Call 949-582-7699 or 582-SKIN to see our phototherapists for narrowband UVB.
Did you know about narrow band UVB?
-Covered by insurance and Medicare
NARROW BAND UVB 311 nm treats:
-Mycosis Fungoides ( Cutaneous T cell Lymphoma)
-Pruritus ( Generalized Itching)
-Renal Disease Itching ( Kidney failure)
-Hepatitis C itching ( pruritus)
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:
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
- Mycosis Fungoides (MF)
- Atopic Dermatitis
- Dermatitis- Refractory
- Eczema/ Refractory
- 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|
|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|
|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|
|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|
|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.|