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What is narrowband light treatment ? How can it help me ? What are the dangers ? What are the benefits ? How does it compare ? Learn how to treat psoriasis, eczema, vitiligo. These guidelines could help you take control of your skin condition. (In tests 95% thought the results were excellent, very good or good and the remaining 5% thought the results were fair - BMJ report below)* . Note - we have a separate treatment plan for Vitamin D Deficiency - Click here to go straight to Vitamin D page).
Most psoriasis sufferers benefit from exposure to UVB light, one of the forms of ultra violet light that comes from the sun. There are 3 forms: UVA, UVB and UVC. Short wavelength UVC is absorbed by the ozone layer and does not reach the earth's surface. The UV light which does reach us is mainly long wave UVA, with some intermediate UVB and it is the UVB rays that help treat and improve skin conditions like psoriasis, vitiligo and eczema. UVB light treatment aids chemical reactions that affect the function of cells, with psoriasis this means that the skin behaves more like normal skin as it's exposed to UVB/ sunlight and that's why when most people go abroad to a sunny climate their skin condition improves as well.Too much UVB however is not a good thing because it burns and natural sunlight is a mixture of UVB and UVA. Too much of both can prematurely age the skin and increase the risk of skin cancers. So you do need to take care even if you find that the sun helps your skin. The people at highest risk are those who have fair or red hair and those whose skin does not tan easily.
UVA only helps slightly for skin conditions but it is a scientific fact that UVB treatment can be used for a number of skin conditions such as psoriasis, vitamin D deficiency (separate link with treatment guidelines is available at the foot of this page), eczema, vitiligo, acne and scleroderma. Even though we specifically mention psoriasis, our notes apply to all these conditions and some other skin conditions that react positively to UVB light. If in doubt please consult your doctor or dermatologist.
UVB contains a wide range of wavelengths and can be used to treat guttate or plaque psoriasis (plus acne and eczema), which is proving resistant to "topical" treatments (i.e. creams and ointments). In the past few years a more refined form of UVB has been developed, known as "narrowband" and this is proving to be very effective. Narrowband is proved to be more readily absorbed into the skin and therefore is generally more effective and safer than traditional broadband UVB phototherapy treatments. Scientists have established that UVB at a certain wavelength (311nm) is particularly therapeutic for skin conditions. Most of the Narrowband UVB in a Philips TL01 tube is at 311nm - more so than any other tube (within a narrow spectrum wavelength ie. the term Narrowband).
Over 400 independent studies have shown Philips TL01/100w High UVB Narrowband to be the market leading Narrowband Tube in the world. Be careful - to get the best results, with the minimum risk make sure any unit you purchase contains Philips Narrowband tubes. Do not buy an inferior product for your phototherapy treatment.
The aim is to diminish, reduce and control the condition and in some cases clear the skin. Although this can vary slightly from person to person it can usually take between 4 and 8 weeks depending on the severity of the condition before you will see any significant improvement*. Session times will range between just a few seconds up to 3 minutes depending on skin type. The treatment should be every other day and compared with broadband UVB and PUVA, narrowband UVB has been found to be much more effective in treating psoriasis/ vitiligo etc. In fact, most hospitals/ clinics now only offer the narrowband treatment and most establishments will only use the Philips TL01 narrowband tubes because:-
That's why all our units are fitted with the latest Philips TL01 or PL01 Medical Narrowband high UVB tubes exactly the same as those used in many hospitals. Depending on severity, either the whole body or just the infected areas can be exposed to the UVB light. The skin must only be exposed to the UVB Narrowband light for a short period of time (seconds to minutes) and precautions must always be taken to protect the eyes (use Goggles provided) and genital areas.
A number of protocols regarding the exact treatment times exist depending on the individual's skin type, age, skin condition and other factors. As a general guideline, treatment times should start around 30 secs and then build up the time gradually (ie. by an extra 10 secs per session) to a maximum of around 3 minutes. Remember exact maximum times will be determined by skin type. During treatment, the skin may remain pale or turn slightly pink after each session, may also itch and may feel a little sore for a short while. This is perfectly normal.
If you feel really uncomfortable or experience longer periods of soreness then that may be indication that your session times are too long for your skin type. Reduce your session times and let your doctor or dermatologist know if you still continue to feel sore. Patches of psoriasis generally start to become thinner after five to ten treatments. Most patients with psoriasis need about 15-30 treatments to experience significant improvement.
