Phototherapy of Skin - Types, Contraindications, and Complications

Introduction:

Sun is the primary UV light source with many skin benefits and risks. UV light is artificially made and used in treating skin lesions. It is either used separately or in combination with other medications. Using light beams for treating lesions is known as phototherapy.

How Does Phototherapy Work?

When the immune system overreacts, the UV light targets the lesion and halts the immune reaction.

UV light also stimulates melanocytes, the skin’s pigment-producing cells

What Are the Types of Phototherapy?

There are two main types of phototherapy:

1. Ultraviolet B (UVB) - UVB includes

• Broadband UVB: Uses light of broad range wavelengths and does not treat areas of skin folds.

• Narrowband UVB (NB-UVB) — Uses light of narrower range wavelengths. It covers specific areas, even skin folds.

• Excimer laser therapy.

2. Ultraviolet A (UVA) - UVA includes

• UVA1 - Uses high wavelengths.

• UVA2 - Uses low wavelengths.

• Psoralen-UV-A (PUVA) - Uses UVA light and an oral medicine called psoralen that makes your skin more sensitive to light.

What Is UVB Therapy?

NB-UVB and BB-UVB: UVB light (NB-UVB and BB-UVB) damages the cell DNA and kills melanin-producing and immune cells. Narrow band-UVB is the first-line treatment for moderate-to-severe skin lesions. Narrow band is mainly replaced with broad band lights because it has high efficacy and low recurrence.

Excimer Laser Therapy: An excimer laser is a focused UVB treatment. Excimer is a combination of noble gas (Argon/Krypton/Xenon) and halogen gas (Fluoride or Chloride). Excimers are beneficial for difficult-to-treat areas like the scalp, palms, and soles. The USA approved excimer laser to treat psoriasis, vitiligo, and localized skin inflammation.

What Is UVA Therapy?

UVA destroys the blood vessels, nerves, and fibers.

UVA is further categorized into UVA1 (340–400 nm) and UVA2 (320–340 nm).

PUVA Therapy: PUVA is exposure to UVA by phototherapy or direct sunlight after administering psoralen, either oral, topical, or bath. Psoralens chemically activate DNA reversing the proliferation of blood and immune cells. It also stimulated melanin formation. PUVA is effective for several skin lesions. PUVA treatments can cause severe burns and are associated with a higher risk of skin cancer than any other form of phototherapy.

What Are the Approaches Towards Phototherapy?

Personalized Care - After a detailed evaluation, treatment is customized to the patient’s needs.

Preparing for Treatment:

• Full-body skin examination is done to know about skin reaction to sunlight.

• History of skin cancer of personal and family skin cancer and light-sensitive disorders.

• Pregnancy and breastfeeding details.

• Medications include patches, creams, herbal supplements, Retinoid, antibiotics, cancer medications.

• Consult with an eye specialist before beginning the treatment.

Phototherapy in Dermatologist’s Office:

The area to be treated should not be covered with any clothes, and the surrounding untreated area should be covered and protected. Other safety measures include:

• Applying sunscreen on the neck, lips, and backs of hands.

• Wear special glasses or goggles to protect eyes from UV light.

• Cover genitals in men; apply sunscreen for nipples and areola in women.

During phototherapy, skin gets quickly adapted to the dosage of light delivered. The dosage is continuously increased to promote faster healing, based on the skin’s response to light therapy. Since the response to every individual and every area is different, the dermatologist evaluated the treated skin the next day.

Phototherapy is usually done in a skin specialist clinic, but in cases where long-term therapy is needed, then home treatment is advised.

Phototherapy at Home:

Taking a phototherapy session will require a phototherapy machine at home.

The following steps are done in-home phototherapy.

• Skin specialists propose a home phototherapy order form for the patient. It includes the type of therapy and the dosage.

• In addition, a home LED blue light; tanning bed may be efficacious in treating psoriasis.

• Less costly and more convenient for patients.

• Do not apply lotion or moisturizer for 24 hours before treatment.

• Wear protective goggles provided by the phototherapy machine company. If eyelids are to be treated, keep your eyes closed until the treatment is complete.

• Cover all the areas, exposing only the lesion.

• The company will pre-set the dosage of phototherapy.

• Stay at a distance from the unit throughout the treatment; expose affected skin to the phototherapy light, as directed by a dermatologist.

Phototherapy Session Length:

A phototherapy session varies depending on the skin type and strength of the light. It usually lasts from a few seconds to minutes.

• Broadband therapy needs three to five sessions each week.

• Narrowband therapy needs two to three sessions each week.

• PUVA therapy needs about 25 sessions over two to three months.

• Laser therapy is usually done twice a week.

Treatments continue till clear skin is obtained. Sometimes, maintenance treatments may be required. The maintenance therapy can be done with a dermatologist or a home UV light unit.

What to Expect and Do After Phototherapy?

• Avoid natural sunlight.

• Clothing and sunscreen are mandatory when outdoors to avoid overexposure to UV light.

• Psoralen can increase the risk of sunburn after PUVA treatment.

• Protect your eyes from sun exposure for the next 24 hours after PUVA treatment to avoid cataracts.

• Antihistamines may be prescribed to comfort the itching.

• Redness, itching, or a burning sensation are side effects of phototherapy.

• Phototherapy can cause dryness of the skin. Moisturize skin with a fragrance-free moisturizer at least once a day.

What All Conditions Require Phototherapy?

Phototherapy is used to treat multiple skin conditions, like:

1. Psoriasis.

2. Vitiligo.

3. Eczema.

4. Lichen planus.

5. Cutaneous T-cell lymphoma.

6. Itchy skin.

7. Sclerotic conditions.

8. Solar urticaria

9. Atopic dermatitis

10. Acute graft-versus-host disease.

11. Pruritus.

12. Atopic dermatitis.

13. Mycosis fungoides.

14. Polymorphous light eruption.

What Factors Increase the Risk of Complications?

1. Sun allergy.

2. Pregnancy or nursing.

3. Skin cancer or lupus that requires you to avoid the sun.

4. History of skin cancer.

5. Liver disease.

What Are the Contraindications?

Absolute contraindications to phototherapy include:

1. Systemic lupus erythematosus (SLE).

2. Xeroderma pigmentosum.

3. Porphyria

Relative contraindications to phototherapy include:

1. History of melanoma or non-melanoma skin cancer.

2. History of treatment with arsenic or ionizing radiation.

3. Immunosuppression.

4. History of treatment with anti-cancer drugs.

What are the Complications of Phototherapy?

If any of the following complications are seen after a phototherapy session, it is advised to visit a dermatologist.

1. Flu-like symptoms like headaches or body aches, fatigue, nausea, vomiting, diarrhea, cough, sore throat, runny or stuffy nose.

2. Burning skin.

3. Cataracts.

4. Headache.

5. Fatigue.

6. Fever, chills, any signs of infection.

7. Redness or any discharge around the skin lesion.

8. Development of new symptoms of discharges around the skin lesions.

9. Severe pain, burning, or blistering of the skin.

10. Skin lesions worsen temp.

11. Premature aging of the skin, like wrinkles or dryness.

12. Freckles.

Conclusion:

Phototherapy is a handsome treatment option anyone can opt for, especially for those who need a natural treatment, unlike creams or steroids. A phototherapy is also an excellent option for children and women during pregnancy.