Psoriasis

What is Phototherapy?

Phototherapy is the use of specific wavelengths of light that have been shown to be very effective in the treatment of psoriasis. This light occurs naturally as a component of sunlight and is called ultraviolet light. It is also very effective in the treatment of many other skin conditions, such as pruritis (itching), atopic dermatitis (eczema), contact dermatitis, alopecia (hair loss), lichen planus, and dyshidrotic eczema.

What is UV Light?

Phototherapy, or the use of ultraviolet light to treat illness, is defined as either mid wave light energy (Ultraviolet-B light [UVB]) or long wave light (Ultraviolet-A [UVA]). UVB is available as narrowband or broadband. It has been known for many years that UVA, UVB, and narrowband UVB light (or ultraviolet phototherapy) slows abnormal growth of normal skin cells which is associated with psoriasis. Narrow band (NB) UVB and PUVA are often used to start the repigmenting process for vitiligo.

What is Narrow Band UVB Light?

Narrow band UVB is light energy that is emitted in a narrow band portion of the UVB light range, 311 nm to 313 nm. UVB-NB has been shown to be the optimal part of the UV light spectrum which slows growth of psoriasis lesions.

What is UVB Narrowband Phototherapy Lamp Technology?

A UVB narrow band lamp emits light energy. Narrowband UVB phototherapy (UVB-NB) comprises a subset of the UVB wideband, or broadband, spectrum centered at roughly 311 nm. This is less than 1% of total range of wavelengths from sunlight.

Narrow band UVB has been shown to be the optimal part of the UV light spectrum which slows growth of psoriasis lesions. Since the narrowband wavelength is shorter than broadband, exposure time to narrow band UVB phototherapy treatment lights can be increased. The result is powerful targeted phototherapy treatment.

Another clear advantage of narrowband UVB is that skin is most sensitive to erythemic response, (sun burning) at 297 nm, so narrow band phototherapy nearly eliminates this problem.

Click on chart for an enlarged view:

Why Use Narrow Band UVB for Psoriasis and Vitiligo?

For Psoriasis – Research shows that Narrow Band UVB lights have a therapeutic advantage over traditional Broad Band UVB lights. This is because Narrowband UVB lights provide faster clearing, less sun burning, and more complete disease resolution.
For Vitiligo – Narrowband UVB light treatment is replacing traditional PUVA phototherapy treatment. UVB Narrow Band for vitiligo requires no photo-sensitizing agents and thus is more easily tolerated and has fewer side effects.

Which Form Of Ultraviolet Phototherapy Is Best – UVA, UVB, or UVB-NB?
All of these light treatments are quite effective, and the form of ultraviolet phototherapy you need will be prescribed by your doctor. However, UVA light must always be used with an oral or tropical drug named Methoxsalen. Consequently, treatment with UVA light requires very active participation by a physician who must supervise your treatment closely. In most cases, it is preferable to use narrow band UVB (UVB-NB) light, since there is no need for systemic drugs like Methoxsalen and treatment times are short. Recent studies show that the use of UVB narrow band light (UVB-NB) results in faster responses and longer remissions than with UVB broadband. Using narrowband UVB, results are similar to a PUVA treatment without the adverse effects of the drug. Also, it is relatively easy for both you and your physician to monitor and control treatment. Narrowband UVB is often replacing conventional UVB because in many cases, it is safe and effective while taking less time. UVB-NB is generally considered to be safe for children and lactating mothers. A significant reduction in psoriasis scaling is seen after the first 3 to 6 treatments and improvement may be noted after 6 to 9 treatments. Repigmenting vitiligo is a longer process.

Is Phototherapy Safe?
As we all know, virtually every treatment for any type of illness carries with it some level of risk. We know that excessive exposure to UV light over a long period of time may increase the chances of skin cancer. However, unlike oral, IV or IM medications, the safety of UV light therapy (ultraviolet phototherapy) has been proven for over 100 years. Recent studies show that narrowband UVB lamps (UVB-NB) has virtually NO incidence of causing skin cancer. Ultraviolet phototherapy in general, and particularly narrow band phototherapy light has been proven for long-term use and for treatment of children with minimal side effects. Ultraviolet phototherapy has been shown to be an extremely effective treatment for controlling Psoriasis and Vitiligo.

How Does Phototherapy Compare With Other Forms Of Psoriasis Treatment?
Other forms of treatment require the use of very strong steroids, immunosuppressive drugs, other systemic drugs or over the counter topical medications. These alternatives, while heavily promoted by drug companies, are costly, not effective for long term use, and have the potential for serious side effects. Ultraviolet phototherapy has been recognized as safe, effective, and economical and has stood the test of time.

How Often are Treatments Taken and How long Are Treatment Times?
This depends on your condition. For psoriasis, treatments are taken 3 to 5 times per week, with ultraviolet phototherapy treatment times beginning at a few seconds and increasing to several minutes over time. Once clearing is achieved, your doctor will determine whether your maintenance needs require regular phototherapy or whether your remission needs only periodic checkups.

