An Overview of Phototherapy

 Table of Contents

History of Phototherapy

Skin Disorders

Mood and Sleep Disorders

Cancers and Precancers

For Newborns

Phototherapy is a type of medical treatment that involves exposure to fluorescent light bulbs or other sources of light like halogen lights, sunlight, and light emitting diodes (LEDs) to treat certain medical conditions.

There are different types of phototherapy and the kind, as well as the technique used by your doctor, will depend on the condition you have that is being treated.

Phototherapy is also known as light therapy and heliotherapy. 

History

Phototherapy has been used to treat medical conditions for as far back as 3,500 years ago when ancient the Egyptians and Indians used sunlight to treat skin conditions like vitiligo.

Modern phototherapy, using artificial light sources, began with Niels Ryberg Finsen. 

(Click here to learn about him )  Widely regarded as the founder of modern phototherapy, he treated a skin condition called lupus vulgaris with sunlight and ultraviolet radiation. From then on, usage of phototherapy in medical fields grew, techniques were refined and developed, and it eventually gained widespread acceptance.

Skin Disorders

Skin conditions like eczema, psoriasis, vitiligo, itchy skin, and the skin symptoms of cutaneous T-cell lymphoma can be treated using phototherapy. The phototherapy treatment involves using UV light—a kind of light present in sunlight—to reduce skin cell growth and inflammation.

There are three main types of phototherapy used for skin disorders:

•Broadband UVB: Also known as BBUVB, broadband UVB involves treating skin conditions like eczema and psoriasis with the full spectrum of ultraviolet-B radiation.

•Narrowband UVB: This involves using only a small portion/part of UVB radiation to treat the skin condition. It is more intense than broadband UVB and it’s the most common phototherapy option used by dermatologists.

•PUVA: This stands for Psolaren ultraviolet-A. This involves combining UVA light with a certain kind of chemical called psoralen. Psolaren can be applied to your skin or you can take it as a pill. This chemical is found in plants and it makes your skin more sensitive to the light that’s to be applied. PUVA is more intensive and has more side effects than broadband or narrowband UVB, and is usually only resorted to when treatment with the others have been unsuccessful. It’s used for conditions like vitiligo, cutaneous T cell lymphoma, and psoriasis.

The effects of phototherapy for skin disorders are usually temporary. This means it’s not a permanent treatment and you may have to undergo numerous sessions—also known as maintenance therapy—of it over your lifetime to maintain the results.

When used for skin conditions, phototherapy is generally considered safe. However, short-term side effects you may experience are redness, dry skin, itchy skin, nausea (if PUVA is used), folliculitis, and blisters. Also, there are some long-term side effects associated with it, the most serious of which are skin cancer and premature skin aging.

Mood and Sleep Disorders

Phototherapy is also used to treat mood and sleep disorders, although it’s most commonly referred to as light therapy in these contexts. The major conditions it is used for are seasonal affective disorder (SAD) and circadian rhythm sleep disorders.

Seasonal Affective Disorder (SAD)

Seasonal affective disorder is also known as seasonal depression, and it is brought on by seasonal changes, usually beginning in the fall and lasting throughout winter. Light therapy for SAD involves using a lightbox—a specially designed box that emits soft light at a standard wavelength.

Light therapy used this way has a number of side effects you should be aware of. Some of them are headaches, fatigue, insomnia, hyperactivity, and irritability.

Light therapy is usually recommended for SAD because while it does have side effects, they are minimal and usually temporary, and it is an easy, relatively cheap treatment option. Also, if it works for you, you may be able to reduce the amount of anti-depressant medication you use (if any). 

Phototherapy has also been explored for non-seasonal depression. As it stands, though, while some studies support the use of light therapy and suggest it is worth exploring if you have nonseasonal depression, there’s no medical consensus that it's an effective treatment.

Circadian Rhythm Sleep Disorders

Phototherapy can help those who have circadian rhythm sleep disorders such as DSPS (delayed sleep phase syndrome) make the shift to normal sleeping patterns and times. With this kind of treatment, the time at which it is done is extremely important. Your doctor or sleep specialist will help you determine the right time for you to be exposed to the light, after taking into consideration your individual symptoms.

Cancers and Precancers

A certain kind of phototherapy known as photodynamic therapy is used to treat some kind of cancer and precancers. It involves using a special type of drug, called a photosensitizer, in combination with a special kind of light. Photosensitizers produce a kind of active oxygen that, when exposed to specific light wavelengths, kills nearby cells.

