Skin Phototherapy in Hyderabad – Advanced Treatment for Skin Diseases

Phototherapy is an effective therapeutic approach in managing various skin related disorders by using UV radiation. Some of the indications of phototherapy include the treatment of the following diseases:

• Psoriasis: Psoriasis is primarily managed through phototherapy, which is both effective and safe. This treatment option is generally recommended when topical therapies are ineffective or unsuitable for the patient, especially in cases of widespread psoriasis. Additionally, phototherapy is often the only practical treatment for severe psoriasis patients who cannot use systemic therapies due to contraindications.

• Vitiligo: Vitiligo is a pigmentation disorder that results from the loss of melanocytes in the skin. Typically, it follows a chronic and stable course, with occasional short episodes of progression. The primary treatment options for this condition are NB-UVB and PUVA phototherapy. At present, NB-UVB is considered the first-line treatment for the generalized type.

• Lymphoma: The choice of phototherapy, whether it be PUVA, NB-UVB, or extracorporeal photochemotherapy, will depend on the stage of the disease, the patient's preferences, and the availability of the methods.

• Parapsoriasis: Parapsoriasis is a persistent inflammatory skin condition with an unclear cause. Phototherapy is recommended for all forms of parapsoriasis and its variations. Generally, narrowband UVB (NB-UVB) is the preferred treatment option. PUVA therapy is suitable for patients with thick plaques, higher phototypes, and those who do not respond to UVB treatment.

• Scleroderma: Scleroderma is a long-lasting connective tissue disorder, and its exact cause is still unclear. This condition is marked by significant collagen buildup in the skin and, in certain instances, in internal organs as well. Phototherapy is a safe treatment option since it targets the skin specifically, minimizing the risk of systemic complications. It offers an effective alternative for patients who do not respond well to topical or systemic treatments.

• Atopic dermatitis: Atopic dermatitis (AD) is a prevalent chronic inflammatory condition that tends to recur over time. Phototherapy has been effective in treating moderate to severe cases of AD. The current treatment options include narrowband ultraviolet B (NB-UVB), UVA1, PUVA, and excimer laser/lamp therapies.

• Photodermatoses: Phototherapy is a valuable approach for preventing seasonal occurrences of photodermatoses. Typically, the doses of NB-UVB and PUVA used are lower than those employed for other skin conditions. While this therapy is generally safe, a small percentage of patients may experience skin rashes; however, these reactions do not hinder treatment or negatively impact the prognosis.

• Pityriasis lichenoides: Pityriasis lichenoides chronica (PLC) is a rare skin condition with an unknown cause. Phototherapy is one of the primary treatment options, especially for more widespread cases of the disease.
  

The contraindications for phototherapy are as follows: 

• Systemic diseases with a photosensitive component
• Systemic lupus erythematosus
• Dermatomyositis
• Photodermatoses
• xeroderma pigmentosum
• Basal cell nevus syndrome
  

Before Phototherapy

• Patient Assessment: The patient’s medical history, skin condition, and any contraindications (like photosensitivity or certain medications) are reviewed. A patch test may be performed to check for adverse reactions to UV light.
• Preparation: The patient is instructed to avoid sun exposure for a few days before the procedure. The skin is cleansed to remove oils, lotions, or other substances that might interfere with the treatment. Protective goggles are provided to shield the eyes from UV rays.
• Treatment Plan: The doctor determines the appropriate type of phototherapy (e.g., UVB, PUVA) based on the skin condition (e.g., psoriasis, eczema, vitiligo).

During Phototherapy

• Photon Application: The patient is exposed to UV light using a specialized light box or handheld device. For UVB therapy, the patient stands or sits in a unit with UVB lamps. For PUVA, the patient takes a photosensitizing medication (psoralen) before exposure.
• Duration: The duration of exposure depends on the type of therapy and the patient's skin type. The treatment is usually brief, ranging from a few seconds to a few minutes.
• Monitoring: The patient’s skin is monitored during exposure to ensure there are no adverse reactions, and the duration of the exposure is adjusted based on individual tolerance.

After Phototherapy

• Post-Treatment Care: After the session, patients are advised to apply moisturizing creams to keep the skin hydrated. They should avoid direct sun exposure to reduce the risk of sunburn. 
• Follow-Up: Multiple sessions are usually required over several weeks to achieve optimal results. Follow-up appointments are scheduled to monitor the skin’s response and adjust treatment if necessary.
• Side Effects Management: Common side effects include redness, itching, or dryness of the skin, which generally subside after a few hours to days. In rare cases, more severe reactions like blistering or increased pigmentation may occur, requiring intervention.
  

The protocol for phototherapy varies based on the type of UV radiation. In addition, as the type of skin disorder varies, the duration of phototherapy application changes depending upon the severity of the disease,

• For NB-UVB phototherapy, the initial radiation dose is based on the minimal erythema dose (MED), typically starting at 50-70% of MED or according to the Fitzpatrick skin phototype.

• Each session sees an increase in dose by 10-20%, and treatments can occur 2 to 5 times a week. If erythema occurs, the dose should be reduced, or the treatment postponed. 

