Phototherapy at a Glance
- Best Results2-20 weeks
- Treatment Recovery0 Days
- Procedure Time1-5 minutes
- Skin SpecialistDermatologist
- Duration of ResultsVariable
- Back to WorkImmediately
- CostNo charge (Medicare)
Phototherapy Narrowband UV
Phototherapy harnesses the energy of light to naturally treat conditions such as acne, eczema, psoriasis & vitiligo. Depending on the condition, dermatologists employ UVA, UVB, blue, red & yellow light to naturally remedy some conditions. Phototherapy sessions take a few minutes to perform, with a frequency that ranges from one to three times a week. Most cases are covered under Medicare.
FactsFacts On Phototherapy
- Phototherapy can treat skin conditions ranging from acne, vitiligo, psoriasis, atopic dermatitis & many more
- The most common form of medical phototherapy uses narrowband UVB
- Medical phototherapy reduces skin inflammation, reducing the requirement for drugs including steroid creams
- Phototherapy takes a few minutes to perform with little if no side effects
- Medicare pays for this treatment, so there is no out of pocket expense
- Results from phototherapy can be seen within 2 weeks of starting
What is phototherapy?
Phototherapy is a broad term that refers to light therapy. In the context of this page, it refers specifically to narrowband UVB. Narrow Band light therapy delivers a precise, calculated dose of light in a photobooth. The procedure is done in the clinic & is supervised by dermatologists. It is considered as a medical treatment under Medicare.
Phototherapy can also be delivered using light emitting diodes that emit blue, red, & yellow light. This form of phototherapy is used to treat acne, wound healing & anti-aging. This form of phototherapy is considered as cosmetic & is discussed in other sections of this website.
What conditions can be treated with phototherapy?
Dermatologists employ different forms of light therapy based upon certain skin conditions. We use UVA, UVB, Narrowband UVB, blue, red, & yellow light.
- Blue light phototherapy is suitable for acne.
- Red Light phototherapy is best for anti-aging & reducing inflammation.
- Narrowband phototherapy is used to treat psoriasis, eczema, vitiligo, & many more inflammatory conditions.
*Medicare classified blue & red light as cosmetic. A rebate does not apply. Rebates apply for narrowband UVB under the guidance of a dermatologist.
What is involved in Phototherapy treatment?
Phototherapy treatment is performed at Cutis clinic and is overseen by dermatologists.
- Phototherapy patients will initially have a consultation with a Dermatologist who will review your medical history and assess your suitability for phototherapy treatment.
- During your appointment your dermatologist will determine your starting dose in phototherapy. You can start this treatment on the same day as the consultation.
- Your phototherapy protocol will depend on the condition being treated, but typically patients have 3 sessions a week, every two days, so either a Monday, Wednesday and Friday or a Tuesday, Thursday and Saturday. A standard course is around 6 weeks.
- The process is as simple as stepping into a private phototherapy booth for 30 to 200 seconds.
- The booth is computer activated and you are exposed to the UVB light while fans keep you cool and well ventilated.
- Following the treatment session, you can leave and return to work or home.
How does phototherapy work?
Narrowband phototherapy works by reducing skin inflammation that is responsible for cases of vitiligo, psoriasis & eczema. Phototherapy with red & blue light can also kill the bacteria in acne lesions. Dermatologists may suggest phototherapy if you have severe flare-ups that your usual treatment – like moisturisers and anti-inflammatory medical creams – doesn’t help enough. It can completely clear many skin problems, but it’s not usually a permanent cure and you may need more treatments.
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Why is phototherapy an essential part of treating vitiligo?
Vitiligo is caused by inflammation of the skin & loss of pigment. Phototherapy treats both these factors & is a highly effective treatment for most cases of vitiligo. Let’s break it down.
Inflammation: this autoimmune activity results in your skin’s immune system attacking the pigment cells located in the upper layers of skin. This is because your immune surveillance (which is responsible for fighting off cancer & infections) mistakes your melanocytes for foreign cells. Anti-inflammatory creams with narrowband phototherapy slow down & in most cases halts this attack.