The photosensitizer drug is applied topically to the body. Both normal and cancerous cells absorb the drug, but it is thought that the drug concentrates preferentially in quickly dividing cancer cells. Furthermore, normal cells clear the drug faster than cancerous cells. So, at the point when most of the photosensitizer has left the healthy cells but is still present in the cancerous ones, light is applied to the area to be treated. A reaction occurs between the light and the photosensitizer drug, creating activated oxygen inside the cancer cells. This activated oxygen kills the cancer cells."

Photodynamic therapy is used to treat cancer like cancer of the esophagus, endobronchial cancer (non-small cell lung cancer), and precancerous conditions like Barret's esophagus.

In addition to being simply called phototherapy, you may hear of photodynamic therapy being referred to as photoradiation therapy or photochemotherapy.

Phototherapy for treating cancers is a great option, as it has a number of advantages over treatments like radiation and chemotherapy. For one, it doesn’t generally have any long-term side effects. It is less invasive and leaves less scarring than surgery. And in general, phototherapy costs a lot less than the other treatment options for cancer. 

However, its application is largely limited to places where light can reach, which is usually just below the skin, and it also can't help much with cancers that have spread.

For Newborns

Phototherapy has been used for over six decades to treat hyperbilirubinemia and jaundice (the yellowing of a baby’s skin, eyes, and body tissues as a result of excess bilirubin). In this case, the phototherapy is used to reduce the baby’s bilirubin levels.

Bilirubin absorbs light, which results in the breakdown of bilirubin to substances that the baby's body can process and excrete.

There are two major ways babies with jaundice are treated with phototherapy. The usual way is to cover the  baby’s eyes and place them under halogen spotlights or fluorescent lamp lights.

For babies who are born preterm or have already been treated with the overhead conventional lights, "biliblankets" may be used. Also known as fibreoptic blankets, these biliblankets are laid with fiber-optic cables which shines the blue light onto the baby’s back and body.

Compact fluorescent light tubes and blue LED (light emitting diode) devices are also used to give babies phototherapy treatment. They can be kept close to the babies' bodies as they do not produce a lot of heat.

Phototherapy for treating hyperbilirubinemia and jaundice is considered very safe medically. However, short-term side effects of it include diarrhea, rashes, overheating, and water loss/dehydration.

New Treatments

Currently, scientists are exploring the use of phototherapy to treat other medical conditions like diabetic retinopathy and hair loss.

Risks

Phototherapy treatments as a whole have a number of risks that should be known.

For one, ultraviolet rays can cause progressive and gradual damage to your skin on a molecular level. This premature aging of the skin is also known as photoaging.

Exposure to high amounts of artificial ultraviolet light also increases your risk of developing skin cancer. The more treatments you undergo and the fairer your skin, the higher your risk of getting skin cancers.

Further, undergoing PUVA treatments for skin or photodynamic therapy for cancer also makes your eyes more sensitive to light. If your eyes aren't properly protected after such treatments, their sensitivity can lead to eye damage from exposure to sunlight or other bright lights, and the development of cataracts.

Who Should Avoid Phototherapy?

If you fall into any of these categories, you should avoid being treated with phototherapy, or at the very least inform your doctor or dermatologist about it in advance.

•Being pregnant or a nursing mother

•Having a family history of skin cancer

•Having liver disease

•Having lupus 

Words of Care

Phototherapy is a great option for treating many conditions. However, you should consult with your doctor before you attempt to use it at home to ensure you're using it right, getting the most benefits with the least side effects. Also, if you’re going to receive phototherapy treatment for skin conditions at your dermatologist’s, you should explore and discuss your different options before committing to a specific kind and schedule of phototherapy.

 What You Should Know About Phototherapy for Psoriasis. 

Phototherapy for Psoriasis

UV Light Therapy for Moderate to Severe Cases

By Ruth Jessen Hickman, MD Medically reviewed by Casey Gallagher, MD Updated on October 24, 2020

Table of Contents

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Purpose

Indications

Risks and Contraindications

Before Phototherapy

During Phototherapy

Phototherapy, also known as UV light therapy, is one of the most effective treatments for psoriasis. It involves exposing the skin to controlled amounts of ultraviolet (UV) radiation similar to that from the sun. It is usually prescribed with other treatments when conservative therapies fail to provide relief and is especially useful for moderate to severe psoriasis covering large portions of the body.

Phototherapy is performed in a dermatologist's office under controlled conditions. Side effects tend to be mild. In addition to psoriasis, phototherapy may also be used to treat eczema, vitiligo, lichen planus, and cutaneous T-cell lymphoma.

Purpose

It has been known for centuries that sunlight can improve many inflammatory skin conditions, including psoriasis and atopic dermatitis. UV radiation has immunosuppressive and anti-inflammatory effects that can help temper the inflammation that drives many of these diseases.