• BB-UVB phototherapy follows a similar procedure, but in the first 10 sessions, the radiation dose is increased by 25% per session, then raised by 10% in subsequent sessions.

• Psoralen can be administered orally at a dose of 0.6 mg/kg, taken 2 hours before exposure to UVA irradiation.

• The initial UVA dose is determined based on the minimum phototoxic dose (MPD), typically 50-70% of the MPD, or according to the patient’s skin phototype. Treatment may involve 2 to 4 sessions per week, with the UVA dose being increased weekly.

• Psoralen can also be applied topically. Alternatively, psoralen baths can be prepared at a concentration of 1 mg/l in water heated to 37˚C for 15 to 20 minutes, followed by UVA exposure.

• The initial UVA dose for this method should be 30% of the minimal erythema dose (MED), and treatments can occur twice a week, with a 20% increase in dosage each week.
  

Phototherapy, or light therapy, offers several benefits for various skin disorders. Here are some key advantages:

• Effective Treatment: Phototherapy is particularly effective for conditions like psoriasis, eczema, and vitiligo, helping to reduce inflammation and promote skin healing.

• Non-invasive: Unlike some medications or surgical options, phototherapy is a non-invasive treatment, which generally means fewer risks and side effects.

• Reduced Steroid Use: For conditions often treated with topical steroids, phototherapy can help decrease the reliance on these medications, reducing potential side effects associated with long-term steroid use.

• Customization: Phototherapy can be tailored to the specific needs of the patient, with different wavelengths and treatment durations adjusted based on individual responses.

• Long-lasting Effects: Some patients experience prolonged remission of their skin conditions after completing a course of phototherapy.

• Minimal Side Effects: While there can be some risks (like skin irritation or increased sensitivity to sunlight), serious side effects are relatively rare compared to systemic treatments.



• Convenience: Treatments can often be done in outpatient settings, and home phototherapy units are available for certain conditions, providing flexibility for patients.
  

Phototherapy is associated with a series of side effects. Short-term side effects include: 

• Erythema
• Xerosis
• Pruritus
• Skin hyperpigmentation
• Blistering
• Worsening skin disease
• Photoconjunctivitis or photokeratitis (eye protection is mandatory)

The long-term side effects include: 

• Photoaging
• Wrinkling
• Freckling
• Xerosis
• Telangiectasia
• Elastosis
• Atrophy 

• Photocarcinogenesis
• actinic keratoses
• squamous cell carcinoma
• basal cell carcinoma
• melanoma
• genital skin cancer
  

What is phototherapy?

Phototherapy involves using specific wavelengths of light to treat various skin disorders. It helps reduce inflammation, promotes healing, and can improve symptoms like redness and itching associated with conditions such as psoriasis and eczema.

How does phototherapy work?

Phototherapy works by penetrating the skin with ultraviolet (UV) light or other wavelengths. This process reduces skin cell proliferation, suppresses inflammation, and modifies immune responses, thereby alleviating symptoms of skin disorders.

Are there different types of phototherapy?

Yes, there are several types of phototherapy, including narrowband UVB, broadband UVB, PUVA (psoralen plus UVA), and blue light therapy. Each type uses different wavelengths and has varying effectiveness based on the condition being treated.

How often should I undergo phototherapy?

The frequency of treatment varies based on the condition and severity. Typically, sessions may be scheduled two to three times per week. Your healthcare expert will develop a personalized treatment plan.

Can I do phototherapy at home?

Yes, home phototherapy units are available for certain conditions, like psoriasis and eczema. However, it's essential to follow your healthcare expert’s guidelines to ensure safe and effective use.

Is phototherapy painful?

Most patients report minimal discomfort during phototherapy. Some may feel warmth or slight itching, but significant pain is uncommon. If you experience discomfort, communicate with your provider for adjustments.

Can I continue other treatments while undergoing phototherapy?

It's essential to inform your healthcare expert about any other treatments you're using. They may adjust your medications or topical treatments to enhance the effectiveness of phototherapy.

What precautions should one take during phototherapy?

During treatment, protect your skin from excessive sun exposure and follow any specific instructions from your healthcare professional. Wearing protective eyewear during certain treatments may also be necessary.

Can phototherapy be combined with other therapies?

Yes, phototherapy can be combined with other treatments, such as topical medications, to enhance overall effectiveness. Discuss with your healthcare expert the best approach for your individual condition.

What happens after completing phototherapy?

After completing treatment, some patients may experience prolonged remission, while others may require ongoing maintenance sessions. Regular follow-ups with your provider can help manage any recurring symptoms.

Will phototherapy cure my skin condition?

While phototherapy can significantly improve symptoms and quality of life, it may not completely cure some chronic skin conditions. Long-term management strategies may be necessary to maintain results.

How do I know if phototherapy is right for me?

Consult with a dermatologist or medical expert specializing in skin disorders. They will evaluate your condition, discuss potential benefits and risks, and help determine if phototherapy is a suitable treatment option for you.