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Psoriasis and phototherapy

We know a lot about the negative influence of sunlight on the body. It is well known that it can cause cancer and accelerate skin aging. But do not forget that sun rays of UVA and UVB are needed for a healthy lifestyle. They contribute to the release of endorphins and vitamin D synthesis that enables its absorbtion. Moreover, they help in the fight psoriasis.

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psoriasis and phototherapy

How does phototherapy work?

Phototherapy is the effect produced on the affected areas of the skin with ultraviolet radiation on a regular basis. Phototherapy involves skin irradiation with special light-emitting UVA and UVB-light. The direct result of treatment is a reduction in the number of T cells of the skin responsible for activating inflammatory processes. As a result, psoriasis stops developing. As a rule, therapeutic procedures are carried out 2-3 times a week throughout 3-6 weeks. However, this is not a rule. Depending on the particular case, the duration of treatment and the frequency of procedures may vary. Often, the first results are visible after a few sessions, but about thirty procedures are sometimes needed to achieve the largest effect.

Phototherapy as an alternative treatment for psoriasis

Some doctors recommend UV exposure as a replacement for some oral medications. In addition, light therapy is used along with other treatments. The duration of phototherapy depends on many factors, and the most important is the severity of psoriasis. In order not to damage your skin, it should be remembered that phototherapy has to be conducted under the supervision of a physician.

What are the general contraindications for phototherapy sessions?

There are not very many unconditional contraindications for phototherapy. They are:

  • tuberculosis
  • eye disease, including cataracts (phototoxicity is possible during the procedure)

  • skin diseases, accompanied by photosensitivity

  • taking medications that affect the photosensitivity of the skin.

  • porphyria - porphyrin disease

  • acute or chronic renal insufficiency

  • severe liver disease

  • hypertension with a tendency to hypertensive crisis, heart failure

  • diabetes

  • severe atherosclerosis

  • stroke, increased probability of hemorrhage

  • increase in hair growth

  • systemic red lupus

  • acute malaria period

  • hereditary or congenital photosensitivity of the skin

  • anorexia

  • mental disorders and manic conditions that occur on the background of increased nervous tension

  • high sensitivity to sunlight (propensity to burns)

  • predisposition to skin cancer and other skin diseases

What are the types of light therapy?

Phototherapy is conducted with the help of various types of ultraviolet radiation. Traditional forms of psoriasis treatment comprise ultraviolet A and B radiation (UVA) and (UVB) respectively. UVB radiation with a wavelength spectrum (290-320 nm) reaches only the epidermis which leads to a weakening of psoriasis symptoms. UVA radiation range is 320-400 nm, it reaches deeper layers of the dermis, so it is used in later and more severe phases of psoriasis. Other types of phototherapy are also used, including selective phototherapy and photochemotherapy, based on complex action using a pharmacological agent (psolarene).

Ultraviolet B (UVB)

An artificial UVB source can be used to treat mild to moderate psoriasis. There are two types of phototherapy with UVB:

  • broadband
  • narrowband

Broadband phototherapy can be used for minor skin lesions, for the treatment of plaque psoriasis or symptoms that can not be treated with topical medications.

A newer type of UVB is narrowband phototherapy, which is the most effective treatment for psoriasis. The narrow strip passes UVB better and more throughly than broadband UVB does.The treatment for psoriasis with narrowband UVB is becoming increasingly popular because it is effective and more convenient. Initially, the patient may need several procedures for narrowband ultraviolet radiation at short intervals to improve the skin condition. Once this (skin condition improvement) has occurred, a patient can continue support therapy once a week. This will be enough to maintain a satisfactory effect. However, this therapy has its disadvantages, namely a chance of causing more severe and prolonged skin burns than broadband phototherapy.

Who can use phototherapy (UVB) as a treatment for psoriasis and how effective is it?

Despite the high popularity of phototherapy as a method of treatment, not everyone can use it. In most cases, this method is recommended for people who suffer from plaque psoriasis and do not get the desired effect from the use of topical drugs that only increase the number of lesions.

The fact that psoriasis deteriorates from the sun should not be a contraindication, because phototherapy uses only a certain type of UV radiation. However, you need to be careful with UV rays always protect your eyes and never look directly at the light source during the procedure.

