Clinic of Dermatology
Balneophototherapy
Balneophototherapy and PUVA therapy are our choice in the treatment of patients with psoriasis and atopic dermatitis in combination regimens with topical or systemic agents.
What is balneophototherapy?
Balneophototherapy (balneo – water, photo – light is a combination of salt water baths and artificial ultraviolet radiation. It recreates in artificial conditions the therapy at the Dead sea. Dead sea salts are dissolved in warm water (30 - 35 C) in a certain concentration and then UVB in the range of 300 to 320 nm (Selective Ultraviolet Phototherapy - SUP) is applied.
How is balneophototherapy performed?
The clinic has a sector equipped with modern devices where balneophototherapy is performed. The procedure starts with a shower of Dead sea salts in concentrations from 5 to 10% which takes place in a specialy designed shower unit for 10 minutes. Prior to the procedure the patient is provided with protective glasses. The door of the unit is transparent which provides a pleasant atmosphere. After finishing the shower the patient enters the irradiation unit with fitted sources of UVB light. During the procedure the patient is wearing protective glasses provided by the staff. The duration and dose of the emission are strictly controlled by a physician through a command desk outside the irradiation device. Procedures are held five times weekly (from Monday to Friday) with a total number varying from 20 to 30. They are performed and controlled by highly qualified specialists in balneophototherapy.
What is Selective Ultraviolet Phototherapy (SUP)?
SUP is irradiation with UVB rays with wave lengths between 300 and 320 nm. It is performed in a unit with rotating base and fitted lamps, emitting UV rays in the spectrum between 300 and 320 nm. Sensitivity to UVB rays is individual and is determined mostly by the skin type. In order to adjust the therapy with one’s individuality it is possible to determine the minimal erythema dose (MED) prior to SUP. For this purpose certain fields in the gluteal or lumbar area are irradiated with gradual increment of the dose. The dose that leads to visible erythema after 24 hours is determined as MED.
The procedures are conducted 5 times weekly (from Monday to Friday) and the total number varies from 20 to 30. The dose is increased every other procedure.
Redness, itching and dryness of the skin are possible side effects observed after phototherapy. This necessitates omission of one or two procedures and application of moisturizers after each session. The duration of radiation and the dose of the rays at each procedure are strictly controlled by the physician. Irregular conduction of the therapy may have a negative impact on the therapeutic result and even compromise it.
Indications for SUP:
- Psoriasis
- Plaque type Parapsoriasis
- Atopic dermatitis
- Cutaneous lymphomas
- Lichen planus
- Pruritus
- Mastocytosis, etc.
Contraindications:
- Cardio-vascular diseases (hypertension, etc.)
- Advanced age
- Xeroderma pigmentosum
- Lupus erythematosus
- Dysplastic nevi
- Personal or family history of malignant melanoma
- Pemphigus
- Bullous pemphigoid
- Porphyrias and other photodermatoses
What is PUVA therapy?
PUVA is a combination of psoralen (a substance that increases skin sensitivity to ultraviolet rays) and radiation with UVA rays.
How is PUVA therapy performed?
There are three types of PUVA therapy depending on the way of psoralen administration:
Systemic PUVA – psoralen is administered orally in the form of tablets in a certain dose according to patient’s weight, 2 hours prior to irradiation. The patient must know that skin sensitivity to UV-rays is increased up to 8 hours after the psoralen intake. This necessitates avoidance of direct sun exposure and the use of sun glasses.
Local PUVA – psoralen is applied over the affected area of the skin in the form of solution 1 hour prior to irradiation.
Balneo PUVA – a 20 minute shower with psoralen solution (in concentration of 0,00005%) which is performed in a specially designed shower unit immediately prior to irradiation. Before entering the shower unit the patient is provided with protective glasses. During the procedure face area including the hair is kept dry. The process is controlled by a physician through a command desk outside the shower device and can be interrupted at any time.
Irradiation is conducted in a unit with rotating base and fitted lamps emitting UV-rays in the spectrum between 340 and 400 nm. The procedure is controlled by highly qualified specialists through a command desk outside the unit. The initial dose is individual for each patient and depends on the skin type.
It is possible to examine patient’s UVA-photosensitivity through determination of mean phototoxic dose (MPD), which like MED depends on skin type and is determined by irradiation of several fields with different doses after the intake of oral psoralen. The reading of the results is done 72 hours after the irradiation.
PUVA therapy is performed 4 times weekly (Monday, Tuesday, Thursday and Friday). The total number of sessions varies between 20 and 30.
Indications:
- Moderate to severe Psoriasis
- Atopic dermatitis
- Vitiligo
- Pityriasis lichenoides chronica
- Plaque type Parapsoriasis
- Urticaria pigmentosa
- Polymorphous light eruption
- Lichen planus
- Cutaneous lymphomas
Contraindications
- Cardio-vascular diseases (hypertension, etc.)
- Advanced age
- Pregnancy and nursing
- Patients under 10 years old
- Impaired liver and kidney function
- Dysplastic nevi
- Skin cancers
- Lupus erythematosus
- Personal and family history of malignant melanoma
- Pemphigus
- Bullous Pemphigoid
- Porphyrias and other photodermatoses
Adverse effects associated with PUVA therapy:
The possible side effects observed with PUVA therapy are redness, itching, dryness of the skin, anorexia and nausea. This necessitates omission of several procedures, application of emollients or switching to other therapy.
Local and balneo-PUVA have several advantages:
- avoidance of systemic treatment – retinoids, Methotrexate, oral psoralen, etc.;
- treatment of limited areas;
- outpatient treatment;
- sparing the unaffected areas;
- shortening the course of treatment in comparison with monotherapy;
- avoidance the use of pigmenting or clothes damaging agents;
- treatment without detachment of professional and family obligations;
- improvement of patient’s quality of life.
Local phototherapy of palms and soles
The device allows selective treatment of palms and soles. The sessions may be performed with UVA rays in the range of 340 - 400 nm or UVB rays in the range of 300 - 320 nm. During the procedure the patient is wearing protective glasses. Sessions are done by highly qualified specialists who control the duration and dose of the radiation. The device is suitable for performing local PUVA in diseases affecting palms and soles (eczema, psoriasis, atopic dermatitis, vitiligo, etc.).
Phototherapy with a comb
The clinic of Dermatology and Venereology is equipped with portable devices emitting UV-light and designated for the treatment of scalp psoriasis. These products utilize attachable combs that effectively part hair and allow UV-light to reach the scalp. Sessions are done 5 times weekly ( from Monday to Friday) with gradual increment of the dose.
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