PHOTOTHERAPY

Treatment of skin diseases with the help of sunlight (heliotherapy) was used by the ancient Egyptians, but the first hardware-based phototherapy techniques appeared only at the beginning of the last century. At the moment, the most widespread methods in the treatment of psoriasis and seborrheic dermatitis are phototherapy methods using ultraviolet B spectrum (280-320 nm). The effect of phototherapy is based on its anti-inflammatory, immunomodulatory and antiproliferative effects. Before starting the course of phototherapy, it is recommended to prepare the scalp with the use of keratolytics, since abundant peeling will significantly reduce the effectiveness of therapy.

For the treatment of psoriasis, mainly UVB rays of a wide spectrum (280-320 nm) and a narrow spectrum (311 nm +/- 1.5) are used. The latter are more preferable since they do not contain the harmful erythemogenic UV spectrum (wavelengths less than 305 nm). Narrow-spectrum phototherapy treatments are shorter and the side effects on healthy skin, such as erythema or irritation, are minimal. Narrow-spectrum phototherapy can be used in children from 5 years old, pregnant women and nursing mothers. Phototherapy UVB 311 nm is prescribed 2-4 times a week, 20-30 procedures per course. After the end of an intensive course of treatment, in some cases, it is advisable to prescribe maintenance phototherapy once a week.

For the treatment of psoriasis, mainly UVB rays of a wide spectrum (280-320 nm) and a narrow spectrum (311 nm +/- 1.5) are used. The latter are more preferable, since they do not contain a harmful erythemogenic spectrum. Narrow-spectrum phototherapy treatments are shorter and the side effects on healthy skin, such as erythema or irritation, are minimal.

Phototherapy regimen

It is advisable to begin phototherapy with the determination of the minimum erythemal dose. Narrow-spectrum phototherapy can be used in children from 5 years of age, pregnant women and nursing mothers. Phototherapy UVB 311 nm is prescribed 2–4 times a week, 20–30 procedures per course. In case of persistent recurrent course, after an intensive course of phototherapy, it may be recommended to carry out phototherapy in a maintenance mode, 1 procedure per week for 1-2 months, to prolong remission and consolidate a positive treatment result. In this case, the UV dosage remains stable, at the level of the last intensive course procedure, and is adjusted only depending on the skin reaction.

The anti-inflammatory, local immunomodulatory and antipruritic effect of UV rays can be used as a therapy for seborrheic dermatitis, especially if previous topical therapy is ineffective or if there are contraindications to its use.

Given the good safety profile and high therapeutic efficacy, local narrow-spectrum UVB phototherapy (wavelength 311 nm) is the optimal phototherapy method for seborrheic dermatitis. The optimal mode of application is 2-3 times a week, the general course is 10-15 procedures.

Phototherapy regimen

The phototherapy regimen can be similar to the treatment of scalp psoriasis; it is advisable to start phototherapy with the determination of the minimum erythemal dose. Before starting the course, it is imperative to carry out keratolytic therapy, especially in the presence of pronounced peeling, which will block UV and significantly reduce the effectiveness of treatment. Considering the fact that preparation of the skin for phototherapy with seborrheic dermatitis is not difficult, as well as minimal skin infiltration in the lesions, the response to the complex treatment of seborrheic dermatitis with the use of phototherapy occurs relatively quickly. In case of persistent recurrent course, after an intensive course of phototherapy, it may be recommended to carry out phototherapy in a maintenance mode, 1 procedure per week for 1-2 months, to prolong remission and consolidate a positive treatment result. In this variant, the UV dosage remains stable, at the level of the last intensive course procedure, and is adjusted only depending on the skin reaction, the appearance of painful erythema, etc.

In our the clinic TRICHOLOGY INSTITUTE we use a device for narrow-spectrum local phototherapy with a wavelength of 311 nm; for its more effective application on the scalp, we use devices optimized for this zone. Such devices are equipped with a comb and light guides, which contribute to the unhindered penetration of UV rays on the scalp. The risk of skin growth with this type of phototherapy is minimal.

Phototherapy works well with topical therapy and can also be used as monotherapy or supportive therapy.

• the presence of photosensitive dermatoses (SLE) in patients
• biopsy-confirmed malignant neoplasms of the scalp