A Guide to Using Light Therapy for Psoriasis

How this underused treatment can help

Psoriasis, an autoimmune disorder characterized by the rapid growth of skin cells leading to itchy, red lesions, has been a longstanding challenge for those affected. Throughout history, sunlight has been a go-to remedy for managing this condition. Even in our technologically advanced era, phototherapy, which employs light as a treatment modality, remains a potent weapon against psoriasis. This article delves into the realm of phototherapy, exploring its efficacy, types, best practices, and why it might not be as widely adopted as one would expect.

The Science Behind Phototherapy

When ultraviolet (UV) light penetrates the skin, it triggers a cascade of beneficial effects. Dr. Steven Feldman, a dermatology professor at Wake Forest University School of Medicine, explains that UV light effectively eliminates immune cells within the skin, a crucial factor in psoriasis management. Moreover, research suggests that UV light may disrupt the flawed signaling pathways between immune cells and skin cells, thereby curbing the development of psoriasis lesions.

One of the key advantages of phototherapy is its limited side effects, making it an attractive option for managing psoriasis. Kathy Kavlick, a community outreach nurse, underscores the potential of phototherapy, emphasizing that “Some people get really good results from it.”

Types of Phototherapy

Phototherapy is typically administered on an outpatient basis, often in a dermatologist’s office. It involves exposure to specific wavelengths of light that can mitigate psoriasis symptoms. There are two primary types of phototherapy:

1. Ultraviolet B light (UVB): UVB is a component of natural sunlight and has proven particularly effective in psoriasis treatment. During UVB therapy, patients are exposed to UVB light, gradually increasing exposure time from a few seconds to several minutes per session. Dermatologists sometimes combine UVB treatment with topical therapies like coal tar, anthralin, or mineral oil. Narrow-band UVB (NB-UVB) is a specialized form of UVB that has demonstrated superior efficacy in comparison to traditional UVB.

2. Ultraviolet A light (UVA): UVA treatment, while not as potent as UVB, remains a valuable option for psoriasis management. Sessions usually require longer exposure times, ranging from 15 to 20 minutes. UVA treatment may be combined with an oral medication called psoralen, a therapy known as PUVA (psoralen plus UVA). PUVA has historically been effective, but its side effects and skin cancer risk have limited its use.

In addition to UVB and UVA, newer phototherapy techniques involve the use of excimer or pulsed-dye lasers, which can target individual psoriasis plaques. While research suggests that laser therapy may require fewer sessions and lead to longer remissions, it may not be practical for individuals with extensive lesions.

Effectiveness of Phototherapy

Typically, patients require approximately 20 phototherapy sessions to witness noticeable skin improvement. While response rates vary, studies indicate that approximately 65% of individuals undergoing UVB treatment and 75% of those receiving NB-UVB experience significant skin clearance. Notably, PUVA therapy may be even more effective.

A 2006 study in the Archives of Dermatology compared PUVA and NB-UVB therapy for chronic plaque psoriasis. The results showed that PUVA had a significantly higher clearance rate (84%) than NB-UVB (65%). Furthermore, PUVA required fewer sessions and led to longer-lasting effects. However, PUVA does have serious side effects, including nausea and an increased risk of skin cancer, especially in fair-skinned individuals. Consequently, it is usually reserved for severe and resistant cases.

UVB phototherapy has been linked to skin cancer, but research has not demonstrated an elevated risk of skin cancer among psoriasis patients receiving UVB treatment.

Barriers to Wider Adoption of Phototherapy

Despite its effectiveness, phototherapy faces practical challenges that hinder its widespread use. One such challenge is convenience, as patients must visit a dermatologist’s office multiple times a week during business hours. Additionally, the cost can be a deterrent. Many insurance companies charge a higher co-pay for office visits compared to prescription drug co-pays.

The Pitfalls of Tanning Beds

While natural sunlight is an effective psoriasis treatment, the use of commercial tanning beds is strongly discouraged. Tanning beds emit light spectra that vary widely and often include wavelengths that can be carcinogenic and detrimental to the skin. The ultraviolet radiation from these devices can damage the skin, accelerate aging, and elevate the risk of skin cancer. Thus, using tanning beds for psoriasis treatment is ill-advised.

Sunlight: Nature’s Healing

As people have recognized for millennia, natural sunlight can be a powerful psoriasis treatment. However, this approach may take several weeks to yield results. It is important to sunbathe cautiously, avoiding sunburn and overexposure. The National Psoriasis Foundation recommends discussing sun exposure with a healthcare provider. They may prescribe short, controlled sunbathing sessions. Some experts advise brief sun exposure without sunscreen, followed by the application of at least SPF 15 sunscreen to protect against further damage

In Conclusion

Phototherapy, which involves harnessing the beneficial effects of ultraviolet (UV) light, remains a valuable and time-tested tool in managing the chronic skin condition known as psoriasis. While undeniably effective in many cases, the practical challenges associated with regular treatments, as well as the emergence of alternative therapeutic options, have somewhat constrained its widespread acceptance and utilization.

Nevertheless, it’s important to underscore that phototherapy retains its significance and relevance within the arsenal of treatment options available for psoriasis. For countless individuals grappling with this often debilitating skin condition, phototherapy represents a ray of hope, offering not only symptom relief but also a potential enhancement of their overall quality of life.

To effectively navigate the complex landscape of psoriasis management, it is imperative for individuals affected by this condition to remain well-informed. Staying abreast of the latest advancements in treatment modalities, including phototherapy, is crucial. Equally essential is the active collaboration with healthcare professionals who can provide tailored guidance and treatment plans that align with each patient’s unique needs and circumstances.

In this journey towards managing psoriasis, informed decision-making becomes a cornerstone. By making well-informed choices, individuals can optimize their treatment outcomes, enhance their well-being, and take proactive steps towards achieving a more comfortable and fulfilling life despite the challenges posed by psoriasis.