What is Phototherapy?

Phototherapy is the treatment of skin diseases with light, commonly using ultraviolet (UV) light.  UV light is that invisible part of sunlight with wavelengths shorter than visible light. The history of phototherapy dates as far back as ancient Egypt, where natural light was used in combination with herbal extracts to treat skin diseases.

The UV spectrum is classified into 3 wavelength ranges – UVA, UVB and UVC – in descending order of wavelengths.  UVA and UVB are used in medical treatments. UVA penetrates deeper into the skin and is more often associated with skin aging.  It is the most abundant form of UV rays in sunlight that reaches the earth surface.  UVB is associated more with sunburns.

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How does Phototherapy work ?

Phototherapy has the effect of reducing skin inflammation and promoting growth of pigment cells in the skin.  Hence it is especially well suited for the treatment of vitiligo and inflammatory skin conditions like psoriasis and eczema. 

What skin diseases can Phototherapy treat ?

Skin conditions that have been effectively treated with phototherapy include:

  • Vitiligo
  • Psoriasis
  • Atopic dermatitis also commonly known as eczema
  • Nodular prurigo
  • Pityriasis rosea
  • Pityriasis lichenoides chronica
  • Lichen planus
  • Chronic spontaneous urticaria
  • Progressive macular hypomelanosis

How is treatment like ?

Phototherapy can be delivered either to the whole body or only to a certain part of the body.  The machines used are different in each case.

Whole body phototherapy is conducted in a stand-up position inside an enclosed treatment booth. The inner walls of the treatment booth are lined with UV lamps all around for a uniform whole body treatment.  This is the most common form of treatment and is suitable for skin diseases that involve a large proportion or span across different parts of the body.

Targeted phototherapy on the other hand, is delivered via a handheld UV lamp operated by a therapist. This form of phototherapy treats only the affected parts of the skin and spares normal skin from unnecessary UV radiation.  It is suitable for treatment of skin diseases affecting only a small part of the body.

In whole body phototherapy, the initial treatment time is brief, usually less than a minute.  This time will gradually increase in subsequent sessions as the skin becomes used to the effects of treatment such that a higher dose of UV light will be required to maintain effective treatment effects.

Treatment times for targeted phototherapy will depend on the amount of skin area to cover in one treatment session. Treatments are usually carried out 2 to 3 times per week for several weeks and sometimes several months in order to see significant improvement in the skin conditions treated.

The number of treatments needed to achieve satisfactory clearance of skin disease is variable and depends on several factors like the type of skin disease being treated, duration of disease, area of the body affected, sensitivity of the skin to UV therapy and others.  Consistently following a regular treatment schedule is usually key to successful therapy.

Once satisfactory clearance of disease has been achieved, maintenance phototherapy once a week or fortnight may be recommended to prevent relapse.

Phototherapy may sometimes be combined with certain oral medication and/or topical creams to enhance treatment effects and success.

Is Phototherapy safe ?

Phototherapy is generally a very safe method of treating skin diseases.  It is an externally applied treatment that does not harm the internal organs compared to certain oral medications that are used to treat skin diseases.

The actual treatment is generally painless.  The most common potential side effects are sunburn, redness of the skin, itchiness and dryness that are easily relieved with frequent application of a moisuriser. Very rarely, severe sunburn can develop that requires medicated creams for treatment.

A tan may also develop after prolonged phototherapy.

The eyes and skin of the male genital organs can be susceptible to damage from UV radiation.  Hence it is important to shield those areas during phototherapy with UV protective goggles and underwear.  Doing so can prevent such risks.

It is possible with any form of UV light that an increased incidence of skin cancer may occur later in some patients, usually only after many UV light treatments.  This risk is minimal in short-term therapy.  Studies to date have not shown association of narrowband UVB phototherapy with increased skin cancer.

Skin aging is another side effect of long-term therapy.

How do I know if I am suitable for Phototherapy ?

Your doctor will ask about your medical history and the medications that you are currently taking before advising if you are a suitable candidate for phototherapy.  Certain medical conditions such as systemic lupus erythematosus can be made worse by phototherapy and if you have such a medical condition, you may not be suitable for phototherapy.  Certain medicines can make you more sensitive to UV light or sunburn easily.  If the medicine that you are taking have this concern, then adjustment to dose or time of taking the medicine may have to be made before phototherapy.

Phototherapy is usually recommended as the next step in treatment if medicated creams are no longer working for your current skin condition.

Phototherapy is available at our DTAP @Orchard Clinic, if you have any question or would like to find out more about phototherapy and how this safe and potentially beneficial treatment method can help manage your skin disease.

Next read: Vitiligo Causes, Signs & Symptoms

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Vitiligo Self-Care & Vitiligo Prevention Tips

People with vitiligo can adopt certain measures in their daily lifestyle to help prevent their disease from getting worse.

Sun protection

Skin that has lost its colour tends to sunburn easily. Sunburn can worsen vitiligo. Getting a tan from sun exposure can also increase the contrast between white vitiligo and normal tanned skin, thereby making the vitiligo patches appear more obvious.

