For psoriasis, “UVB-Narrowband” phototherapy using Philips /01 lamps is the gold standard because it economically delivers only the most medically beneficial wavelengths of light around 311 nm, while minimizing the potentially harmful wavelengths (UVA and the most skin-burning of UVB wavelengths sub~305 nm). Plus there is the immense benefit of making large amounts of Vitamin D naturally, which is carried away by the tiny blood vessels in our skin for health benefits throughout the body. As a simple qualification test, if a psoriasis patient responds well to natural summer sunlight or cosmetic tanning (both of which contain a small amount of beneficial UVB but also with a much larger amount of harmful UVA), then medical UVB phototherapy will almost certainly work as well, and likely very much better.
Practically, UVB-Narrowband works well in dermatologist and hospital phototherapy clinics (of which there are about 1000 in the USA, and 100 publicly funded in Canada), and equally well in the patient’s home2,3,4. Hundreds of medical studies have been done on the subject – try searching “Narrowband UVB” in the US government’s respected PubMed website and you will get over 400 entries!
A close relative to Philips 311 nm UVB-Narrowband is the 308 nm excimer laser. These devices have very high UVB light intensity and are useful for spot targeting and sometimes for scalp psoriasis using a special fibre-optic brush. Excimer lasers are, however very expensive and are therefore found in only a few phototherapy clinics.
UVB LEDs (light emitting diodes) is a promising technology, but the cost per watt is still much more than fluorescent UVB lamps.
The possible side effects of UVB phototherapy are the same as with natural sunlight: skin sunburning, premature aging of the skin, and skin cancer. Skin sunburning is dosage dependent and controlled by the built-in timer in the phototherapy device used in conjunction with the recognized treatment protocols supplied in the SolRx User’s Manual Exposure Guideline Tables. Premature aging of the skin and skin cancer are theoretical long-term risks, but when UVA is excluded, decades of use and several medical studies5 have shown these to be minor concerns, especially when compared to the risks of other treatment options. Indeed, UVB phototherapy is safe for kids and pregnant women6, and is compatible with most other psoriasis treatments, including biologics.
UVB-Narrowband in the patient’s home is effective because, although the devices used are typically smaller and have fewer bulbs than those at a phototherapy clinic, they still use the exact same part number of Philips UVB-NB bulbs, so it is only a matter of somewhat longer treatment times to achieve the same dose and the same results. Home UVB-NB treatment times per area of skin range from under a minute when treatments first start, to several minutes after a few weeks or months of consistent use.
A home phototherapy treatment typically begins with a shower or bath (which sheds dead skin that would otherwise block some of the UVB light, and removes any foreign material on the skin that might result in an adverse reaction), followed immediately by the UVB light treatment, and then if necessary the application of any topical creams, ointments, or moisturizers. During treatment, the patient must always wear the UV protective goggles supplied and, unless affected, males should cover both their penis and scrotum using a sock. Treatments are typically 3 to 5 times per week, with every second day being ideal for many patients. Significant clearing can often be achieved in 4 to 12 weeks, after which treatment times and frequency can be reduced and the condition maintained indefinitely, even for decades.
Versus phototherapy in a clinic, the convenience of taking treatments at home has many advantages, including great savings in time and travel, a more consistent treatment schedule (fewer missed treatments), privacy, and the ability to continue with “lose-dose” maintenance treatments after clearing is achieved, instead of being discharged by the clinic and letting the psoriasis rebound. Solarc is a great believer in the benefits of ongoing low-dose UVB-NB phototherapy for skin disease control and general health.
SolRx devices are of course also used by many phototherapy clinics, but Canada is a big country and to help as many people as possible our true passion is home phototherapy. We were founded in 1992 by a lifelong psoriasis sufferer who continues to use UVB home phototherapy to this day with continued, great success almost 40 years after his first UVB treatment in 1979, and with no adverse side effects or skin cancers.
Beyond topicals and phototherapy come the “systemic” drugs, such as methotrexate, cyclosporine, acitretin (Soriatane®), apremilast (Otezla®) and the “biologics” (Humira®, Stelara®, etc). Systemic drugs are taken orally or by needle, affect the entire body (the “system”), can have serious side effects7, and in the case of the biologics, are far more expensive ($15,000 to $30,000 per year). Systemics should only be considered when the other less risky therapies fail. For example, the Ontario Ministry of Health’s official “formulary” for Adalimumab (Humira®) and Ustekinumab (Stelara®) states that, before prescribing the drug, the patient must first fail a “12 week trial of phototherapy (unless not accessible)”. That caveat is unfortunately too often the excuse used to prescribe a biologic despite home phototherapy being readily available. This is something Solarc is trying to get changed so patients might avoid the potentially serious risks of biologics for a tiny fraction of the cost, and to do what we can to control our runaway public healthcare costs.