We've already mentioned above a few possible short term side effects during light treatment for skin. Overuse of narrowband can result in burning, just like sunlight and broadband UVB. Frequent emollients or moisturisers can be applied, and if recommended by the doctor, topical steroids. It is important that if you use ointments in conjunction with Narrowband UVB treatment, that the ointments should be applied after the treatment, unless you have been advised otherwise by your doctor or dermatologist. UVB sometimes provokes polymorphous light eruption. Long term exposure to ultraviolet radiation ultimately causes skin ageing and skin cancers.
If used sensibly Philips Narrowband is certainly less risky than Broadband and PUVA treatment because most of the UVB narrow band light therapy is within the therapeutic wavelength of 311nm, Broadband light is over a much wider wavelength - less UVB in total (and much less within the therapeutic wavelength) and a greater percentage of UVA. Cheaper narrowband tubes will also emit less light at 311nm and more in the non-therapeutic wavelength - hence increasing your chances of short term and long term problems.
More generally, you must remember that all UV radiation can cause skin damage and light treatment for psoriasis, vitiligo and other skin conditions have to be rationed. Doctors will not put patients at unnecessary risk and care should be taken with the number of treatments over one year and indeed over a lifetime. This will vary from person to person depending on skin type and total dose administered.
This is why, once your condition has improved significantly do not use the unit again until you feel the ailment returning or your condition worsening (this could be after several weeks or months and in some cases over 12 months - everyone is different), then just a few sessions are usually required to keep it under control again. Do must not use the unit continuously, if you do you may increase the risks of long term skin problems !
There are large numbers of studies showing the positive effect of UVB on patients. Generally 95% of psoriasis patients say the results were either excellent, very good or good, the remaining 5% said the results were fair at the end of the treatment period (see BMJ report)*. You must remember this is not a cure but a way of keeping your condition under control, most people will be clear for a period of time but this will vary from person to person - you may be clear for a few weeks or well over a year - everyone is different. As we have previously mentioned, once you are clear or at an acceptable level stop using the unit and only use again when the condition begins to reappear. Do not use the unit continuously, give your body a break from the UV radiation anyway after 10 weeks treatment (maximum) if you are not at an acceptable level before then.
An independent study by the BMA states "that treatment of skin conditions at home is no less beneficial than the treatment at hospital" as long as the user controls their session times and frequency in accordance with the guidelines set out. Treatment at home is much more convenient and generally more stress free than actually spending time (possibly hours) getting to a hospital, taking time off work every few days - for just a few minutes treatment.
Wrinkling of the skin (Actinic Elastosis) and skin malignancies are associated long-term side effects. However, in one study in a Swedish clinic of patients who had been on UVB treatment during a 20 year period, no increase of wrinkling of the skin or skin malignancies were found, when compared to an age and sex matched group from the same city. Philips TL01 narrowband minimises the risk further because most of the light emitted is now mainly at the theraputic wavelength of 311nm.
Short-term side effects can be totally avoided by following the instructions with care. These are blistering with redness (erythema), which is uncomfortable but absolutely not dangerous. Every person has a different skin type and some burning may be experienced if session times are slightly too long for a particular skin type (particularly fair skin), this can be completely avoided by being sensible and reducing session times.
To summarise, the risks involved with UVB are about the same as for an outdoor worker such as farmer or builder, who are exposed to sunlight on a daily basis. It is advised that anyone undertaking UVB Therapy visits a dermatologist or doctor once or twice a year for regular check up.
Please take the time to look at the following page about Philips narrowband UVB therapy and learn why you should never buy a unit that contains anything but Philips TL01 UVB Narrowband Tubes for light therapy treatment.
Apologies for the dodgy American video below but it does explain the basics very well !
Gelfand JM, Weinstein R, Porter SB, Neimann AL, Berlin JA, Margolis DJ. Prevalence and treatment of psoriasis in the United Kingdom: A population-based study. Arch Dermatol 2005;141:1537-41.Cohen MR, Reda DJ, Clegg DO. Baseline relationships between psoriasis and psoriatic arthritis: analysis of 221 patients with active psoriatic arthritis. Department of Veterans Affairs cooperative study group on seronegative spondyloarthropathies. J Rheumatol 1999;26:1752-6.
Anstey Alex, professor. Home UVB phototherapy for psoriasis:Editorials BMJ 2009;338:b607
Koek M, Buskins E, van Weelden H, Steegmans P, Bruijnzeel-Koomen C, Sigurdsson V. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis; pragmatic multicentre randomized controlled non-inferiority trial (PLUTO study) British Medical Journal 2009:338:b1542 doi:10.1136/bmkj.b1542 - available to download from top of page
Further Information from Psoriasis Charity Papaa re psoriasis and phototherapy