PAMANTASAN NG LUNGSOD NG MAYNILA

COLLEGE OF PHYSICAL THERAPY

ULTRAVIOLET

RADIATION
01 Clinical Uses of UVR
07 Calculation of Necessary Dosages

02 Frequency, Wavelength, &

Classification
08 Indications, Contraindications, &

Precautions

03 Classification of apparatus that

produces UVR
09 Related Dangers

04 Physiological Effects: General & Local

10 Procedures Related to Application of

UVR

05 Therapeutic Effects
11 Proper Documentation

06 Various Dosages Used

TOPIC OUTLINE
CLINICAL USES OF UVR
Frequency of UV radiation lies between that of x-rays

and visible light

UV radiation exposure produces skin erythema,

tanning, epidermal hyperplasia, and vitamin D

synthesis

Form of energy that is used therapeutically

and absorbed 1-2 mm into the skin

Skin disorder: most effective use of UV

FREQUENCY
Frequency range:
14 15
7.5 x 10 to over 10 Hz

WAVELENGTH
400 to below 290 nm

CLASSIFICATION
UV A UV B UV C
320 - 400 nm 290 -320 nm <290 nm
Long UV, Blacklight Medium UV, Erythemal UV Short UV, Germicidal UV
Non-ionizing Non-ionizing Ionizing
Physiological effects are influenced by:
Wavelength
Intensity
Proportional to:
Power output of the lamp
Inverse square of the distance of the lamp from the patient
Cosine of the angle of incidence of the radiation beam with the tissue
Depth of penetration
Affected by:
Intensity reaching the skin
Wavelength
Power of radiation source
Size of area being treated
Thickness and pigmentation of skin
Duration of treatment
ULTRAVIOLET LAMPS
Output ranges:
Broad UVA – 320- 400 nm
Wideband UVB – 250- 320 nm
Narrowband UVB – 311 – 312 or

313 nm
UVC lamps- 200- 290 nm

(peaks at 250 nm)

ULTRAVIOLET LAMPS
Types:
Arc lamps
Generally small
Emit radiation of a consistent

intensity
Single-arc lamps -

recommended for treating small

areas
Units incorporating array of arc

lamps - recommended for

treating large body areas

ULTRAVIOLET LAMPS
Types:
Fluorescent lamps
Long
Emit higher-intensity radiation

in the middle than at the ends

Generally not recommended

because of variability of

intensity along their length

 ULTRAVIOLET LAMPS
Grouping of apparatus:
1. Air-cooled lamps
Recommended for generalized skin conditions
e.g. Hanovia Alpine Sun Lamp, Hanau Hohensonne and

Birtcher
2. Water-cooled lamps
Kromayer Lamp - localized lesions
3. Fluorescent tubes
Primarily UV A
Large body areas such as psoriasis
e.g. Theraktin Lamp (semicircular tunnel)
 ULTRAVIOLET LAMPS
Grouping of apparatus:
1. Hot quartz
High-pressure mercury lamp, low voltage and high currents

(near and far band)

2. Cold quartz
High voltage, low current, low temperature, low pressure

(bactericidal effect)
Usually used for localized treatment
PHYSIOLOGICAL EFFECTS
Penetration depth: 2 mm (epidermis and the superficial dermis)
Effects are primarily local

LOCAL GENERAL
Erythema Vitamin D production &

Pigmentation or tanning synthesis

Epidermal hyperplasia Esophylactic effect
Desquamation
Antibiotic effects
ERYTHEMA PRODUCTION
Redness of the skin resulting from

dilation of superficial blood vessels

caused by the release of histamines.

Produced primarily in response to UVB

exposure, or in response to UVA

exposure after drug sensitization.

Mediated by prostaglandin release from

the epidermis
May be related to the DNA-damaging

effects of UV radiation
PIGMENTATION OR TANNING

Result of increased production and

upward migration of melanin granules

and oxidation of premelanin in the skin

EPIDERMAL HYPERPLASIA

Thickening of the superficial layer of the skin

Occurs approximately 72 hours after exposure to UV radiation
Caused by the release of prostaglandin precursors --> increased

DNA synthesis by epidermal cells --> increased epithelial cell

turnover and cellular hyperplasia

Most pronounced in response to UVB exposure
DESQUAMATION OR PEELING

Casting off of the cells destroyed by UVR

Extent of desquamation is proportional to

the intensity of erythema

ANTIBIOTIC EFFECT

Mainly, UVB enhances the destruction of

viruses, bacteria, and other small

organisms found on the skin surface.

