Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Whole body or local irradiation with UV rays (UVA broadband, UVA1, UVB or mixed UVA/UVB rays). Can be used in combination with light sensitizing substances as systemic or local photochemotherapy. S.u. PUVA-therapy and KUVA-therapy.

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Dose depending on skin type, if possible after determining the MED with the corresponding UV spectrum:
  • UVB Broadband (initial dose):
    • skin type I: 20 mJ/cm²
    • Type II: 30 mJ/cm²
    • Type III: 50 mJ/cm²
    • Type IV: 60 mJ/cm².
  • UVB narrow band (311 nm) (initial dose):
    • skin type I: 200 mJ/cm²
    • Type II: 300 mJ/cm²
    • Type III: 500 mJ/cm²
    • Type IV: 600 mJ/cm².
  • UVA (initial dose):
    • Skin type I: 0.5 J/cm²
    • Type II: 1.0 J/cm²
    • Type III: 1.5 J/cm²
    • Type IV: 2.0 J/cm².
  • UVA1 (dose per irradiation):
    • Low-dose: 20≤50 J/cm² (initial 5 J/cm², increase dose by 5 J/cm² after every 3 sessions).
    • Medium-dose: 50≤90 J/cm² per treatment.
    • High-dose: 90-130 J/cm² per treatment.

Undesirable effects
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  • Absolute AI: Infectious diseases, acute infections, venereal diseases, parasitoses.
  • Relative AI: Acute dermatoses, acute episodes of chronic dermatoses, chronic venous insufficiency, collagenoses (except circumscript scleroderma), blistering dermatoses, advanced pregnancy.

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General guidelines for the implementation of a photo(chemo)therapy (recommendations of the DDG):
  • Observe the indications and contraindications. Absolute contraindications are e.g. genetic defects with an increased sensitivity to light or an increased risk of skin cancer (Xeroderma pigmentosum, Cockayne syndrome, Bloom syndrome). Relative contraindications (possibly modified treatment regimes) are patients with convulsions (taking photosensitizing drugs), anamnestically known malignant skin tumors or with dysplastic melanocytic nevi.
  • Informing the patient about the course of therapy, side effects (acute and long-term side effects). Written consent is essential.
  • Before starting photo(chemo)therapy, it is recommended to determine the individual light sensitivity ( MED) or the minimum phototoxic dose ( MPD).
  • The applied UV doses must be stated and recorded in exact radiation physical units (J/cm2, mJ/cm2).
  • During therapy, patients must be monitored by a physician at regular intervals (weekly). Therapy success and NW must be documented in writing.
  • In general, eye protection is required during therapy. In case of non-infection, the chronically light-exposed areas (face, neck, back of the hand) must also be protected (exception: mycosis fungoides).
  • Phototherapy for children is possible at any age (eye protection). Strict indication necessary.
Staphylococcus aureus is held responsible for an exacerbation of atopic eczema. According to a Brazilian study a narrow band UVB therapy is supposed to significantly reduce the colonization of Staphylococcus aureus on the skin.

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Last updated on: 29.10.2020