Pigment loss is universal in vitiligo. This is due to death of pigment cells secondary to inflammation. Phototherapy stimulates re-population & migration of melanocytes, thereby causing re-pigmentation white patches. Light essentially wakes up sleeping pigment cells.
What forms of vitiligo will respond best to phototherapy?
A good way to understand your prognosis of improvement is to subtype your vitiligo. You have a 85-90% chance of re-pigmentation in vitiligo involving your face. The presence of black pigment within tiny hair follicles is a good sign.
Trunk vitiligo & proximal arms, upper limbs, upper legs will have a 55-75% chance of re-pigmentation. Long standing acral vitiligo of the hands, fingers, toes & feet will only have a 10-20% chance of re-pigmentation. Segmental vitiligo has an extremely low chance of resolution.
How many phototherapy sessions will I require?
A minimum of 20 weeks is required. Most cases of re-pigmentation will occur within a period of 6-10 weeks, thereby slowly increasing over time.
Phototherapy is only one part of the treatment. Anti-inflammatory creams & melanocyte migrating topicals are important adjuncts. Other adjunctive methods to help treat vitiligo include –
- Vitamin D creams
- CS anti-inflammatory creams
- Calcineurin inhibitors
- Vitamin D tablets & anti-inflammatory tablets
- Dietary supplements including ginkgo biloba
How effective is Phototherapy?
Phototherapy has long been the option of choice for Dermatologists. While not all patients will respond to light therapy, most patients find that they achieve excellent results which last for several months.
In psoriasis, significant improvement from phototherapy may be seen within two weeks. Most patients achieve clearance after 15 to 20 treatments and experience a remission rate of 38% after one year. Vitiligo patients will require 20-30 sessions before knowing if narrowband works. Phototherapy is also hugely successful in treating pityriasis rosea, & eczema.
What are the side effects of phototherapy?
Side effects are very rare & in most cases mild; however the following can occur-
- Inflamed skin / minor phototherapy burn. Usually mild & will settle in 2-3 days. Occurs if you expose new areas to light or take an extended period of time off from phototherapy.
- Dry & itchy skin may occur early during treatment. Will settle with moisturisers.
- Cold sore are rare, but have been reported in the literature.
How many sessions will I require?
This depends on the condition. As a guide-
- Vitiligo: 4-6 months. Hence 35 to 40+ sessions.
- Psoriasis: Guttate psoriasis 8 to 20 sessions.
- Plaque psoriasis: 20+ sessions
- Eczema: Cyclical sessions 20+
- Pityriasis rosea: 20+ sessions
What are some tips for narrowband phototherapy?
This will be covered by your treating dermatologist as we all have slightly different protocols. Here are my top 5 recommendations-
- Always wear the same style of clothing to your session. This will prevent burning. The computer is not that smart to account for changes in clothing & coverage.
- Cover your face & eyes if these areas are not affected. This will reduce darkening of these areas.
- Spaced your intervals out. A good interval is every second day. Cutis is opened on Saturdays; hence you have 6 days to get your sessions in.
- Drop your dose if you skip more than 7 days since your last session. This will prevent unwanted burns.
- Moisturise. Using a moisturizer a few minutes or hours prior to your session improves light transmission, in turn making your treatment more effective.
How is medical phototherapy different from a tanning bed?
Tanning – sunbeds shouldn’t be used as a solution for a skin condition because they aren’t tightly regulated or calibrated. This means you may not receive the exact spectrum of light or dose that effectively balances treating your condition against your risk of skin cancer.
Tanning beds have a broad spectrum of UVB & in most cases UVA. The amount of ultraviolet B (UVB) light, which is the most effective type of light for treating vitiligo, psoriasis & eczema, for instance, is frequently reduced in tanning beds. This means that the light produced by sunbeds may be of no benefit in treating your skin condition & in most cases can even be harmful. UVA destroys collagen; hence you will age faster!
The same is true of home sunbeds. The type of tube used and the ultraviolet light produced can vary so you won’t know exactly how much exposure you’re getting. It’s harder to build up the amount gradually and sunbeds can damage your skin before it goes red.
