Call 949-582-7699 or 582-SKIN to see our phototherapists for narrowband UVB.
NARROW BAND UVB 311 nm treats:
Psoriasis
Vitiligo
Mycosis Fungoides ( Cutaneous T cell Lymphoma)
Pruritus ( Generalized Itching)
Renal Disease Itching ( Kidney failure)
Dialysis Itching
Atopic Dermatitis
Eczema
Hepatitis C itching ( pruritus)
Morphea
How does Narrow Band UVB work?
Narrow Band UVB light is shown to selectively help decrease inflammation in skin cells
thereby reducing the signs of many types of skin rashes and skin conditions like psoriasis and vitiligo.
Advantages of NARROW BAND UVB:
Why is NB UVB preferred instead of PUVA? (Reference)
Psoralen pills are not required in UVB
Less Risk of drug induced photosensitivity in UVB
No need for eye protection after sessions in UVB
UVB is very good for children or adolescents
UVB works very well for adults with thin plaque psoriasis
UVB is Ok to use in pregnant or breastfeeding women
UVB may be a better fit in HIV patients
| Diagnosis: | UVB Responsive Conditions Psoriasis |
| Vitiligo |
| | Mycosis Fungoides (MF) |
| | Atopic Dermatitis |
| | Dermatitis- Refractory |
| | Eczema/ Refractory |
| | Pityriasis Lichenoides Chronica |
| | Scleroderma |
| | Morphea |
| | Aopecia Areata (AA) |
| | Pruritus- Refractory |
| Pruritus: Renal disease/ Dialysis |
| | Pruritus: HIV/ Refractory |
| | Pruritus: Hepatitis C/ Refractory |
Narrow-band UVB is effective for the treatment of psoriasis. There are many protocols available in the literature. One of the best practices for UVB includes starting at about 1 1/2 minutes to 2 minutes based on the individual skin type and increasing gradually by 10-15% of the total dose each week.
To start UVB phototherapy, the dermatologist starts with one of two main clearing regimens. The two main types of narrow-band (NB UVB) protocols are the Skin Type and MED (minimal erythema dose) protocols.
MED and skin type testing to determine the dose of narrow-band UVB to begin treatment are detailed in a step-by-step process. Subsequent treatment doses are based on the skin’s response to the previous treatment. Further adjustments in light dose can accommodate missed treatments. Narrow-band light treatments are continued until psoriasis clears or almost clears, followed by tapering maintenance treatments. The goals of therapy are to establish and maintain control over psoriatic flares, and to balance the risks and benefits of narrow-band treatment.
Narrow-band ultraviolet B (NB-UVB) was first used starting in 1976. NB UVb was introduced in the U.S. in 1996. NB UVB was used prior to that in Europe and the rest of the world, especially in Europe and Australia.
NB UVB emits a wavelength between 311-313 nm, which is most therapeutic for the clearing of psoriasis. NB-UVB has been shown to be more effective than broad-band ultraviolet B (BB-UVB) and almost as effective as PUVA for the treatment of psoriasis, but with a shorter remission time, and possibly with a lower risk of skin cancer.
SKIN TYPE BASED UVB DOSING:
1. Determine patient's skin type by Fitzpatrick types.
2. Begin UVB treatment at usually 1-2 minutes based on skin type and gradually increase by 10-15% per treatment dose as tolerated.
3. Typically an average of 20-30 treatments are anticipated for many psoriasis patients to achieve clearing.
4. Assess the response during the next treatment visit. The next light dose is dictated by the skin’s response to the previous treatment.
NB UVB phototherapy is best managed by dermatologists trained in dose adjustment. UVB doses are adjusted to maintain a barely perceptible erythema ( redness).
Psoriasiform Dermatitis: photo of psoriasis patient getting UVB light treatment
Skin Type NB-UVB | |
Initial Dose | Type I Type II Type III Type IV Type V Type VI | 130 mJ/cm2 220 mJ/cm2 260 mJ/cm2 330 mJ/cm2 350 mJ/cm2 400 mJ/cm2 | |
Subsequent Doses | Skin response: Severe erythema Mild erythema No erythema 15 mJ/cm2 for 25 mJ/cm2 for 40 mJ/cm2 for 45 mJ/cm2 for 60 mJ/cm2 for 65 mJ/cm2 for | Adjustment: No Tx. When burn resolves, 50% of last dose, then dose by <– 10% same dose dose by: Type I Type II Type III Type IV Type V Type VI | | |
Frequency of Treatment | 3 times weekly**(Monday, Wednesday, Friday) ** Dawe et al have found no significant difference in clearing rates of psoriasis between five times weekly verses three times weekly to warrant the added inconvenience of more frequent treatments.9 Similarly, Leenutaphong et al found no significant difference in efficacy and clearing rates of psoriasis between two times weekly verses a four times weekly NB-UVB treatments.13 However, Cameron et al found that three times weekly NB-UVB cleared psoriasis significantly faster compared to two times weekly treatements.16 Most treatment centers have adopted a three times weekly (TIW) regimen. Subsequent treatments are not to be given less than 24 hours from the last treatment. |
Adjustment for Tx | missed days: 1-7 days 8-11 days 12-14 days 15-20 days 21-27 days 28+ days | adjust dose: dose per skin type same dose by 2 Tx’s worth by 25% by 50% start over |
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Skin Type Type I Type II Type III Type IV Type V Type VI | Response to sun Always burns, never tans. Usually burns, sometimes tans. Sometimes burns, usually tans. Minimally burns, tans well. Very rarely burns, tans profusely. Almost never burns. | Tone Very fair skin. Blonde, red, or light brown hair. Blue, green, or gray eyes. Fair skin. Blonde, red, or brown hair. Blue, green, gray, or brown eyes. Black or brown hair. Brown eyes. Light brown skin. Moderately pigmented, brown skin. Deeply pigmented. |
Reference article: Why is UVB Narrow band better therapy than PUVA for hand eczema and palmar psoriasis?
Why is UVB Narrow band therapy than PUVA for vitiligo? A study titled "Treatment of vitiligo with UV-B radiation vs topical psoralen plus UV-A. W." by Westerhof and L. Nieuweboer-Krobotova publihsed in the Archives of Dermatology in 1997 compared the efficacy and safety of 2 treatment modalities using PUVA (topical psoralen plus UV-A) and 311nm NB UVB radiation in patients with vitiligo. The study results confirmed that NB UVB 311 nm was equally as effective as PUVA but with less side effects and better safety. |
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Specialized Scalp Psoriasis: Narrow Band UVB for scalp ( Available at The Skin Center)
PSORIASIS PLAQUES ON THIGH: PICTURE OF LEG PSORIASIS