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Ultraviolet Therapy

Ultraviolet Therapy. Ultraviolet Radiation (UVR). Electromagnetic spectrum (2000 to 4000 nm) Divided into three ranges: UV-A = Near UV (3200 to 4000 nm) Little or no physiologic effect UV-B = Middle UV (2900 to 3200 nm) Sunburn and age-related skin changes

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Ultraviolet Therapy

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  1. Ultraviolet Therapy

  2. Ultraviolet Radiation (UVR) • Electromagnetic spectrum (2000 to 4000 nm) • Divided into three ranges: • UV-A = Near UV (3200 to 4000 nm) • Little or no physiologic effect • UV-B= Middle UV (2900 to 3200 nm) • Sunburn and age-related skin changes • UV-C = Far UV (2000 to 2900 nm) • Bactericidal

  3. Ultraviolet Radiation • Most likely to be used • UV-B or UV-C • UVR depth of penetration is 1 to 2 mm • Physiologic effects are superficial • Used to treat various skin disorders

  4. Effect on Cells • UVR causes chemical excitation of cells • Results in alteration of cell biochemistry and cellular metabolism • Affects synthesis of DNA and RNA • Protein and enzyme production is altered, which may result in cell death

  5. Effects on Skin: Erythema • Generalized response to UVR exposure • Reddening of skin • Acute inflammatory reaction • End results: • Erythema- sunburn • Pigmentation - tanning • Increased epidermal thickness

  6. Effects on Skin: Photosensitization • Process in which a person becomes overly sensitive to UVR • Acute effects of UVR exposure may be exacerbated if certain chemicals or medications are present on skin (or in body)

  7. Effects on Skin: Tanning • Increase of pigmentation • Protective mechanism activated by UVR exposure • Increase of melanin • Pigment responsible for darkening skin • Melanin functions as a biologic filter of UVR • By scattering radiation • By absorbing UVR • By dissipating absorbed energy as heat

  8. Effects on Skin: Tanning • Artificial Tanning - produce only UV-A • Production of UV-A is largely unregulated • Effects of long-term exposure to UV-A are unknown

  9. Effects on Skin: Long-term • Premature aging of the skin • Dryness, cracking, and decreased elasticity • Linked to UVR-induced DNA damage • Skin cancer • Most common malignant tumor found in humans • Basal cell carcinoma (rarely metastasizes) • Squamous cell carcinoma (metastasizes in 5%) • Malignant melanoma (usually metastasizes) • Damage to DNA suspected as cause • Rate of cure exceeds 95% with early detection

  10. Effects on Eyes • UVR exposure causes acute inflammation called photokeratitis • Delayed reaction, occurs within 6 - 24 hours • Signs/Symptoms: • Conjunctivitis accompanied by erythema of adjacent facial skin • Sensation of a foreign body on eye • Photophobia • Increased tear production • Spasm of the ocular muscles

  11. Systemic Effects • Photosynthesis of vitamin D • Following exposure to UVR in UV-B range • May be used to treat Ca++ and phosphorus disorders • Rickets and tetany • Treatment of choice; however, is dietary supplementation

  12. Ultraviolet Generators • Carbon arc lamp • Xenon compact arc lamp • Fluorescent ultraviolet lamp (black light) • Mercury arc lamp • Most commonly used in sports medicine

  13. Mercury Arc Lamp • Mercury contained in a quartz envelope • Heavy metal in a liquid state • At 8000°C, mercury atoms vaporize and become incandescent • Emit ultraviolet, infrared, and visible light

  14. Mercury Arc Lamp • High-pressure lamp = “Hot” lamp • UVR produced falls within UV-B range • Mainly used to produce erythema and accompanying photochemical reactions

  15. Mercury Arc Lamp • Low-pressure = “Cold” lamp • Does not require warm-up or cool-down • Used mainly for bactericidal effect

  16. Mercury Arc Lamp • Positioning • Apply cosine law and inverse square law • Distance of lamp must be kept constant if intensity of treatments is to be equal • Standardized at each clinic • Usually ranges between 24 - 40 inches

  17. Techniques of Application • Minimal Erythemal Dose (MED) • Exposure time needed to produce a faint erythema of the skin 24 hours after exposure • Question patient regarding photosensitizing drugs

  18. Minimal Erythemal Dose • Patient draped only exposing test site • Height of lamp adjusted to same level as testng • Paper with five cutouts (1” square) 1” apart placed over test site • Shutters are opened and cutouts exposed at 15-sec intervals

  19. Minimal Erythemal Dose • Visual inspection after 24 hours to determine MED • No erythema = suberythemal dose • Erythema still present at 48 hours • 1st degree erythemal dose (2.5 times MED) • Erythema persists from 48-72 hours • 2nd degree erythemal dose (5 times MED) • Erythema lasting past 72 hours • 3rd degree erythemal dose

  20. Minimal Erythemal Dose • Skin adapts to UVR exposure, therefore, MED will gradually increase with repeated treatments • Must gradually increase exposure time to achieve the same reaction • Increased by 5 seconds per treatment • Height of lamp remains constant

  21. Clinical Applications • Dermatologic conditions • Psoriasis, acne, and hard to cure infectious skin conditions such as pressure sores • Development of oral and topical medications has greatly reduced the use of ultraviolet

  22. Acne Aseptic wounds Folliculitis Pityriasis rosea Tinea capitum Septic wounds Sinusitis Psoriasis Pressure sores Osteomalacia Diagnosis of skin disorders Increased vitamin D production Sterilization Tanning Hyperplasia Indications

  23. Porphyrias Pellagra Lupus erythematosus Sarcoidosis Xeroderma pigmentosum Acute psoriasis Acute eczema Herpes simplex Renal and hepatic insufficiencies Diabetes Hyperthyroidism Generalized dermatitis Advanced arteriosclerosis Active and progressive pulmonary tuberculosis Contraindications

  24. Thank you

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