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shorter wavelengths, shorter wavelengths

Ultraviolet Therapy
Introduction
Ultraviolet therapy is a form of treatment
commonly used to treat certain skin disorders. It
consists of irradiation of the patient with the
UVA band of ultraviolet light. The therapeutic
application of ultraviolet (UV) portion of the
electromagnetic spectrum (or UV therapy) has
been used for decades, although the recognition
of the therapeutic effect of sunlight, dates back to
ancient times, artificial UV radiation that allows
precise dosing has only been available since last
century with UV-A in 1974, narrowband UV-B in
1984, UV-AB in 1985, and UV-A1 in 1992.
penetrate less deeply. Absorption depends on the
thickness of the epidermis and any pigmentation
of the skin. Skin thickening due to lesions will
result in increased scattering and absorption and
thus reduced penetration.
Types of ultraviolet radiations
On the basis of dominant biological effects
displayed by each region as :
UV - A 315 - 400 nm Encourage wound healing
UV - B 280 - 315 nm Skin erythematous region

Ultraviolet therapy has been reported to be very UV - C 100 - 280 nm Germicidal region
effective in destroying bacteria and promoting
wound healing and therefore a promising
adjunctive therapy for chronic wounds infected Production of ultraviolet radiation
with resistant bacteria. The sun emits broad spectrum of ultraviolet
radiation, including UV-A, UV-B, UV-C. Both
UV-A and UV-B reach the earth from the sun.
Ultraviolet therapy is commonly used to treat However, UV-C is filtered out by the ozone layer.
conditions like, psoriasis, atopic dermatitis,
vitiligo, mycosis fungoides, and hand/feet
eczema. For therapeutic purposes, some form of generator
is used to emit ultraviolet radiation
Though there is evidence present for
effectiveness of Ultraviolet therapy in the Types of UVR Generators:
management of wounds and other skin
conditions and the significant role
physiotherapists play in its application, anecdotal 1. Mercury vapor lamp: It is a gas-discharge
evidence suggests that this modality is not lamp that uses an electric arc through
vaporized mercury to produce light. These
routinely applied for treatment in regular clinical
are used for the production of ultraviolet
practice. rays for therapeutic purposes. There are
two types of mercury vapor lamp:
 Air cooled medium pressure
Description mercury vapor (Alpene sun
Ultraviolet Radiation (UVR) is a non-ionizing lamp) : It is a U-shaped glass tube
radiation that lies between soft x-rays and visible filled with argon gas at low pressure. A
light in the electromagnetic spectrum. It has a small amount of mercury is enclosed in
the tube. The tube is sealed at both
wavelength of 100 nm to 300/480 nm. The ends. Burner is made up of quartz as
therapeutic part of ultraviolet spectrum are this material allows passage of UVR and
classified by International Commission on can withstand very high temperature.
Radiation (CIE). At the end of glass tubes, electrodes are
placed in metal caps. Step up
transformer is used to apply high
Ultraviolet radiation obeys the law that governs potential difference i.e 400V across two
all the radiations, they may reflect, scatter and metal caps. Step up transformer (400V)
are absorbed by molecular chromophores. The used to apply high potential difference
degree of absorption is generally greater for across the two metal caps. There occurs
ionization of Argon gas that promote