Phototherapy is a method of treatment that is relatively safe, convenient and in most cases effective. However, do not forget about the consequences which resemble the effects sunbathing produces. Most often it is over-drying and aging of the skin. But these factors can be eliminated by applying appropriate moisturizing creams that do not contain salicylic acid.

Studies show that 85% of psoriasis patients respond positively to UVB exposure to and this method of treatment is considered to be one of the safest, regardless of whether broadband or narrowband radiation is used. Due to the short length of the UVB wave that does not reach the deeper layers of the skin, this radiation type doesn’t bring any harm to pregnant women not causes serious liver diseases and cataracts. This therapy can also be used for psoriasis treatment in children. Another benefit of this therapy is that the risk of developing skin cancer is very low.

However, one should keep in mind that treatment with be longer with this this radiation type than that with PUVA therapy. It consists in therapeutic procedures 2-3 times a week for the duration of the session - from several seconds to several minutes, during which the skin gradually gets used to radiation. Significant improvements can be seen after a patient undergoes 20-30 procedures.

Various side effects, such as mild erythema, dry skin, increased sensitivity to sunlight or even burns, often occur on the affected areas. You also have to inform your dermatologist when you would like the next procedure to begin. Then your doctor decides whether to continue treatment or stop it until the symptoms described above disappear. On average, it takes about 4-5 days for the symptoms to go away.

The list of factors that determine the effectiveness of treatment is very large. There are patients for whom phototherapy was quite effective and there are those who did not notice any changes, but there are also patients who complained about worsening of psoriasis symptoms. The latter category are the patients who have been allergic to sunrays or those who have a tendency for skin cancer.

UVA + Psolaren - Photochemotherapy

Photochemotherapy, the type of treatment for psoriasis taking the shortest amount of time with the help of ultraviolet irradiation and andsimultaneous use of a photosensitizer, psolaren (hence the name of PUVA therapy). With the support of drug treatment, this type of phototherapy is more effective but has more contraindications and side effects.

Treatment with PUVA therapy is contraindicated:

  • pregnant women and those who plan to conceive a child in the near future
  • children under the age of five

  • people with cataracts

  • patients with severe liver or kidney disease

  • people with neurological disorders

  • for patients who have been treated with radiotherapy in the past

  • people taking immunosuppressants

  • Patients with hypersensitivity to the drug psoralen

  • people who have had cancerous tumors

Before starting treatment, a series of tests is needed to determine if the patient has the proper health condition to begin the therapy. These tests include the analysis of the liver for enzymes, visual examination and a pregnancy test. During UV exposure it is recommended to use contraception to prevent the danger the fetus is at because of the drugs and it’s also suggested to take test for liver ferments.

Taking light sensitizing drugs is necessary 2 hours before UV treatment that is conducted 2-3 times a week. This should be done during meals, because they are better absorbed. Patients may feel weak, more sensitive to light, the worsening of general health condition caused by dizziness, abdominal pain, nausea or vomiting. The above symptoms are the most common side effects of the drug psoralen. They disappear in a few hours. Sunlight exposure should be avoided during the treatment and about a week after withdrawal As it can cause burns. This is due to the fact that natural skin protection is disturbed when taking medication. To minimize side effects such as nausea, you can drink ginger beer or milk before or after taking psolarin.

With PUVA therapy, the period of psoriasis remission may be longer than with other methods. However, one should keep in mind that prolonged treatment with photochemotherapy enhances its side effects and can lead to:

  • increased erythema and blistering
  • the appearance of rash and itching

  • faster skin aging

  • higher probability of skin cancer

Advantages and risks of phototherapy

The use of phototherapy for the treatment of psoriasis has a number of distinct advantages over other treatments for this disease:

  • almost all the patients tolerate this kind of therapy well
  • The safety of the method for medical professionals who directly undergo treatment sessions

  • the effect after the end of phototherapy is most positive

  • it’s possible to adjust the dosage of ultraviolet light in topical therapy to minimize the risk of cancer

  • selective phototherapy can prevent psoriasis emergence on healthy skin

As any other method of treatment, phototherapy can have side effects. It is advisable get ready for them in advance. These negative symptoms may appear immediately after the procedure or in a few months or even years.

Among the manifestations that appear in the coming terms there are:

  • excessive dryness of the skin
  • itch

  • erythema of mild toxicity

Unfavorable symptoms that may occur later:

  • hyperpigmentation, spots on the skin
  • atypical skin degeneration (malignant formations)

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