Clinical Indications For Ultraviolet Radiation

Clinical Indications for Ultraviolet Radiation
The treatment of cutaneous tuberculosis- the earliest modern clinical use

of UV radiation, for which Niels Finsen was awarded the Nobel Prize in 1903.
Clinical Indications of UV Radiation

Provided by Dermatologists or Provided by Physical therapist
their assistant
UV radiation is used primarily to treat UV radiation is used
psoriasis and other dermatological occasionally as a component of
conditions, including scleroderma, treatment for chronic open wounds.
eczema, atopic dermatitis, cutaneous
T-cell lymphoma (mycosis fungoides),
vitiligo, and palmoplantar pustulosis.
These treatments may be applied in
conjunction with a range of topical
medications.
Psoriasis
Psoriasis is a common benign, acute, or chronic inflammatory
skin disease that appears to be based on genetic
predisposition. It is characterized by bright red plaques with
silvery scales, usually on the knees, elbows, and scalp, and is
associated with mild itching. These dermatological
manifestations may be associated with joint changes known
as psoriatic arthritis.
Phototherapy of psoriasis with UV light has been provided
for almost 100 years; in 1925, Goeckerman introduced a
combination of topical crude coal tar and subsequent UV
irradiation. This treatment is still a first-line option for treatment of moderate to
severe psoriasis. Psoriasis causes hyperproliferation of keratinocytes. UV
phototherapy inhibits keratinocyte division, inhibits DNA synthesis and mitosis
of hyperproliferating keratinocytes, induces keratinocyte apoptosis, and
inhibits proinflammatory cytokine pathways. Psoriasis is most responsive to
UVA administered in conjunction with oral or topical psoralen sensitization
(PUVA) and is almost as responsive to narrowband targeted UVB alone.
However, prolonged treatment with PUVA is associated with keratinocyte
cancers, whereas prolonged treatment with UVB has not been shown to have
this risk.
Wound Healing
UV radiation is used occasionally as a component of the treatment of chronic
wounds despite limited high-quality research on the effectiveness of this
intervention. When UV radiation is used for wound treatment, UVC is the
frequency band most commonly chosen because it may help the wound to
heal while causing little erythema or tanning. UVC also has a low carcinogenic
effect and is absorbed almost equally by all skin colors. UV radiation is
thought to facilitate wound healing by increasing the turnover of epithelial
cells, causing epidermal cell hyperplasia, accelerating granulation tissue
formation, increasing blood flow, killing bacteria, increasing vitamin D
production by the skin, and promoting sloughing of necrotic tissue.
Contraindications and Precautions for Ultraviolet
Radiation
 Irradiation of the Eyes

UV irradiation of the eyes should be avoided because UV radiation can
damage the cornea, the eyelids, or the lens. Exposure of the eyes can be
avoided by having the patient wear UV-opaque goggles throughout treatment
as well as having the therapist wear UV-opaque goggles when at risk of
irradiation when turning the UV lamp on or off.
 Certain Systemic Conditions

UV radiation should not be applied to areas in which skin cancer is present
because UV exposure may be carcinogenic. Details of the carcinogenic
effects of UV radiation can be found in the section on adverse effects. It is
generally recommended that UV radiation not be used in patients with
pulmonary tuberculosis; cardiac, kidney, or liver disease; systemic
lupus erythematosus; or fever because these conditions may be
exacerbated by exposure to UV radiation.
 Photosensitizing Medications and Dietary Supplements

Care should be taken when applying UV radiation to patients who are taking
photosensitizing medications or supplements. Photosensitizing oral
medications include sulfonamide, tetracycline, and quinolone antibiotics; gold-
based medications used to treat rheumatoid arthritis; amiodarone
hydrochloride and quinidines for cardiac arrhythmias; phenothiazines for
anxiety and psychosis; and psoralens for psoriasis. While patients are taking
these medications or supplements, their sensitivity to UV radiation increases,
resulting in a decrease in the MED and increased risk of adverse effects. A
patient's minimal erythemal dose must be remeasured if the patient starts to
take a photosensitizing medication or supplement during a course of UV
treatment.
 Photosensitivity
Some individuals, particularly individuals with fair skin and hair color and
individuals with red hair, have greater sensitivity to UV exposure. Because
these individuals have an accelerated and exaggerated skin response to UV
radiation, low levels of UV radiation should be used both when determining
the MED and for treatment.
 Recent X-Ray Therapy

It is recommended that UV radiation be applied with caution to areas that
have had recent x-ray radiation exposure because the skin in these areas
may be more likely to develop malignancies.
 Erythema From Prior Ultraviolet Dose

To minimize the risk of burns or an excessive erythemal response, UV
irradiation should not be repeated until the erythemal effects of the previous
dose have resolved.

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Clinical Indications for Ultraviolet Radiation

The treatment of cutaneous tuberculosis- the earliest modern clinical use

Clinical Indications of UV Radiation

 Irradiation of the Eyes

 Certain Systemic Conditions

 Photosensitizing Medications and Dietary Supplements

 Recent X-Ray Therapy

 Erythema From Prior Ultraviolet Dose

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