Phototherapay
Phototherapy is the use of natural or artificial ultraviolet light to help slow the production of skin cells. This form of treatment is prescribed by a Dermatologist and usually administered at a specialist clinic or hospital to ensure it is medically supervised and harm to the skin is minimised.
Overview of Phototherapy
Phototherapy is the use of natural or artificial ultraviolet light to help slow the production of skin cells. Many people report that their psoriasis has improved when they have been exposed to sunlight.
This form of treatment is prescribed by a Dermatologist and usually administered at a specialist clinic or hospital to ensure it is medically supervised and harm to the skin is minimised. This form of treatment is different to the use of sunbeds, which primarily are used for tanning can cause substantial harm to the skin when used incorrectly. Commercial solariums are banned in Australia.
Light therapy is a safe and effective way to treat psoriasis.
Types of Phototherapy
1. UVB Phototherapy
- Broadband UVB (BB-UVB): This type of phototherapy uses a broad spectrum of ultraviolet B (UVB) light (290-320 nm). It has been effectively used for decades to treat psoriasis, but it has largely been replaced by narrowband UVB (NB-UVB) due to safety concerns.
- Narrowband UVB (NB-UVB): Narrowband UVB emits a smaller range of UVB light (311-313 nm). It is the most commonly used phototherapy for psoriasis in Australia. NB-UVB is preferred over BB-UVB due to its superior efficacy and lower risk of side effects. Studies have shown that NB-UVB is effective in clearing psoriasis plaques, with remission periods lasting several months after treatment completion.
2. PUVA (Psoralen + UVA)
PUVA therapy combines a photosensitizing agent (psoralen) with UVA light (320-400 nm). The psoralen can be administered orally or applied topically. Once the psoralen has been absorbed, the skin is exposed to UVA light. This combination is effective in treating more resistant cases of psoriasis. However, PUVA is associated with more significant side effects, including an increased risk of skin cancer, and is generally reserved for severe cases.
3. Excimer Laser
The excimer laser is a targeted phototherapy that delivers high-intensity UVB light to specific areas of the skin. This treatment is particularly beneficial for localized psoriasis plaques, such as those on the scalp, hands, and feet. It allows for higher doses of UVB to be delivered to affected areas while sparing the surrounding healthy skin.
Treatment Process
Phototherapy treatments are typically conducted in a clinical setting, under the supervision of a dermatologist or other healthcare professional. In some cases, home phototherapy units may be prescribed for patients who require long-term treatment.
Frequency and Duration: Patients usually undergo phototherapy sessions two to three times per week. The duration of each session can vary but typically lasts between 10 and 30 minutes, depending on the type of phototherapy and the patient’s skin type. Treatment courses generally last several weeks, with maintenance sessions possibly required to prolong remission.
Safety Precautions: Prior to starting phototherapy, patients are advised to avoid tanning beds, excessive sun exposure, and photosensitizing medications that may increase the risk of burns. During the treatment, patients wear protective eyewear to shield their eyes from UV light.
Effectiveness
Numerous clinical studies support the effectiveness of phototherapy in managing psoriasis:
UVB Phototherapy: NB-UVB is highly effective, with studies indicating that approximately 70-90% of patients experience significant improvement or clearance of psoriasis after 20-30 sessions. The remission period can last several months.
PUVA: PUVA is particularly effective for severe, widespread psoriasis and has been shown to achieve clearance in 85-90% of cases. However, due to its side effect profile, it is used less frequently than UVB phototherapy.
Excimer Laser: This treatment is effective for localized psoriasis, with studies showing improvement in over 80% of treated areas.
Side Effects and Risks
While phototherapy is generally well-tolerated, there are potential side effects and risks:
- Short-Term Side Effects: These may include redness, itching, and dry skin, which are usually mild and manageable.
- Long-Term Risks: Prolonged exposure to UV light increases the risk of skin aging and skin cancer. PUVA carries a higher risk of these complications compared to UVB therapy. Therefore, long-term monitoring by a healthcare provider is essential.
Phototherapy in Australia
In Australia, phototherapy is widely available in major cities and larger regional centers. Patients in rural or remote areas may face challenges accessing phototherapy services, but home phototherapy units can sometimes be an alternative. The Medicare Benefits Schedule (MBS) provides some coverage for phototherapy treatments, although patients may still incur out-of-pocket costs.
Summary
Phototherapy remains a cornerstone in the management of psoriasis in Australia, offering effective relief for many patients. While it is generally safe, it is important for patients to be fully informed about the potential risks and to undergo treatment under the guidance of a qualified healthcare provider. Advances in phototherapy technology and techniques continue to improve outcomes for people with psoriasis, helping them achieve better control over their condition.