The sun gives off electromagnetic energy in various forms. Of these, UV radiation is the type that has a shorter wavelength and more energy than the visible light. There are two types used in phototherapy:

UVA radiation, which has a wavelength closest to that of visible light

UVB radiation, which has a shorter wavelength and slightly more energy than UVA radiation1

Beginning in the early 20th century, clinicians began to develop different types of phototherapy to help people with psoriasis. Today there are several modalities used to treat the disease, including:

Broadband ultraviolet B (BB-UVB)

Narrowband ultraviolet B (NB-UVB)

Psoralen plus ultraviolet A (PUVA)

Laser excimer therapy

Although limited exposure to the sun can be beneficial to the skin, phototherapy is preferred for moderate to severe psoriasis since the UV radiation can be dosed and controlled.

BB-UVB and NB-UVB

BB-UVB was the first type of phototherapy to be developed. It involves exposing the skin to wavelengths of light between 290 and 313 nanometers (nm). Years later, researchers developed a kind of UVB therapy that uses smaller wavelengths (between 308 and 313 nm). That is why it is called "narrow band."1

NB-UVB is the most common type of phototherapy used today, for several reasons:

•It is more effective than BB-UVB.

•It can be used for a variety of different skin conditions.

•It is easier to use than other forms of phototherapy.

•It has fewer side effects compared to BB-UVB or PUVA.

Both BB-UVB and NB-UVB therapy can benefit from the application of coal tar to the skin. The procedure, referred to as Goeckerman therapy, appears to enhance the effects of phototherapy.

PUVA

PUVA, the second-most common form of phototherapy, is performed in two parts. First, you will be given a topical or oral compound, called psoralen, to sensitize your skin to the UVA radiation. Depending on your condition, you will either take a pill or have a topical formulation applied to your skin.

Because UVA radiation is not as strong as UVB, you need this extra boost to make the therapy effective.

Laser Excimer Therapy

A newer and less commonly used form of phototherapy is called laser excimer therapy. It is a form of UVB-NB therapy in which the beam of light is narrowed to target smaller areas of skin. The lasers deliver higher doses of radiation, which can help treat the skin more quickly.

Laser excimer therapy is approved by the U.S. Food and Drug Administration for mild to moderate psoriasis.

Indications

Phototherapy is rarely used on its own. It is generally recommended when topical therapies, such as corticosteroids, are unable to provide relief.

Phototherapy can be used to enhance the effects of topical therapies. For moderate to severe psoriasis, phototherapy is often used with oral or injectable drugs that temper inflammation from within. These include:

•Disease-modifying antirheumatic drugs (DMARDs) like methotrexate or cyclosporine

•Newer generation biologics like Humira (adalimumab), Enbrel (etanercept), or Remicade (infliximab)

Phototherapy is often an attractive option, since it is cost-effective, has few side effects, and can be used during pregnancy, unlike some other psoriasis treatments.

 How Psoriasis Is Treated

Risks and Contraindications

Most people do relatively well with phototherapy. However, it may cause side effects in some, including itching, skin redness, and occasionally sunburns (mainly with UVB).

Less commonly, psoralen used in PUVA phototherapy may cause nausea. Since PUVA is performed in a standing lightbox, protective eye goggles are needed to prevent cataracts that may develop as a result of the increased light sensitivity.

Despite the benefits of phototherapy, it may not be a good option for you if you:

•Have a history of a photosensitivity disorder

•Take photosensitizing medications

•Have a history of melanoma

•Have lupus or severe liver or kidney disease

•Are immunosuppressed

People with fair skin may also need to be cautious as they are more likely to experience irritation.

Skin Cancer Risk

A number of older studies suggested that phototherapy may increase the risk of skin cancer, particularly a type known as squamous cell cancer. The risk may be highest in people who get PUVA therapy over an extended period of time, although UVB therapy may also increase the risk. The current evidence, however, suggests the risk is extremely low.

According to a a 2015 review of studies published in the Journal of Psoriasis and Psoriatic Diseases, there is no clear evidence of an increased skin cancer risk associated with UVB phototherapy among all skin types.

To be on the safe side, doctors recommend that you have regular skin screenings to check for any pre-cancerous lesions. If you have concerns about cancer, don’t hesitate to discuss them with your dermatologist in advance of your treatment.

UV radiation used for phototherapy should not be confused with the ionizing radiation used for X-rays. UV radiation mimics sunlight, while high-energy ionizing radiation can damage the DNA in cells, potentially causing cancer.

 Does Psoriasis Increase Lymphoma Risk?