Biologics are protein-based medications that interact with the immune system to reduce the inflammation causing psoriasis. Newer biologics are highly targeted to affect only certain parts of the immune system. The first group of biologics developed were the tumor necrosis factor-alpha (TNF-alpha) mediators. Since then, interleukin 17-A, 12, and 23 mediators have been also developed. These biologics are approved for psoriasis, psoriatic arthritis, or both.

Introduction: Excimer lasers can treat psoriasis more effectively, safely, and conveniently than topical creams or conventional phototherapy booths.

Effective: Some patients enjoy clearing in about 8 treatments.1 Remission can last several months.

Safe: Targeted treatment of psoriatic lesions protects healthy skin from exposure.

Convenient: Treatments are painless and take only a few minutes, twice a week, for a few weeks.

Is Treatment Safe? The laser may have fewer shortcomings than many common psoriasis treatments. Due to the targeted nature of laser therapy, healthy skin is not exposed to the ultraviolet light. This may reduce the risk of premature skin aging that is often associated with lamp phototherapy. There is no thinning of the skin, easy bruising, or stretch marks often caused by steroids, nor any of the systemic side effects caused by some oral medications.

How do PHAROS Excimer Lasers work? The EX-308 excimer laser creates a concentrated, but painless, beam of ultraviolet light that is delivered to psoriatic lesions through a handpiece that rests directly on the skin. By precisely targeting only active lesions without exposing healthy skin, the laser safely delivers high-dose treatment for fast clearing and long remission.

ADSCI has recently acquired the Cooltouch laser, which is FDA-approved for use on the skin.  It has recently has been used for the treatment of toe nail fungus. The principle behind the treatment is the heating of the nail bed and nail plate to about 40C.  This kills the fungus and the spores. We recommend three Cooltouch laser treatments once a month apart combined with a topical anti-fungal lacquer. We have seen fantastic results with this new anti-fungal treatment.  The advantage of this treatment is that oral anti-fungals, which could have potential side-effects, are not needed.

Who is a Candidate for Treatment? The laser is ideal for treating mild to moderate psoriasis. Traditionally hard-to-treat areas such as knees, elbows, and scalp are easily treated, thanks to the laser’s aiming beam and adjustable spot size handpiece. The targeted high-dose therapy can effectively treat stubborn plaques, even those that have not responded to other treatments. Ask your doctor if laser treatment is right for you.

How does treatment compare with other psoriasis treatments? Unlike topical creams and gels, treatment with the laser does not require any daily maintenance. Each patient is unique, but some patients enjoy several months of treatment-free remission after completing about 8 laser sessions. Excimer laser treatments are painless and take only a few minutes. Equally important, some patients only need about 8 laser treatments, as opposed to 30 or more conventional booth sessions.

What can I expect during treatment? Treatment will take place in your doctor’s office. First, your doctor will determine the best dosage level for you. Then, the doctor will place the handpiece directly on the psoriatic lesions and apply the laser therapy. You will hear a gentle hum and see a blue colored light from the handpiece tip. Most treatments take only a few minutes.

Does treatment hurt? No. Most patients experience no pain or discomfort. A few patients may feel slight warmth shortly after treatment. This warmth is mild and short-lived. No anesthesia is needed.

How many treatment sessions will I need? Your doctor will create a customized course of therapy for you based upon the extent, thickness, and location of the lesions. Some patients enjoy clearing after about 8 sessions.

How do I prepare for treatment? No extensive preparation is required for laser therapy. Just ensure that the skin to be treated is clean, dry, and free of any make-up, lotion, or creams containing SPF protection.

Are there side effects? The side effects of laser therapy are minimal. Most patients report no side effects. A few patients have reported a mild and short-lived redness at the lesion site. More serious side effects such as blistering and hyper-pigmentation are rare and short-lived.

Are laser treatments covered by insurance? Many national, state, and local insurance companies cover the laser treatment, but coverage levels will vary by plan. Talk to your doctor’s billing staff for details about your insurance coverage.

What Patients Say about EX-308 Excimer Laser Treatments:

“I’ve had moderate psoriasis since I was a child. My doctor told me he could help me achieve remission with the EX-308 excimer laser. I was skeptical, but now, for the first time in 10 years, I can wear short-sleeves and a bathing suit. I am experiencing remission for the first time in my life.” 
Marilyn R. 

“The EX-308 is the only treatment that has ever worked for my scalp. I’ve tried injections, creams, shampoos, oral medications, and none of it worked. But, since I started the laser treatments, my scalp has cleared more than 85%. There is no pain or side-effects.”
Gary D.

Systemic psoriasis medications are taken orally or injected into the skin or veins. These medications work from the inside of the body and treat the entire body. Some of the commonly prescribed oral medications include

• methotrexate
• cyclosporine
• acitretin.

A newer class of medication is the biologics. These medications suppress the immune system to control the over-activity causing the psoriasis. The biologics are taken by injection (Etanercept, adalimumab, ustekinumab) or infusion (infliximab). Other biologics include Secukinumab, Ixekizumab, and Guselkumab.