from the unit throughout your treatment, as directed by your doctor or your home phototherapy machine instructions.
  • Expose your affected skin to the phototherapy light, as directed by your doctor.
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    How Is Phototherapy Used To Treat Psoriasis

    Both UVB and UVA can be used to treat psoriasis. UVB is used on its own, but UVA requires that the skin be sensitised by a plant-derived chemical called psoralen before it is effective. The treatment combining Psoralen and UVA is termed PUVA.

    Both forms of phototherapy are given as a course of treatment over many weeks, where the time of exposure to the UV is gradually increased to prevent burning the skin and to allow the skin to acclimatise to the treatment. After a course of phototherapy the treatment is stopped in some cases improvements last for more than a year, while in other cases the psoriasis may start to recur after a few months or even weeks. Further courses of treatment may be given. It is not possible to predict how individuals will respond or how long their response will last after the phototherapy course ends. Psoriasis is the skin condition that responds best to phototherapy and in most phototherapy units 60-70% of the people attending are being treated for psoriasis.

    Tanning Beds: Yay Or Nay

    The National Psoriasis Foundation, the American Academy of Dermatology, the United States Department of Health and Human Services, and the World Health Organization all discourage the use of commercial tanning beds for treating psoriasis. The spectra of light in tanning beds vary greatly and often include wavelengths of light that are carcinogenic and photo-damaging. The ultraviolet radiation from these devices can damage the skin, cause premature aging and increase the risk of skin cancer.

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    Why Does Dosage Constantly Change During Phototherapy

    During phototherapy, your skin quickly becomes accustomed to the dose of NB-UVB energy delivered. In order for healing to continue, the dose of light delivered to targeted areas must be continually increased, depending on your skin’s response to therapy. Since everyone responds differently to phototherapy, and different areas of the body respond differently, clinicians depend on patients’ self-assessment of their skin the day after a light treatment is delivered.

    With Clarify Medical Home Light Therapy, personalized education and careful examination of your photos helpsyou to decide whether light dosage should increase, decrease, or stay the same. The Clarify System automatically calculates the amount of time the NB-UVB is delivered based on your doctor’s prescription.

    Narrowband Uvb Phototherapy For Psoriasis: How It Works And What You Can Expect From The Treatment

    Psoriasis UVB Light Treatment From Home – Vlog #3

    Contents

    Psoriasis is a complex inflammatory condition affecting about 2% of Americans. Patients develop characteristic skin lesions that respond variably to treatment. Mild cases involve limited areas of the skin. Severe ones present with widespread plaques and may affect the joints and other organs.

    Narrowband UVB phototherapy is the treatment of choice for moderate to severe psoriasis. In this procedure, ultraviolet light of a specific wavelength and energy level is used to reduce excessive skin inflammation and thickening. It is highly effective and safe if done properly.

    In this article, we explain how NB-UVB phototherapy works on psoriasis. We also discuss its advantages and disadvantages compared to other treatments, as well as what to expect during your sessions.

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    How Does Sunlight Work To Treat Plaque Psoriasis

    Natural sunlight contains both UVA and UVB light. Many psoriasis patients are advised to have regular, brief periods of sun exposure to help improve symptoms on affected areas. This is usually recommended for people with mild or moderate psoriasis that is not made worse by sun exposure1.

    During sunlight exposure, areas of the body that are not affected by psoriasis can be protected with sunscreen or clothing. Healthcare providers will provide advice about how long to spend in the sunlight and how often, and check the patient regularly for sun damage to the skin. It can take up to a few weeks or more to see improvements from sun exposure.

    Before starting treatment with sun exposure, let your healthcare provider know if you are using any topical medicines, many of which can make your skin more sensitive to light and more likely to burn. People who are being treated with other types of phototherapy may be advised to avoid sun exposure when possible2.

    It is very important to protect unaffected areas from getting too much sun exposure and becoming sunburned, which can make psoriasis symptoms worse. Sunburns also increase the risk of skin cancer and can make the skin age prematurely.

    What Are The Side Effects Of Light Therapy

    As compared with other treatment options, light therapy poses fewer side-effects risks. Most people do not experience side effects when they are treated with phototherapy, says Shari Lipner, MD, PhD, an assistant professor of dermatology at Weill Cornell Medicine in New York City. The most common side effect is a mild sunburn reaction, and this is more likely to occur if the person is taking a medication that causes sun sensitivity.

    Before receiving light therapy, patients should tell their doctor about any drugs theyre taking. The treatment also may not be an option for people who should avoid sunlight exposure, such as those with lupus.

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    Challenges To Light Future Research Directions

    Although light therapy is effective for psoriasis, there are serious, serious roadblocks, Katz stressed, including both financial and time commitment barriers.

    The reimbursement for light therapy is moderately low and patients are expected to come in for therapy two to three times per week for at least 8 to 12 weeks, according to Katz. Also, insurers may not always cover a visit and a light treatment on the same day. Many offices do not offer either narrowband or excimer laser because its not economically feasible, she added.

    As a dermatologist, you need to be able to afford to offer light to patients, she told Healio. You have to dedicate part of your real estate to a light box and you have to dedicate your staff to light therapy. You have them assisting and delivering light. You need people who are properly certified and trained, you need to be able to offer light to enough patients to pay for that real estate.

    However, Katz also said that the overall cost of phototherapy is much less than the cost of any of the biologics.

    Economic research is needed that show these challenges, Katz said.

    I would love to see economic studies that essentially force the hand of perhaps the insurers to restructure the way in which they cover this very valuable and safe treatment for patients, she said. Were talking about great cost savings to everyone. That really is a concern.

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