UVB Psoriasis Treatment - Ultraviolet-B Light Therapy

UVB Psoriasis Treatment

Ultraviolet-B rays are highly effective in treating psoriasis. Phototherapy with ultraviolet-B alone or in combination with other agents, such as coal tar or anthralin (Psoriatec), can improve psoriasis. Ultraviolet-B can be given as:
  • Ultraviolet-B (290-320 nanometers) - known as broadband UVB 
  • Narrow-band UVB (311 nanometers)
  • Goeckerman regimen (UVB plus coal tar)
  • Ingram regimen (UVB plus anthralin)
  • UVB plus systemic agent
  • UVB plus another topical agent (calcipotriol [Dovonex, Daivonex], tazarotene [Tazorex], topical steroid)
The starting dose for each patient depends on his or her skin type, and typically ultraviolet-B treatments start with only a few seconds of exposure to light. Over time the exposure time is gradually increased until the skin is clear. You could require treatment anywhere from three to five times a week, and as your skin begins to clear, your doctor might stop light treatments or start you on a regular schedule to maintain your improvement. This can include coming in once every week, two weeks, or monthly. During your active treatment period, you will be examined on a regular basis by the treatment staff at the phototherapy unit. If you burn during treatment, immediately notify your dermatologist or the treatment staff.

 
UVB Psoriasis Treatment

Precautions to Take While Undergoing Ultraviolet.B Therapy
  • Do not attend tanning beds while receiving light treatment.
  • Cover up when outdoors or use a sunscreen (SPF 15+), especially on the days you receive light treatment and for the duration of the treatment.
  • Use sunscreen during treatment on sensitive areas, such as nipples and lips.
  • Men should shield their genital area when getting light treatments.
Combining Ultraviolet-B with Topical Agents 

 Goeckerman Regimen

Developed in 1925 by Dr. Goeckerman, the regimen name after him is a combination therapy of tar and UVB radiation. Tar can be highly effective in the treatment of psoriasis when combined with ultraviolet-B because tar makes the skin more sensitive (photosensitizes) to ultraviolet light. Together, tar and UVB can help slow the high turnover of skin cells, and reduce inflammation and itching.
 
While there have been many modifications to the Goeckerman regimen, this procedure in general calls for the application of distilled coal tar before exposure to ultraviolet light, followed by a bath after exposure to remove any excess tar:
  • Distilled coal tar is applied by topical application, or by taking a tar bath, before exposure to UVB radiation.
  • Have exposure to UVB phototherapy according to the dose determined by the treatment staff.
  • Take a plain soap-and-water bath to remove excess tar. Do not rub vigorously to remove it.
  • If this process is to be repeated the next day, you might be asked to apply tar and a stockinette suit or sauna suit, which is left on until the next day, before leaving the treatment center.
The Goeckerman regimen is one of the most effective methods of reducing a temporary clearance of psoriasis; however it has several disadvantages: The tar is messy and causes staining and discoloration of the skin, and the regimen is inconvenient.
 
Ingram Regimen
 
Dr. Ingram pioneered the use of anthralin with UVB. Anthralin and ultraviolet-B work together to help remove psoriasis plaques and stop the rapid turnover of skin cells, which, in part, causes the raised areas of skin in psoriasis. The regimen varies in each center, but the general principles involve the application of a 0.1-2 percent anthralin cream before exposure to ultraviolet radiation.


 Anthralin is applied and covered by a stockinette or sauna suit the day before UVB treatment. At the treatment center, do the following:
  • Remove anthralin paste by dabbing all areas with mineral oil and wiping off.
  • Bathe in a tar bath (cup of coal tar solution in bath water) for ten minutes using soap.
  • Dry off.
  • Have exposure to UVB phototherapy.
The anthralin paste is then reapplied and covered with a stockinette or sauna suit.
 Anthralin can stain clothes and bed linens permanently, so patients are advised to wear old clothing and use old linen. Also, the eyes and normal skin are extremely sensitive to anthralin and can quickly become irritated. Always wash your hands carefully after contact with anthralin.


 Calcipotriol Plus UVB
 
In combination with ultraviolet-B, calcipotriol has been found to be highly effective in controlling psoriasis. The combination of calcipotriol with twice weekly UVB phototherapy may reduce the amount of ultraviolet-B required without using any other combinations. Unlike tar, calcipotriol is applied after ultraviolet-B exposure.


 Tazarotene
 
Tazarotene has also been used with UVB; again the combination may work better than the sole use of UVB. 

UVB Psoriasis Treatment

 Combining Ultraviolet-B with Systemic Agents 

Ultraviolet-B can also be combined with systemic agents, including methotrexate (Rheumatrex), cyclosporine (Sandimmune), and retinoids. Depending on the individual, any of these combinations could increase the effectiveness of therapy. To find out more, you can check out UVB Psoriasis Treatment.
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