In laboratory setting, UVC radiation is

used in hospitals as it is effective in

removing pathogens from hospital

surfaces.
VIT D PRODUCTION

& SYNTHESIS
Conversion of ingested provitamin

D to vitamin D
ESOPHYLACTIC EFFECT
Resistance of the body to infection is increased or enhanced,

particularly if general irradiation of UVRA is given

Stimulation of the reticulo-endothelial system with higher doses of

UVR
 THERAPEUTIC EFFECTS
Erythema - increased circulation is beneficial for areas with

infection & poor skin condition; the inflammatory reaction to

marked erythema is used for counter-irritant effect

Desquamation - useful for blocked pores
Growth of epithelial cells - used in treatment of open skin

areas & acnes

Antibiotic effects - to address infective conditions
VARIOUS DOSAGES USED
Determine the patient’s sensitivity to UV radiation by getting

the minimal erythemal dosage (MED)

Factors that can affect response to UVR:
Skin pigmentation
Age
Prior exposure to UVR
Type of UV
Use of sensitizing medications
The same lamp that will be used for treatment should be used

to assess a patient's UV sensitivity.

MINIMAL ERYTHEMAL DOSE

(MED)
Time of exposure needed to produce an area of mild redness

between 8-24 hours after treatment

DOSE-RESPONSE ASSESSMENT
The UV dose is graded according to the individual’s erythemal

response and is categorized as follows:

Suberythemal dose (SED): No change in skin redness occurs in

the 24 hours after UV exposure.

Minimal erythemal dose (MED): The smallest dose producing

erythema within 8 hours of exposure that disappears within 24

hours after exposure.

First-degree erythema (E1): Definite redness with some mild

desquamation appears within 6 hours after exposure and lasts

for 1 to 3 days. This dose is generally about 2 1⁄2 times the

MED.
DOSE-RESPONSE ASSESSMENT
Second-degree erythema (E2): Intense erythema with edema,

peeling, and pigmentation appears within 2 hours after

treatment and is like a severe sunburn. This dose is generally

about 5 times the MED.

Third-degree erythema (E3): Erythema with severe blistering,

peeling, and exudation. This dose is generally about 10 times

the MED.
 DOSAGE FACTORS
Basis for calculation: MED (skin test)
Units of measurement for dosages:
Length of time (secs)
Distance from the source of UVR to the patient (mm)
Formulas:
E1 = 2.5 x MED
E2 = 5 x MED
E3 = 10 x MED
EXAMPLE
If MED of pt is 25 s at 100 mm, calculate the E2 at 100 mm.

Formula: E2 = 5 x MED
Where: MED = 25 s at 100 mm
Substitute: E2 = 5 x 25s
Answer: E2 = 125 s at 100 mm
EXAMPLE
If MED is 1 s in contact with the pt, calculate for E3.

Formula: E3 = 10 x MED
Where: MED = 1 s I/C
Substitute: E3 = 10 x 1 s
Answer: E3 = 10 s I/C
CALCULATION OF DOSAGES
Progression of treatment:
Progression (P = progression; 1 = number of progression;

thus, P1 = first progression… )

Formulas:
MED x 25% preceding dosage
E1 x 50% preceding dosage
E2 x 75% preceding dosage
EXAMPLE
If MED is 30 s at 450 mm, find the second progression (P2MED).

Step 1: Find P1 first

MED = 30 s at 450 mm
P1MED = MED + 25% (MED)
P1MED = 30 s + 25% (30s) Step 2: Calculate for P2MED
P1MED = 30 s + 7.5 s P2MED = P1MED + 25% (P1MED)
P1MED = 37.5 s at 450 mm P2MED = 37.5 s + 25% (37.5 s)
P2MED = 37.5 s + 9.4 s
P2MED = 46.9 or 47 s at 450 mm
CALCULATION OF DOSAGES
Alteration of intensity with distance:
The law of inverse squares: As the distance between the

source and the patient increases, the intensity decreases in

proportion to the square of the distance.

Formula: nt = ot x (nd) 2 / (od)2

Where:
nt = new time
ot = old time
od = old distance
nd = new distance
EXAMPLE
If MED at 900 mm is 60 s, find MED at 450 mm.

2 2
Formula: nt = ot x (nd) / (od)
2 2
Substitute: nt = 60 s x (450 mm) / (900 mm)
2
Answer: 60 (1) / (2) = 60/4 = 15 s
MED at 450 s is 15 s
CALCULATION OF DOSAGES
When using a Kromayer Lamp:
When using a Kromayer lamp (water-cooled lamp), patient

will always be at least 25 mm from the source of the

ultraviolet even if I/C.

EXAMPLE
If MED I/C is 1 s, fine E2 at 100 mm using kromayer lamp.

