Narrow-band UVB PHOTOTHERAPY
for Skin Diseases
By
Dr. Manal Bosseila
Cairo University, Egypt
Nb-UVB Phototherapy by Manal Bosseila, M.D.
HISTORICAL ASPECT
In 1978: Irradiation cabin with broad band UVB tubes was ...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
HISTORICAL ASPECT
In 1984: Introduction of fluorescent bulbs (Phillips mode...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Broad Band vs Narrow Band UVB
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Broad Band vs Narrow Band UVB
Conventional broad band UVB lamps: ranging fr...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Nb-UVB Cabin
Nb-UVB Phototherapy by Manal Bosseila, M.D.
MECHANISM OF ACTION
In the skin, NB-UVB radiation is absorbed by DNA and uro...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
MECHANISM OF ACTION
Thus, the ability of NB-UVB radiation to systemically su...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
The breakthrough: 1988; narrow-band UVB (NB-UVB) phototherapy was introduced...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
INDICATIONS
Psoriasis
Vitiligo
Early stage MF (stage I & II)
Pityrias...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Nb-UVB in Psoriasis
15 - 20 treatments to achieve > 50% improvement in psor...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Nb-UVB in Vitiligo
In 1997: Westerhof and Nieuweboers- Krobotova first repo...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Nb-UVB in early MF
Effective in clearing skin lesions of small plaque parap...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Nb-UVB in Atopic Dermatitis
Moderate-to-severe atopic dermatitis
Favorabl...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Dosing schedule
Two regimens are most commonly used.
1- Determination of t...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
1- Determination of MED
Area tested: Hip, back.
All body covered and this...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
1- Minimal Erythema dose (MED)
 Determination of the individual's minimum e...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
2- Ready Calibrated Tables
Supplied with the Nb-UVB device.
Standard star...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
The goal of therapy is to achieve persistent asymptomatic mild erythema.
Nb-UVB Phototherapy by Manal Bosseila, M.D.
General Guidelines
Regimen: 3 times/week.
Eyes and male genitalia should ...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
BEWARE
In case of painful erythema, “with or without edema/blistering ”, fu...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Advantages
Lack of psoralen- related side effects, no drug induced nausea a...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Adverse Effects
Erythema.
Blistering of plaques.
Dry skin with pruritus...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Prolonged Safety
Insufficient data available to provide recommendations reg...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Maximum Safe Duration
Responsive patients can be given this treatment for a...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Maximum Safe Duration
After the first course of one year, a resting period ...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Contraindications
Xeroderma pigmentosum.
Systemic lupus erythematosus.
...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
Home Appliances
Inconvenience and cost of travelling to the phototherapy cl...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
 First-line phototherapy option due to the
safety and convenience of avoidi...
Nb-UVB Phototherapy by Manal Bosseila, M.D.
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Narrow Band UVB for skin diseases

Details about NB-UVB as regards its historical aspect, its scope of indications, treatment regimens, advantages, side effects, home appliances
Published on: Mar 3, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Narrow Band UVB for skin diseases

