UVB Light Therapy For Psoriasis: FAQs
I’m a third of the way through my light treatment for psoriasis. During this time, I’ve been asked lots of questions by friends, family and colleagues about the treatment I’m having.
In this post, I will attempt to answer the questions I hear most. I hope you find it useful!
Please note, these questions have been answered based on my experiences of UVB light therapy at my local hospital. Treatments and therapies will alter around the country and around the world. Speak to your dermatologist about light therapy to find out exactly how it works in your hospital.
What is light therapy?
Light therapy is the exposure of your skin to UVA or UVB light in controlled conditions. This normally takes place in a hospital or dermatology facility. Some people treat their skin at home using phototherapy units, which can be full body or handheld.
Why do you need it?
Light therapy is usually prescribed if affected skin covers a large area or isn’t responding to topical treatments. It’s used in the case of moderate to severe skin conditions including: psoriasis, eczema, prurigo, vitiligo and dermographism. (If you don’t know what that last one is, Google it. It’s worth checking out).
How does it work?
UVA and UVB are both present in natural sunlight. UVA pentrates deep into the skin, whilst UVB affects the surface epidermal layers. Controlled UV exposure to the skin reduces skin cell growth, so your skin eventually becomes lovely and flat and looks like normal skin. Eventually. (Fingers crossed.)
In the case of UVA treatment, also known as photochemotherapy or PUVA treatment, patients ingest an oral medication, psoralen, before being exposed to UVA light, hence the name, PUVA (Psoralen + UVA). This medication is taken around two hours before exposure. Sometimes, psoralen is added to bathwater and the patient can bathe in it before treatment. This will be carried out at the hospital rather than at home. Psoralen can also be applied to small areas of psoriasis topically. The role of psoralen is that of a sensitiser, making the UVA more effective on the skin. The exposure time for UVA treatment is 15 – 20 minutes.
For UVB treatment, there are actually two different types available:
UVB Broadband: Where the full spectrum of light is used
UVB Narrowband: Where only a specific spectrum is used
In recent years, this second option has proved to be the most beneficial as it is more likely to clear the skin, the course of treatment is shorter and remission times are longer before the skin condition reoccurs.
The exposure times for narrowband treatment are shorter than broadband, but they are more intense. UVB is the main cause of sunburn and burning is the major risk of light therapy. Because of this, patients will be exposed to UV light for just a few seconds at first, building up their tolerance over time, all under the watchful eye of a trained phototherapist.
The key to the success of either treatment is down to consistency. You must commit to hospital visits three times a week for 8 -12 weeks to secure UVB treatment. Click To Tweet
What are the side effects?
For PUVA patients who have ingested psoralen, nausea is a possible side effect. For UVB, side effects can include itchiness, redness and mild sunburn.
Another side effect is people commenting that ‘you’ve caught the sun.’ That means you’re in full red face flow. There’s no going back. Embrace red face.
What are the long-term risks?
Both UVA and UVB treatment might contribute to the premature aging of skin and the increased risk of some skin cancers. Because of this, courses of treatment are not unlimited during your lifetime. Your dermatologist will recommend a top limit depending on your history with phototherapy and your skin type.
There are links to useful articles from reputable sources at the end of this blog that go into further detail on the side effects and long term risks.
What happens on the first session?
(As I said earlier, this post focuses on my experiences with UVB treatment.) The phototherapist goes through a big questionnaire with you (nothing too surprising, just questions on your skin (dur), family health history, current medications etc). She’ll (or he’ll) explain the whole process and what to do if you do have any skin irritation after your treatment. You’re bound to be worried about burning and the risks surrounding this are fully explained. It isn’t anything to worry about as long as you follow the care instructions your phototherapist will give you. Any burning won’t appear until several hours after you have left the facility, so it’s also important that you know what to do and how to manage it should there be a problem.
This first appointment will probably include your first light therapy session as well. I’ve got fair skin and don’t really tan, so I was given thirty seconds on my first session and have had the time increased by twenty seconds on every subsequent visit. Remember, it might be different for you.
What’s the unit like?
The UV is exposed to your skin whilst you are in a stand up machine (not too dissimilar from a stand up sunbed.) The machine has no roof, so you won’t feel too hot or ‘trapped’ whilst you’re in there. There’s a door, with a tiny window, so they can check you’re naked. (Females = naked, guys get to wear a ‘sock’…*stifled lol*) wearing the goggles, you’re centralised in the machine and have started marching.Yes. Marching. More on that later. That cord is for emergencies. Like if you start freaking out and want it to stop!
Can’t you just go on a normal sunbed?
No. commercial sunbeds primarily emit UVA light, which is no good for me and wouldn’t be suitable for psoriasis patients undergoing UVA treatment either as you need to take a psoralen tablet or bath beforehand to make the treatment effective.Sunbeds are not regulated in the medical space, so you risk overbaking and harming your skin. Click To Tweet
How long does the treatment last?
My course of treatment is thirty sessions over ten weeks. The days and times are always the same. The dermatology unit at my local hospital is open Monday/Wednesday/Friday and so those are my treatment days.
How long is each session?
At the start, you’ll spend more time getting changed than actually treating your skin! Your exposure to the UVB will increase in increments. So for me, I started on 30 seconds and the nurse has been increasing it by twenty seconds or so every time I go. The whole visit normally lasts thirty minutes.
What do you wear for treatment?
This is an easy one to answer: NOTHING (except goggles/goggles and visor). If you have psoriasis on your face, you wear goggles. If you don’t, you wear goggles and the visor.
Oh my god. So the phototherapist sees you naked?