Step 1: Find E2 I/C

MED = 1 s I/C
Formula: E2 = 5 x MED
Substitute: E2 = 5 x 1 s I/C = 5s I/C

Step 2: Find E2 at 100 mm

2 2
Formula: nt = ot x (nd) / (od)
2 2
Substitute: nt = 5 s I/C x (100 + 25) / (25)
Answer: E2 = 25 s at 100 mm
CALCULATION OF DOSAGES
When using an applicator:
When using an applicator attachment to kromayer lamp, the

dose must be adjusted to compensate for the loss in intensity

of the UVR as it passes through the applicator.

The dose required for the sinus or shelf to be treated must be

calculated first as an in-contact dose; then the applicator dose

is then calculated as:

Applicator dose = I/C dose x Coefficient of the applicator
Where coefficient of the applicator = length of

applicator / 25
EXAMPLE
Calculate the P4E3 using an applicator with 120 mm in length if the MED of

the pt is 1 s I/C.
Step 1: Calculate E3
MED = 1 s I/C
Formula: E3 = 10 x MED
Substitute: E3 = 10 x 1 s I/C
Answer: E3 = 10 s I/C
Step 2: Calculate IC dose
Formula: P4E3 = 4 x E3
Substitute: P4E3 = 4 x 10 s I/C
Answer: P4E3 = 40 s I/C

Step 3: Calculate applicator dose

* If using 120 mm applicator then
Formula: Applicator dose = IC dose x (length of the applicator / 25)
Substitute: Applicator dose = 40 s I/C x (120 mm/25)
Applicator dose = 40 s I/C x (4.8)
Answer: Applicator dose = 192 s
 DOSAGE LEVEL
Dosage level is selected according to the effects required for

the treatment of the presenting condition.

Large areas are not recommended to be exposed to high doses

of UVR.
What therapeutic effects/physiological effects do you want?
Guidelines when applying to large areas:
MED = TBA (total body area)
E1 = 20% TBA
2
E2 = up to 250 cm of a (N) skin
2
E3 = up to 25 cm of a (N) skin
 DOSAGE FREQUENCY
Frequency of treatment depends upon the level of erythema

produced.
Successive doses of UVR must never be given to normal skin

while the erythema produced by the preceding dose is still

visible.
For non-skin areas, all doses must be given daily as there is NO

erythema reaction produced.

Successive dose should be DECREASED when desquamation

occurs, once it reaches the original erythemal level, progress

again at each successive treatment (GENERAL RULE).

 DOSAGE FREQUENCY
Guidelines for dosage frequency:
MED = Daily
E1 = q 2nd day
E2 = 2x /wk
E3 = 1x/wk or until erythema of the previous dose have

subsided
 INDICATIONS
Psoriasis
Chronic open wounds/Wound healing
Other skin conditions:
Acne
Scleroderma
Chronic eczema
Atopic dermatitis
Vitiligo
Cutaneous T-cell lymphoma (mycosis fungoides)
Palmoplantar pustulosis
 PSORIASIS
Characterized by bright red plaques with silvery scales, usually on the knees,

elbows, and scalp, and is associated with mild itching. May also be associated

with psoriatic arthritis.

Therapeutic efficacy of UVR: result of its ability to inactivate cell division and

inhibit DNA synthesis and mitosis of hyperproliferating epidermal cells, which

are characteristic of psoriasis.

Treatment:
PUVA (oral or topical psoralen)
Most commonly used sensitizers:
Tar-based topicals
Psoralen-derived drugs
Narrowband UVB, wavelength: 311 to 313 nm
Excimer UVB laser
Home phototherapy
 WOUND HEALING
UVC
Facilitates wound healing by:
Increasing epithelial cell turnover
Epidermal cell hyperplasia
Accelerating granulation tissue formation
Increasing blood flow
Killing bacteria
Increasing vitamin D production by the

skin
Promoting sloughing of necrotic tissue
 CONTRAINDICATIONS
Irradiation of the eyes
Skin cancer
Pulmonary TB
Cardiac, kidney, or liver disease
SLE
Fever
 PRECAUTIONS
Photosensitizing medications
Sulfonamide, tetracycline, & quinolone antibiotics
Gold-based medications used for treatment of RA
Amiodarone hydrochloride & quinidines (cardiac arrhythmias)
Phenothiazines (anxiety & psychosis)
Psoralens (psoriasis)
St. John's wort (dietary supplement)
Photosensitivity / Hypersensitivity to sunlight
Recent x-ray therapy
No dose of UV radiation should be repeated until the effects of

previous dose have disappeared

 RELATED DANGERS
Burning
Premature aging of the skin
Carcinogenesis
Eye damage
Photokeratitis
Conjunctivitis
Cataracts
 DOCUMENTATION
The following should be documented:
If and how psoralen was given
Area of the body treated
Type of UV radiation used
Serial number of the lamp
Distance of the lamp from the patient
Treatment duration
Response to treatment
THANK YOU FOR

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