Learn About Phototherapy

Phototherapy using Narrowband UVB lamp technology is a primary treatment for psoriasis, vitiligo, and many other skin disorders.  Hundreds of clinical studies confirm effective results with lower risk than alternatives.  You can use phototherapy to treat your skin in the clinic or at home with specialized home phototherapy products.  Learn more about phototherapy below.

Background
Phototherapy (also called light therapy) is the use of sunlight or artificial light to treat certain health disorders.  Early phototherapy used sunlight, and its use for health benefits has been documented since the ancient Egyptians.  However, sunlight is a combination of many kinds of light, some therapeutic and some damaging.  The technical challenge for modern phototherapy has been to provide concentrations of beneficial light while eliminating the damaging light.

Modern medical lamp technology allows us to separate the basic types of light found in sunlight and produce them artificially.  The most common types of artificial light used to treat skin disorders are two spectra of ultraviolet (UV) light found in sunlight, ultraviolet-A (UVA) and ultraviolet-B (UVB).  Equipment emitting this spectrum of invisible light has been used to treat skin disorders for over 80 years.  The spectrum of light that is best for a specific disorder can be determined by a dermatologist.

Narrowband UVB Light
Advances in medical lamp technology have enabled medical lamps to produce a tiny slice of the UVB light spectrum called Narrowband UVB.  This narrow range of light is very effective in treating psoriasis, vitiligo, and other skin disorders, but does not have the harmful effects of broad spectrum UVB light found in sunlight and typical (broadband) UVB lamps of the past.  Narrowband UVB light is considered more effective than sunlight or topical steroids and much safer than biologic drugs, and without the side effects of those alternative treatments.  While Narrowband UVB medical lamps have been available for about 30 years, their widespread use has been limited.  However, with new medical studies continuing to demonstrate Narrowband UVB light’s effectiveness and safety, phototherapy is increasing in popularity as a first-line treatment of psoriasis, vitiligo, and many other photo-responsive skin disorders.

Home Phototherapy
Advances in Narrowband UVB lamp technology have allowed a variety of phototherapy products that can be used conveniently at home.  These home products range from small handheld devices for treating a few small areas, to full-body booths that treat the whole body at once.  Your dermatologist will determine the size and type of equipment that is best for your symptoms. Home phototherapy products use the same lamp technology used in clinical phototherapy equipment so you can expect similar results at home.  Home phototherapy products using Narrowband UVB require a prescription from a licensed healthcare provider, and your provider will provide a treatment plan.  Please see your dermatologist or other healthcare provider to learn more.

Often these devices are covered by health insurance, depending on your insurance plan, diagnosis, and other factors.  In many cases, insurance will require you to try clinic phototherapy first to prove effectiveness before they will cover a home device.  There may be other requirements from your health insurance plan.

Alternative Treatment Overview

 The three most common treatments for psoriasis and vitiligo are a) biologic drugs (administered through injections or IV), b) topical anti-inflammatory steroid treatments (applied externally to the skin), and c) phototherapy using Narrowband UVB light.  Below is a brief description of each with their associated risks and side effects.

Biologic Drugs

There has been a lot of interest lately in new biologic drugs to treat auto-immune disorders such as arthritis and psoriasis. These biologics, such as Humira, Enbrel, and Skyrizi, appear to be convenient and effective for many people but also have potential risks and side effects that must be considered before using them.  As with all medications that suppress the immune system, taking biologics increases the short and long-term chance of infection and other diseases.  In addition, biologics increase the risk that dormant diseases (e.g. tuberculosis) may become active.  Common short-term side effects include flu-like illness, fever, chills, and nausea, headache, and injection site reactions.  Long-term side effects are not fully understood but are thought to be related to the body’s lower resistance to serious infections and disease.  Weight gain has also been recently found to be associated with biologics.  Biologics can be very expensive over time since they usually treat chronic conditions.  

Topical Steroids

Treatments using topical anti-inflammatory steroids can be effective for some skin disorders but also have risks and side effects.  Side effects include skin damage such as thinning, bruising, pigmentation changes and dilated surface blood vessels.  When used over a long period of time, topical steroids can be absorbed through the skin and cause changes to internal organs.  In addition, topical steroids can have negative impacts on bone remodeling, potentially leading to osteoporosis and fractures. The treatments can inhibit the skin’s ability to fight off bacterial or fungal infections.  Topical steroids are commonly associated with the “rebound effect” (or “topical steroid withdrawal”) where after stopping long-term use, the symptoms may be worse than before treatment began.

Phototherapy

Medical lamps have been used for over 80 years as an effective solution for psoriasis, vitiligo, and many other skin diseases.  The newer Narrowband UVB lamp technology is even more effective, with hundreds of medical studies demonstrating its safety and extremely low risk of side effects.  Phototherapy is also safe for use by pregnant women, children, and the elderly.  For an extremely small percentage of people, there may be redness, itching and premature aging of skin.  

Some people should not use phototherapy.  Phototherapy is contraindicated for patients with history of melanoma, porphyria, lupus, epilepsy with light-triggered seizures, and others.  Please ask your physician if you have a contraindication for phototherapy.

Summary

To summarize, phototherapy is more effective than topicals, is cheaper than biologics, has no side effects for nearly all patients, and has much less health risk compared to alternatives.  Please conduct more research from reputable sources and talk to your dermatologist to learn more.

IMPORTANT: This information is provided to facilitate a more productive discussion with your physician.  Thoroughly discuss the benefits, risks, and side-effects of all treatment options with your physician.  Treatment benefit vs. risk discussions should include how your skin condition affects your self-esteem and lifestyle.  Please discuss all options with your physician to ensure the treatment option chosen is best for you.