Before Phototherapy

Before the phototherapy session is even scheduled, your dermatologist will determine if it is safe for you. To do this, they will perform a head-to-toe examination of your skin and ask whether you have a family history of skin cancer or photosensitizing disorders.

You will also want to advise your doctor about any and all drugs and supplements you are taking. This includes patches, creams, and over-the-counter remedies. Some medications, such as retinoids, certain antibiotics, and chemotherapy drugs, can make your skin more sensitive to UV light.

If you are having PUVA therapy, you may be asked to see an ophthalmologist to have an eye exam before you begin.

Timing

The duration of treatment can vary by the type of phototherapy used, the severity of symptoms, the amount of skin involved, and what type of photosensitizing agent is used.

With respect to the actual procedure, the first treatment may last only a few seconds. Over time, the sessions will increase based on your skin type, your tolerance to treatment, and the strength of the light used. Treatments rarely last longer than a few minutes.

Several treatments are usually required each week:

BB-UVB may require three to five treatments each week.

NB-UVB requires two to three treatments per week.

PUVA generally requires 25 treatments over two to three months.

Laser excimer therapy is usually given twice weekly and requires fewer treatments.

Treatments generally continue until your skin is clear. Maintenance treatments are sometimes needed to prevent acute flares.

Location

Phototherapy is typically done in a dermatologist’s office in a 5 x 7-foot lightbox. Newer handheld devices are also available for spot treatments, while full-body lamps and lightboxes can treat the hands and feet. Home phototherapy units are also available and are typically used for maintenance.

What to Wear

No special clothing is needed for your appointment, but you may want to bring older clothes if your doctor plans to use coal tar. Coal tar not only smells but can stain your clothes if you happen to get some on your hands.

If your arms are being treated, a lightweight, long-sleeved shirt may help prevent sun exposure on the way home. Soft socks and a pair of open-toe sandals can do the same if your feet are sore or sunburned after treatment.

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.

What to Bring

Be sure to bring your ID and insurance card to the appointment as well as an accepted form of payment for copayment or out-of-pocket costs.

If coal tar is being used, you may want to bring a nailbrush and some deodorant to help minimize the smell. A moisturizing cream can also help. You should also bring sunscreen, sunglasses, and a hat to reduce sun exposure when outdoors, especially if psoralen is used.

During Phototherapy

When you arrive, you will be asked to sign in and present a photo ID and insurance card. Once completed, you will be escorted to a changing room and asked to remove any clothes that cover the skin being treated. Areas that do not need treatment should be covered and protected as much as possible.

If needed, you may be provided with the following protective tools:

•Sunscreen to protect your neck, lips, and backs of the hands

•Special glasses or goggles to protect your eyes

•Sunscreen for nipples and areola in women

•A covering for the male genitals

The nurse or phototherapy technician will be tasked with applying coal tar or topical psoralen to the affected skin, if needed. If oral psoralen is used, you will be asked to take it one to two hours before the procedure. If undergoing PUVA therapy to treat a large area of skin, you may be asked to soak in a bath of psoralen solution for several minutes.

Once prepared, you will either be taken to a lightbox for treatment or treated with a handheld device while standing or sitting. The actual procedure may induce a warm sensation similar to that of a mild sunburn.

Once the session is completed, you can shower or wash and change back into your clothes. The nurse or doctor will then check the condition of your skin and recommend medication if you have any discomfort.

After Phototherapy

It is important to avoid natural sunlight after receiving phototherapy. This is especially true for the first 24 hours, when your skin will be most inflamed. Among some of the precautions to take:

Wear long-sleeved shirts, long pants, sunscreen, sunglasses, and a hat when outdoors.

Take extra care to protect your eyes from the sun for the next 24 hours. This will help prevent cataracts after PUVA treatment.

Oral antihistamines and a topical hydrocortisone cream may help ease any itching.

Moisturize your skin with a fragrance-free moisturizer as often as needed, and at least once daily.

While skin redness and irritation are common after phototherapy, call your doctor if you experience blisters, rash, burns, ulcers, drainage, or a fever of 100.4 degrees F or more.

Upon the completion of therapy, you'll typically schedule a follow-up with your dermatologist to evaluate your response and the need for maintenance therapy. You may also be asked to see your ophthalmologist for a follow-up examination of your eyes.

A Word From Care Bear

Phototherapy is an age-old treatment with practical applications today. If your psoriasis is not under control with topical medications, ask your dermatologist whether phototherapy is an appropriate option for you. Never self-treat your condition with a home phototherapy unit unless given proper guidance by a dermatologist. Treating psoriasis inappropriately can actually make your condition worse. The same applies to the use of tanning beds and tanning lamps, both of which should be avoided without exception.