How is natural sunlight different from phototherapy?
Natural sunlight is known to be helpful for skin conditions such as acne, vitiligo, eczema & psoriasis. The flipside is that it can be hard to control how much sunlight you get and to keep it within a safe amount. The beneficial wavelength is UVB – this is the burning wavelength & is most prevalent at midday. Natural sunlight also has UVA & visible light; hence you will be getting exposure to the cancer inducing wavelengths of light.
Narrowband phototherapy supervised by dermatologists are carefully controlled in terms of both the dose that is delivered to your skin and the wavelength. Both of these factors will be recorded as your treatment is gradually increased. This means you can be given the most effective light treatment in the safest way.
What are factors to consider before going on phototherapy?
A dermatologist will discuss your care and the procedure with you. This will be designed to meet your individual needs so it may be different from what’s described on this page. Factors to consider before starting on narrowband UVB include-
- Medicines you’re taking, including anything you apply to your skin
- How sensitive you are to light
- Your genetic skin type or skin colour
- Any history of eye conditions
- Your risk of developing skin cancer, including family or personal history of melanoma
- The logistics of this treatment (ideally 2- 4 times a week)
Sensitivity to light varies between different areas of your body – your trunk (the central part of your body not including your head, arms or legs) is especially sensitive.
Can anyone have phototherapy?
The majority of the population can have phototherapy with the exception of-
- Patients with a personal or family history of melanoma & or multiple dysplastic moles
- Patients with super rare blood disorders including porphyria.
- Very young children who are not yet ready to stand in a phototherapy room for 2 to 3 minutes.
Ultraviolet B (UVB) treatment is generally safe for children & pregnant / breastfeeding women. You need to be able to attend regular sessions of Phototherapy for it to be effective. Furthermore, because of the equipment used, you may need to stand up unaided for at least 2-3 minutes or even longer. There’s also a limit to how many sessions you can safely have. Your dermatologist will consider your lifetime exposure number as this depends on your skin type.
Can phototherapy cause accelerated skin aging?
Narrowband phototherapy is one specific wavelength of UVB, namely 311 nm. The main action spectrum for photoaging is UVA, as this goes deeper into the dermal layer of skin. UVB is the spectrum for sunburn & is less destructive to collagen than long wave UVA.
What is the cost of phototherapy?
There is no charge for this service if you hold a Medicare card. Yes, this is completely bulk billed.
If you are an overseas visitor or hold medical insurance, you may be covered for this procedure. Check with your insurance company. If you are not insured, the clinic charges $34 for each treatment.
Note: You are required to have follow ups 2-3 times a year, standard charges apply for these visits.
Davin’s Viewpoint: Phototherapy
Phototherapy is a broad term to describe light in a narrow wavelength as well as in a concentrated spectrum known as low level laser therapy (LLLT). This also extends to LED or light emitting diodes. Light plays an important role in the biology of skin. Depending on the wavelength of light, the fluence & the presence of chromophores or targets, light can heal or conversely light can destroy.
This page refers primarily to narrowband phototherapy or nUVB. This form of phototherapy has been adopted by dermatologists throughout the world for the treatment of inflammatory skin conditions including psoriasis, lichen planus, atopic & exogenous dermatitis, as well as vitiligo. It can also be used to treat rare skin conditions such as lymphomas, morphea, PLEVA & over a dozen other conditions. In this role, UV modulates cellular inflammation.
Narrowband phototherapy is one of the most useful treatments for vitiligo as it can offer efficient, safe treatments with no cost to patients. Treatments are bulk billed under Medicare. In this context phototherapy also encourages melanocyte migration & melanin production. An analogy of narrowband phototherapy is the excimer laser or excimer-like 308 nm lamp; essentially 3 nm short of the nUVB wavelength. I have used this device before (308 laser). It can be effective in spot treatments for vitiligo however Medicare does not recognise this service, & hence nUVB is more cost effective, saving patients over five to nine thousand dollars a year.
In other sections of this website, I discuss other forms of phototherapy including red, blue & yellow light as well as photodynamic therapy.
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