UVB

Call 949-582-7699 or 582-SKIN  to see our phototherapists for narrowband UVB.


Did you know about narrow band UVB?

-No Pills
-No Chemicals
-No Pain
-No Needles
-Open System
-Flat open panels
-Covered by insurance and Medicare

 

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:

  • faster clearing
  • less skin sun burning
  • more complete disease improvement
  • No internal drugs or chemicals as in PUVA

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

Type I 130 mJ/cm2
Initial Dose Type II 220 mJ/cm2
Type III 260 mJ/cm2
Type IV 330 mJ/cm2
Type V 350 mJ/cm2
Type VI 400 mJ/cm2

UVB


 Skin response:
Subsequent Doses Severe erythema Adjustment:No Tx. When burn resolves, 50% of last dose, then dose by <–10%
Mild erythema same dose
No erythema Increase dose by:
15 mJ/cm2 for Type I
25 mJ/cm2 for Type II
40 mJ/cm2 for Type III
45 mJ/cm2 for Type IV
60 mJ/cm2 for Type V
65 mJ/cm2 for Type VI

UVB

 

3 times weekly**(Monday, Wednesday, Friday)
Frequency of Treatment ** 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

UVB

  missed days: adjust dose:
     
Adjustment for Tx 1-7 days Increase dose per skin type
8-11 days same dose
12-14 days by 2 Tx’s worth
15-20 days by 25%
21-27 days by 50%
28+ days start over

UVB

Skin Type Response to sun Tone
Type I Always burns, never tans ToneVery fair skin. Blonde, red, or light brown hair. Blue, green, or gray eyes.
Type II Usually burns, sometimes tans Fair skin. Blonde, red, or brown hair. Blue, green, gray, or brown eyes.
Type III Sometimes burns, usually tans Black or brown hair. Brown eyes.
Type IV Minimally burns, tans well Light brown skin.
Type V Very rarely burns, tans perfectly Moderately pigmented, brown skin.
Type VI Almost never burns Deeply pigmented.

UVB