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movement of positive ions and free
electrons which constitute current flow
across the tube. Electrons move
towards (+) electrode, positive ions
move towards (-) electrode and
collision between moving ions and
neutral argon causes further ionization
of neutral argon gas (produce UVR).
Flow of current across the tube
produces heat making vaporization of
liquid mercury (Hg). Hg vapor gets
ionized by flow of current causing
further acceleration of flow of
current. [5] UVR produced by the
process of – -Ar Ionization -Hg
Vaporization -Hg Ionization •This
process takes about 5mins for the
emission of ultraviolet after the burner
is started. •When lamp is turned off,
ions of Ar and Hg recombine so that
within the tube everything returns to its
neutral state. [5]
 Water cooled mercury vapor lamp
(kromayer lamp) : It is a water
cooled UV lamp which eliminate the
danger of burn and absorb IR. The lamp
is surrounded by circulating distilled
water to absorb IR. A pump and a
cooling fan are organized into body of
lamp to cool water. After using, water
circulation should be continued for 5
minutes and then burner is switched off
to cool lamp. At the front of lamp’s
head, water is circulated between two
quartz window, which allows UV to
emerge. Advantage- direct contact
method- (safe as circulating water
absorb IR). [5][6]
1. Fluorescent lamps: One major problem
with the mercury lamp is that it produces a
certain proportion of short ultra-violet rays
and modern treatment regimen requires the
use of long-wave ultra-violet without the
short wave to avoid side effects, hence
various types of fluorescent tubes have been
designed. Each fluorescent tube is about 120
cm long and made of a type of glass that
allows long-wave ultra-violet to pass. The
inside of the tube is coated with a special
phosphor and the spectrum of each
fluorescent tube depends on the type of
phosphor coating. Here, if any short
ultraviolet radiation is produced it is
absorbed by the phosphor and is re-emitted
at a longer wavelength. [6] Depending upon
which particular phosphor is used, the
output of the tube may be part UVB and part
UV-A or UV-A, as in the PUVA apparatus,
but accurate control of the emitted
wavelength is possible.
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2. Theraktin tunnel: The theraktin tunnel is a
semi-cylindrical lamp, which has four
Fluorescent lamps mounted inside it, with
each tube being mounted in its own reflector,
in a way that even radiation is produced to
allow treatment of whole body to evenly
occur in two halves.
3. PUVA apparatus: It is usually used for
treatment of psoriasis, where a large amount
of UVA, is required. The tubes in PUVA are
usually mounted in a vertical battery on a
wall, or four sides of a box surrounding the
patient. This form of ultra-violet radiation is
usually given two hours after the patient has
taken a photoactive drug such as psoralen:
hence the term PUVA (psoralen ultraviolet
A)[6]
Dosage of ultraviolet radiation
therapy
Dosage of ultraviolet radiation therapy depends
on number of factors like; distance between lamp
and the skin, angle at what the radiation touches
the skin and the time for which skin is exposed to
the radiation.[1] [6]
Degree of erythema post ultraviolet therapy is the
deciding factor of the dose;
1. Dose E1 - causes mild pink appearance of
the skin which lasts for up to 24 hours with
no presence of skin edema or discomfort. E1
is also called as MED - Minimal erythema
dose. It is the smallest dose of ultraviolet
radiation to result in erythema that is just
detectable by eye.
2. Dose E2 - is 2.5% of E1 and causes definite
milk red appearance of the skin that
blanches on pressure which lasts for up to 2
days with no edema but slight soreness and
irritation of the skin and powdery skin
desquamation.
3. Dose E3 - is 5% of E1 and causes very red
skin appearance with no blanch of skin on
application of pressure, it lasts for 3 to 5
days. Post dosage some some edema is
present at the area of application, also the
application area feels hot and painful with
thin sheet like desquamation of skin.
4. Dose E4 - which is 10% of E1 and leads to
angry red appearance of the skin which lasts
for a week. It also leads to formation of
blisters on the skin which is very painful. It
also causes thick sheet like desquamation of
skin.
UVR
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Calculation of dosage: Therapeutic use of ultraviolet

radiation therapy
 E1 is determined from the skin test and the other
erythemal doses are calculated as follows:
 Suberythemal - 75% of E1
 Psoriasis

 E2 = 2.5×E1
 Acne vulgaris

 E3 = 5×E1
 Eczema

 E4 = 10×E1
 Chronic infection

 Double E4 = 20×E1
 Vitiligo

 E4 and double E4 are used on an open wound

 Treatment of vitamin D deficiency
 Pruritus
Physiological effects of
ultraviolet radiation therapy Contraindications of Ultraviolet
radiation therapy
1. Erythema because of dilation of the
capillaries and arterioles.  Irradiation of the eyes
2. Pigmentation or tanning of the skin
 Skin cancer
3. Desquamation or Increased skin growth
4. UVB can convert sterols in the skin to  Pulmonary tuberculosis
vitamin D, therefore increasing the  Cardiac, kidney and liver disease
production of vitamin D in the body.
5. Prophylactic effect starts in the body as the
 Systemic lupus erythematosus
resistance of the body to infection is  Fever
increased because of the stimulation of
reticuloendothelial system.
6. Ultraviolet radiation destroys Langerhan’s
Danger of Ultraviolet therapy
cell and stimulates the proliferation of
suppressor T cells, these immunosuppressive
effects may contribute to the development of  Burn
skin cancer.  Premature skin aging
7. Strong dose of UVB and C radiation to the
eyes can lead to conjunctivitis and  Carcinogenesis
photokeratitis which in turn results in  Damage to eyes
Irritation of the eye, a feeling of grit in the
eye, watering of the eye and aversion to light.
 over dose of ultraviolet therapy
(photophobia). A strong dose of UVA may  Shock
also lead to the formation of cataracts.
8. Prolonged exposure of UVR lead to,
premature ageing of the skin, this is
especially so in the light -skinned people. It
(Next Session for Lab)
also decreases function of sebaceous and
sweat glands. The skin becomes wrinkled,
dry and leathery.
9. Cancer: Carcinogenesis is a danger, as these
rays may influence the DNA and thus effect
cell replication. Squamous cell carcinomas
are a serious side effect. Hence, Shorter
ultraviolet waves should be avoided, and
course of treatment should not exceed four
weeks. [1][2]

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