  • 1. Narrow-band UVB PHOTOTHERAPY for Skin Diseases By Dr. Manal Bosseila Cairo University, Egypt
  • 2. Nb-UVB Phototherapy by Manal Bosseila, M.D. HISTORICAL ASPECT In 1978: Irradiation cabin with broad band UVB tubes was introduced for psoriasis & uremic pruritus. In the 1980s: Therapeutic effect of UVB in ameliorating psoriasis centered at the 313-nm wavelength .
  • 3. Nb-UVB Phototherapy by Manal Bosseila, M.D. HISTORICAL ASPECT In 1984: Introduction of fluorescent bulbs (Phillips model TL- 01) that deliver UVB in range: 310 to 315 nm, peak at 311 nm. Narrow spectrum of emission. Reduction in erythemogenic wavelengths in the 290-305 nm range. 5-6 fold increased emission of the longer UVB wavelengths.
  • 4. Nb-UVB Phototherapy by Manal Bosseila, M.D. Broad Band vs Narrow Band UVB
  • 5. Nb-UVB Phototherapy by Manal Bosseila, M.D. Broad Band vs Narrow Band UVB Conventional broad band UVB lamps: ranging from 280-330 nm. Narrow band UVB: emit only wavelengths 311- 312 nm. Peak therapeutic effectiveness of UVB at 295- 313 nm. Wavelengths below 300 nm: cause erythema, severe burning and increase risk of skin cancer.
  • 6. Nb-UVB Phototherapy by Manal Bosseila, M.D. Nb-UVB Cabin
  • 7. Nb-UVB Phototherapy by Manal Bosseila, M.D. MECHANISM OF ACTION In the skin, NB-UVB radiation is absorbed by DNA and urocanic acid. Inhibits DNA synthesis. Inhibits epidermal keratinocyte hyperproliferation. Induces T-cell apoptosis. Induces immunosuppression. Induces anti-inflammatory cytokines. Alters antigen presenting cell activity.
  • 8. Nb-UVB Phototherapy by Manal Bosseila, M.D. MECHANISM OF ACTION Thus, the ability of NB-UVB radiation to systemically suppress the major components of cell mediated immune function is linked to its beneficial effect in several inflammatory skin diseases.
  • 9. Nb-UVB Phototherapy by Manal Bosseila, M.D. The breakthrough: 1988; narrow-band UVB (NB-UVB) phototherapy was introduced for psoriasis by Van Weelden et al. and Green et al.
  • 10. Nb-UVB Phototherapy by Manal Bosseila, M.D. INDICATIONS Psoriasis Vitiligo Early stage MF (stage I & II) Pityriasis lichenoides chronica Lichen planus Atopic Dermatitis Achromia parasitica Generalized pityriasis alba Uremic pruritus
  • 11. Nb-UVB Phototherapy by Manal Bosseila, M.D. Nb-UVB in Psoriasis 15 - 20 treatments to achieve > 50% improvement in psoriasis. 63-80% of all patients achieve clearance with Nb-UVB. NB-UVB compared with broad band: greater improvement, reduced incidence of burning episodes, increased efficacy and longer remission. NB-UVB compared with PUVA: little overall difference in efficacy. Others: Efficacy of Nb-UVB was slightly lower than but approached that of PUVA in patients.
  • 12. Nb-UVB Phototherapy by Manal Bosseila, M.D. Nb-UVB in Vitiligo In 1997: Westerhof and Nieuweboers- Krobotova first reported NB-UVB phototherapy for vitiligo. NB-UVB compared with topical PUVA: 67% of patients showed repigmentation versus 46% of patients after 4 months of therapy.
  • 13. Nb-UVB Phototherapy by Manal Bosseila, M.D. Nb-UVB in early MF Effective in clearing skin lesions of small plaque parapsoriasis and early stage of MF (1999; 2000). Produces complete clearance in 75% of patients with patch stage MF < 10% of body surface area (2002). However, relapses occurred within a mean time of 6 months
  • 14. Nb-UVB Phototherapy by Manal Bosseila, M.D. Nb-UVB in Atopic Dermatitis Moderate-to-severe atopic dermatitis Favorably accepted by patients. Effective alternative to steroids for chronic AD.
  • 15. Nb-UVB Phototherapy by Manal Bosseila, M.D. Dosing schedule Two regimens are most commonly used. 1- Determination of the individual's minimum erythema dose (MED). 2- Using ready calibrated tables.
  • 16. Nb-UVB Phototherapy by Manal Bosseila, M.D. 1- Determination of MED Area tested: Hip, back. All body covered and this area covered with garment having 6 openings 2 cm2 Openings receive Nb-UVB doses as: 0.8 J, 1 J, 1.2J, 1.4 J, 1.6 J, 1.8 J (for skin types IV-VI). Openings covered and examined next day. +ve reading: identifiable erythema within opening.
  • 17. Nb-UVB Phototherapy by Manal Bosseila, M.D. 1- Minimal Erythema dose (MED)  Determination of the individual's minimum erythema dose (MED).  70% of the MED value is used for the first treatment. Thereafter 20% or 10% increments depending on skin type tolerance.
  • 18. Nb-UVB Phototherapy by Manal Bosseila, M.D. 2- Ready Calibrated Tables Supplied with the Nb-UVB device. Standard starting dose (0.3J/cm2), with stepwise increase (usually 20%) depending upon the patient's erythema response. In case of mild erythema, the irradiation dose is held constant for subsequent treatments.
  • 19. Nb-UVB Phototherapy by Manal Bosseila, M.D. The goal of therapy is to achieve persistent asymptomatic mild erythema.
  • 20. Nb-UVB Phototherapy by Manal Bosseila, M.D. General Guidelines Regimen: 3 times/week. Eyes and male genitalia should be covered during sessions. Session duration varies between seconds to minutes according to the skin type.
  • 21. Nb-UVB Phototherapy by Manal Bosseila, M.D. BEWARE In case of painful erythema, “with or without edema/blistering ”, further treatment is withheld till the symptoms subside.  After resolution : the dose administered is 50% of the last dose, subsequent increments by 10%.
  • 22. Nb-UVB Phototherapy by Manal Bosseila, M.D. Advantages Lack of psoralen- related side effects, no drug induced nausea and no drug costs. No need for post-treatment eye protection. Safe use in children and pregnant or lactating women. It has shorter irradiation times which aid patient’s compliance.
  • 23. Nb-UVB Phototherapy by Manal Bosseila, M.D. Adverse Effects Erythema. Blistering of plaques. Dry skin with pruritus. Increased frequency of herpes simplex reactivation. Long-term adverse effects: photodamage.
  • 24. Nb-UVB Phototherapy by Manal Bosseila, M.D. Prolonged Safety Insufficient data available to provide recommendations regarding the maximum safe duration and cumulative NB-UVB dose. Skin saving principles, i.e. covering the parts that have improved satisfactorily and shielding the genitals. Shield the face : to prevent photoaging.
  • 25. Nb-UVB Phototherapy by Manal Bosseila, M.D. Maximum Safe Duration Responsive patients can be given this treatment for a maximum of 24 months. In children, the maximum duration allowed is 12 months.
  • 26. Nb-UVB Phototherapy by Manal Bosseila, M.D. Maximum Safe Duration After the first course of one year, a resting period of 3 months to minimize the annual cumulative dose. Subsequently, if required, only limited areas should be exposed. If no response is observed after six months, further therapy should be discouraged.
  • 27. Nb-UVB Phototherapy by Manal Bosseila, M.D. Contraindications Xeroderma pigmentosum. Systemic lupus erythematosus. A history of skin cancer.
  • 28. Nb-UVB Phototherapy by Manal Bosseila, M.D. Home Appliances Inconvenience and cost of travelling to the phototherapy clinic for the numerous exposures .  Home delivery of Nb-UVB phototherapy may be suitable for some patients; however, appropriate training is required.
  • 29. Nb-UVB Phototherapy by Manal Bosseila, M.D.  First-line phototherapy option due to the safety and convenience of avoiding psoralen therapy.  However, Nb-UVB may be insufficiently aggressive to clear severe disease. Conclusion
  • 30. Nb-UVB Phototherapy by Manal Bosseila, M.D.

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