Once you are called in, you go into a changing area and get changed down to your underwear. You call the nurse back in and she takes a look at your body to make sure there are no burns or any other signs of skin damage. Today, she said my face was a little pink, so as my facial psoriasis has cleared up now, I am wearing a visor and goggles in the unit.
What happens after the phototherapist has inspected you?
The phototherapist leaves the curtained-off area, you get changed down to nothing (unless you’re a guy – then bring out that sock *definitely not laughing*), get those goggles and visor on and get in the machine.
What happens during treatment?
Once you’re in and have called the phototherapist back (“Ok! I’m ready!”), she will return to the curtained-off area and programme your machine. Then she asks you your date of birth (a check to make sure she gives the right dosage to the right person) and she’ll ask if you’ve got your goggles on properly. Then she’ll hit start, open and close the door a little to start the machine and then your treatment has begun!
The treatment sounds a bit like a microwave. Lots of beeping and whirring. It is a bit weird, marching and goggles etc, but I saw results really quickly, which was a big motivator for me.
What was the deal on ‘marching?’
I’m not sure if it’s the same for all dermatology day units, but, whilst being ‘zapped’, I have been told to ‘march’ in my machine. There are two reasons for this: firstly, it means you’re constantly moving, so there shouldn’t be any area of skin that isn’t getting treated. Secondly, the UVB bulbs do not reach down to the floor of the unit. There is a gap of a few centimetres. If you’ve got psoriasis on your feet or ankles (like I have), you need to make sure this area is being exposed to the bulbs. The phototherapist told me she used to have a ‘step’ in the UVB machine so users could stand on it to make sure the bulbs were exposed to their skin. Sadly, she was asked to remove it due to health and safety. Hence the marching!
What happens after the session?
You have to moisturise, cover up and stay out of the sun.The big dosage of UV means your skin is super sensitive right now, so you have to be very careful. Click To Tweet
Exposure is actually more potent through windows, so bear that in mind.
You can moisturise in the hospital, mine has Cetraben, but I prefer to go home and use Epaderm or Aveeno.
Remember, it’s UVB light in sunlight that is responsible for sunburn, so care must be taken in exposure times and aftercare of your skin once your session has finished.
Do you put any creams on your skin before you get treated by the unit?
For UVB therapy, the answer is no. I was told to use a low PH shower gel before I come in for treatment, but that was it. No moisturiser, no perfume, no deodorant, nothing else.
How else do you prepare for a session?
You can’t wear make up, jewellery or a watch or apply any creams or lotions. You should be moisturising throughout the course of your treatment, so make sure there is no dry skin on any plaques as the UVB cannot penetrate dead skin. You cannot cut your hair during treatment as any light exposure to new skin might cause burning. I have to have my hair in a high pony tail every time I have treatment. If you have a beard, they will probably ask you to keep the length consistent so no new skin is exposed to the UV light, as you will risk burinng.
At least in my hospital, they are very picky on the clothes you wear. You can’t come in for treatment wearing shorts, t shirt and sandals. You have to have arms, legs and feet covered up. I got told off today for wearing a jumper with a wide neck. They are really strict and won’t give you treatment if they don’t think you can adequaltely cover up afterwards. The nurse told me a lot of people don’t wear socks (on their feet this time!) and come in wearing sandals. It’s a big no-no. So yeah, always long sleeves and bottoms. And always socks.
Does it hurt?
Personally, I don’t find UVB treatment painful. It’s just like being in a sunbed. A stand up sunbed, but a sunbed no less. However, afterwards, when I have got back home, I have sometimes found my skin to be itchy and a little sore. Just like if you’ve been out in the sun too long. This is a common side effect and nothing to worry about. However, if you do suffer from severe itching or burn-like symptons, you need to get your skin seen to, pronto!
It would be cool if there was a video
I agree. Fortunately, you’re in luck.
This excellent video by #GetYourSkinOut psoriasis campaigner, Holly Dillon, gives you an full overview of her experience of UVB treatment and you get to see the swanky machine she uses. (Sadly the one I have at my hospital is no way as cool as her one!)
Holly explains the DQLI test (Dermatology Quality Life Index test), which offers you an opportunity to talk about how your psoriasis (or other skin condition) affects your life. Interestingly, I wasn’t given this test, so can’t comment on whether my questions were the same or how I answered.
See that step in Holly’s video? Just shows how different it can be between hospitals. Also, she didn’t mention marching… so I guess it’s just in my hospital I have to do that. Great.
The link to Holly’s website can be found at the end of this article.
When do you start to see results?
For me, I would say after the first six or seven treatments, my psoriasis started to flatten out and redness was reduced. After the first couple of treatments, I did think ‘this is never going to work,’ but persist with it and it will.
After the first couple of treatments, I did think ‘this is never going to work,’ but persist and it will!Your persistence will pay off. Click To Tweet
So what are the key points from this rather lengthy post? For various reasons, lot of psoriasis sufferers are not offered UVB treatment, so if you are lucky enough to be offered it, make sure you do the full course.
That means turning up on time, every time.
Remember, no jewellery, deodorant or moisturised skin before treatment. After treatment, go mad on the moisturising.
Keep an eye on your skin during the full course. Make sure your skin is not too red. Have someone monitoring moles if you can’t see them.
Long sleeves, trousers and socks are the attire for every day. Even non-treatment days.
Always pack those goggles
Keep moving on the spot
Once again, moisturise like crazy after the treatment and at least once more during that day
Keep moisturinsing as much as you can on non-treatment days too.Your skin is super sensitive now, so be very careful in the sunlight. Click To Tweet
Speak to your nurse if you have any questions or concerns.
So that’s it! If you’re going for treatment I would love to know how it goes. Please let me know in the comments section. And Good Luck!