A Typical Narrowband UVB Treatment Regime

Varieties of procedures (protocols) for UVB phototherapy have been developed and are tailored to fit different skin conditions.  Protocols vary according to dermatologist preferences and patient’s skin conditions.

A typical protocol for narrowband UVB treatment of psoriasis consists of three sessions per week.  Treatment sessions every other day are the most effective.  Full remission is usually achieved in a period of 6 to 10 weeks.

The first treatment will be a small initial dose.  The size of this dose is dependent on your sensitivity to UVB. Doses in subsequent treatments will then increase as your skin becomes more tolerant to UVB.

When narrowband UVB treatment is administered at home, the most practical and convenient way to determine the initial dose is to make an estimation of your skin sensitivity based on skin type (see table below). The size of this initial dose is small enough to be considered safe for your skin type.  In subsequent treatments the dose is increased to more effective and therapeutic levels.

It is important to test a small area of skin by exposing it to the proposed initial dose, before whole body exposure.  The area should be inspected 24 hours later. If erythema (reddening of the skin) is present then try a lower dose or consult your dermatologist.

A test dose may not be required if you have had narrowband UVB treatment within the previous year without problems, and are not taking any systemic medication.

Skin types are determined by the Fitzpatrick Skin Types table


Fitzpatrick Skin Types

 

Skin Type

Sunburn/Tanning History

I

Always burns, never tans; sensitive ("Celtic")

II

Burns easily, tans rarely

III

Burns moderately, tans gradually to light brown

IV

Burns minimally, always tans well to moderately brown (Olive Skin)

V

Rarely burns, tans profusely to dark (Brown Skin)

VI

Never burns, deeply pigmented; not sensitive (Black Skin)

 

The following tables are non specific and do not consider your individual situation.  They are based on a typical home phototherapy canopy fitted with 9 Philips TL01 narrow band tubes, positioned approximately 6 inches away from the skin, (times are per side).

Initial Treatment Times for NB-UVB based on Skin type (for psoriasis)

For a nominal UVB intensity of 10mJ/cm²

Skin type

Initial treatment time (seconds)

Initial dose mJ/cm²

Type I

13

130

Type II

16

160

Type III

24

240

Type IV

30

300

Type V

36

360

Type VI

50

500

 

Subsequent increases in treatment time and dose are based on your skin type and your response to the most recent treatment.

If erythema or pinkness of the skin did not result from the most recent treatment, then increase treatment time based on your skin type.

Treatment Times for NB-UVB based on Skin-type (for psoriasis)

For a nominal UVB intensity of 10mJ/cm²

Skin type

Initial treatment time (seconds)

First 3 increments

Subsequent increments

Type I

13

5

20% of previous dose

Type II

16

7

20% of previous dose

Type III

24

10

20% of previous dose

Type IV

30

12

20% of previous dose

Type V

36

15

20% of previous dose

Type VI

50

20

20% of previous dose

If erythema did result from the most recent treatment, then treatment is based on the level of erythema

Treatment based on Erythema

Level of erythema

Treatment

Just perceptible erythema (pinkness of the skin)

Repeat previous dose and then reduce subsequent increments (e.g. instead of 20% increments use 10% increments)

Well defined marked erythema which is causing minimal discomfort

Omit treatment until settled, then repeat previous dose and reduce subsequent increments (e.g. instead of 20% increments use 10% increments)

Sore erythema without oedema (swelling or puffiness of the skin)

No treatment until erythema has settled, then resume treatment at half previous dose and reduce subsequent increments (e.g. instead of 20% increments use 10% increments)

Fiery sore erythema with oedema

No treatment until erythema has settled and patient has been reviewed by a doctor. Topical steroids, emollients and analgesia may help

Severe fiery erythema with oedema and/or blistering

No treatment. Review by doctor for treatment and plans for alternative treatment when erythema has subsided. 

Maximum dose for psoriasis 5000mJ/cm or 500 seconds at 10mJ/cm²

Phototherapy sessions are continued until remission is achieved or no further improvement can be attained, and for a maximum of 30 treatments, unless medical advice is given to the contrary. 

Your dermatologist may advise a maintenance program to help prevent your condition flaring up again.

You should see your dermatologist at least every 6 months to evaluate your skin condition, any possible damage to your skin from the ultraviolet light treatment, and the need for continued treatment.

Further Reading>>>