Light therapy (phototherapy)

Overview

Many skin conditions – such as psoriasis, atopic dermatitis (neurodermatitis), chronic hand and foot eczema or sun allergies – can, depending on the findings, be treated with a suitable light therapy (phototherapy). In our practice we use whole-body irradiation units as well as devices for the targeted irradiation of the hand and foot region.

In addition, we have a bathing department for outpatient balneophototherapy (bath-salt-light therapy) and bath PUVA therapy. Which method is suitable for you is determined individually following a medical examination and indication assessment.

Areas of application

• Psoriasis
• Atopic dermatitis (neurodermatitis)
• Chronic hand and foot eczema
• Sun allergies (e.g. polymorphic light eruption)
• Certain forms of persistent itching (pruritus)
• Further suitable inflammatory skin conditions following medical assessment

Procedure

1. Medical indication assessment and dose planning

   First we assess which procedure is suitable for your condition. The irradiation dose is determined individually and increased under medical supervision at regular intervals.

2. UVB therapy (narrowband / selective)

   UVB therapy uses the wavelength spectrum between 280 and 320 nm and can be carried out as partial-body or whole-body irradiation. Narrowband UVB therapy (wavelength around 311 nm) is frequently used for psoriasis. Treatment is usually given on three to five days per week; it can be combined with further measures (e.g. brine baths).

3. UVA/UVB combination

   Combined UVA and UVB irradiation has proven effective for atopic dermatitis and certain forms of itching. As with any phototherapy, particular attention must be paid to the use of photosensitising medications.

4. PUVA (photochemotherapy)

   In PUVA, the skin is pretreated with a photosensitising agent (from the group of psoralens) and then irradiated with long-wave UVA light. In bath PUVA, an approximately 20-minute bath at around 37 °C with the agent is given first; in cream PUVA, the affected areas (e.g. palms, soles) are coated with cream. The UVA irradiation follows shortly afterwards. In the initial phase, treatment is usually given four times per week.

What to expect

• The irradiation dose is determined individually and increased step by step.
• Frequency depending on the procedure: UVB usually 3–5×, PUVA initially about 4× per week.
• The duration of treatment depends on the condition (e.g. about 6–8 weeks for psoriasis) and varies from person to person.
• During each irradiation you wear UV-protective goggles.
• After completion, we recommend regular long-term dermatological check-ups.
• Cost reimbursement for balneophototherapy: as a rule by private health insurers, and by statutory health insurers currently only for the diagnosis of psoriasis – we will discuss the details with you.

Risks & notes

• After a PUVA treatment, the treated areas remain more sensitive to light for at least 4 hours; they must be consistently protected from UV radiation.
• UV therapies can increase the risk of skin cancer in the long term – the dose is therefore controlled and limited under medical supervision; in the whole-body cabin, the genitals are covered for men.
• The most common acute side effect is a sunburn-like reddening; if the dose is too high, stronger reactions up to blister formation are possible – particularly with PUVA. In the long term, UV light can also cause the skin to age prematurely.
• Not suitable for everyone: in the case of certain light-sensitive conditions (e.g. lupus erythematosus, porphyria), an increased risk of skin cancer or a very fair, UV-sensitive skin type, we assess suitability before treatment begins.
• If psoralen is exceptionally taken as a tablet (systemic PUVA), UV-protective goggles must be worn all day on the treatment day; we primarily use bath and cream PUVA, where this effect is smaller.
• Certain medications (e.g. some antibiotics, blood pressure or sedative medication, St John's wort) increase light sensitivity – please inform us of all preparations you are taking.
• Pregnancy must not exist during PUVA therapy; please inform us immediately of any pregnancy and also if you are breastfeeding.
• Before the treatment, do not apply any sun-protection products or perfumed cosmetics (perfume, soap, aftershave) to the skin.

Our light therapy procedures

• UVA and UVB whole-body phototherapy
• Photochemotherapy (PUVA therapy)
• UVA, UVB and PUVA hand and foot irradiation
• Balneophototherapy (bath-salt-light therapy)
• Bath PUVA therapy

Guidance for conduct on PUVA treatment days

To ensure the treatment proceeds safely, please observe the following:

• Protect the treated skin areas consistently from UV radiation for at least 4 hours after the irradiation.
• During this time, avoid spending time outdoors – UV is also active under cloudy skies and behind window glass.
• Wear cotton gloves and long-sleeved, light-impermeable clothing if needed.
• Refrain from sunbathing and tanning beds on treatment days.
• With cream PUVA, the areas coated with cream must be protected from the moment they are creamed; do not touch any other areas of skin with them (e.g. the face).
• Do not bathe or cream new, previously untreated areas on your own initiative – discuss this with us beforehand.
• Inform us before you start taking any new medication.

Frequently asked questions

For which skin conditions is light therapy an option?

Frequently for psoriasis, atopic dermatitis, chronic hand and foot eczema, sun allergies and certain forms of itching. Whether it is suitable for you is something we decide following a medical examination.

What does PUVA mean?

PUVA stands for pretreatment with a photosensitising agent (psoralen) followed by UVA irradiation. It is carried out as bath PUVA (agent in the bath water) or as cream PUVA (rubbing the affected areas with cream).

How often and for how long do I have to come for treatment?

This depends on the procedure and the condition: UVB usually three to five times, PUVA in the initial phase about four times per week. The total duration is often 6–8 weeks for psoriasis, for example, and varies from person to person.

What do I need to be mindful of during the therapy?

Wear the UV-protective goggles, protect the treated areas consistently from light after a PUVA, report any new medication and refrain from perfumed cosmetics beforehand. Pregnancy must not exist during PUVA therapy.

Does health insurance cover the costs?

This depends on the procedure and the diagnosis. Balneophototherapy is, as a rule, reimbursed by private health insurers, and by statutory health insurers currently only for the diagnosis of psoriasis. We will clarify the specific scope with you.