Recommended measures:

1. Use sunscreen everyday

  • choose sunscreen lotions that are water resistant, SPF greater than 30 and offer broad spectrum (UVA + UVB) protection. Remember to reapply every 2 hours, after spending time in water or when you sweat
  • apply sunscreen to all skin that is not covered by clothing 

2. Wear clothing that protects you from the sun

  • The ability of clothing to protect your skin against UV radiation from the sun can be measured as a UPF rating
  • Some clothing comes pre-treated with UV absorbers that gives them a high UPF rating.
  • In general, loose fitting, dark or brightly coloured clothing made of densely woven fabric of unbleached cotton, shiny polyester or satiny silk confers the greatest UV protection
  • You can also increase the UPF of your clothing by adding UV blocking additives to the wash cycle.

3. Stay in the shade when possible

4. Do not use tanning beds and sun lamps

Skin protection

Take precautions to minimise skin injury and irritation

A cut, graze, scratch or friction to skin may lead to new patches of vitiligo

Avoid exposure to chemicals

Compounds containing phenols, catechols and sulfhydryls present industrial chemicals, cleaning agents and some hair dyes are known to cause loss of skin colour 

Reduce mental stress

Psychological stress has been known to trigger vitiligo flare-ups perhaps through its effect on immune cells and nervous systems of the skin.

Hence maintaining good mental health is essential to controlling the disease.

Do not get a tattoo

Do not tattoo your skin other than for treatment purpose as the micro-injuries caused by tattoos can lead to new vitiligo patches

Psychological & Social Impact of Vitiligo

People with vitiligo often suffer from low self-esteem, depression and anxiety.  

The appearance of the disease often affects one’s self image, makes one feel self conscious, anxious and embarrassed. It is sometimes made worst by perceived discrimination from others.  Children are especially vulnerable to teasing and bullying from their peers.

The early treatment of vitiligo is always advised.

People with vitiligo are encouraged to learn more about their condition to improve their own understanding and control of the disease.

Talking and sharing experiences with other people in a similar situation via support groups can also be helpful. 

Counselling provided by a psychologist is another option that is especially useful for addressing issues with self image, depression and anxiety.

Everything You Need to Know About Molluscum Contagiosum

What is molluscum contagiosum?

Molluscum contagiosum is a fairly common skin infection or condition caused by a virus called Molluscum contagiosum, a type of poxvirus. It manifests as raised, pearly, flesh or skin coloured bumps which may sometimes have a central dimple (known as “central umbilication”).  

How does molluscum contagiosum spread?

Molluscum contagiosum is spread through skin contact with the virus. 
This can occur if you come into direct contact with someone else’s molluscum lesions, be it through sexual contact, or during contact sports like wrestling.

Unfortunately, the virus can survive on surfaces outside the body and can remain on infected surfaces like clothing, towels, gym equipment etc. Someone else who then comes into contact with these surfaces can get infected. 

In someone who is already infected, scratching or touching the lesions and then touching other parts of their body can result in the virus spreading. Shaving over infected skin can also spread the virus and worsen the infection. 

Once lesions resolve, an infected individual is no longer contagious. 

Who is affected by molluscum contagiosum?

Both children and adults alike can be infected by the virus. It is common amongst young children who may spread the virus through playing with each other. Lesions may occur anywhere – on the trunk, limbs, armpits, neck and possibly even face.

In adults, it is more commonly spread through sexual contact and may be considered an STD. The resultant lesions occur anywhere on the lower abdominal wall to the external genitalia and perineum. 

Individuals with weakened immune systems e.g. cancer patients or immunosuppressed patients, or individuals with skin conditions like eczema are at higher risk of being infected. 

What are the symptoms of molluscum contagiosum?

Molluscum contagiosum gives rise to shiny, pearly, skin coloured bumps which may range in number from few to many. These can occur anywhere on the body depending on where the virus inoculates the skin. These bumps are painless and can range in size from barely visible to several millimeters in size or larger. When lesions are larger, you may be able to notice a central dimple. 

In individuals with weakened immune system, lesions may be far more widespread e.g. >100 lesions.

Symptoms usually surface between 2 weeks to 2 months from initial infection, but can be delayed for up to half a year even. 

What are the complications of molluscum contagiosum?

Molluscum contagiosum is a benign and self-limiting condition. However, scratching lesions can result in scarring or secondary bacterial skin infections.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is diagnosed clinically i.e. by identification of the classic pearly skin bumps. If the lesions look atypical, a skin scraping of a bump may be useful – examination under a microscope will reveal “molluscum bodies” which confirms the diagnosis, but this is not routinely performed in most patients. 

How is molluscum contagiosum treated?

Treatment of molluscum contagiosum is not always necessary as the condition is self-limiting and lesions will eventually resolve by themselves without scarring. Most lesions will resolve within a year but can take longer than that. 
Treatment is recommended for:

  • Lesions around the genital or perianal region
  • If lesions are large 
  • In immunocompromised individuals with extensive lesions 

Various treatment methods available include:

  • Physical removal of lesions – with laser removal or cryotherapy (freezing with liquid nitrogen)
  • Topical creams or ointments e.g. podophyllotoxin application, imiquimod cream – but the efficacy of topical treatment may vary 
  • In immunocompromised individuals, usual treatment methods may fail and specific, special treatment (e.g. intralesional interferon) may be required 

How do I minimize my risk of getting molluscum contagiosum?

Good hygiene habits are crucial to minimize your risk of molluscum – regular hand washing, not sharing towels or sports equipment, wiping down equipment at the gym before usage, or covering equipment with your own towel rather than sitting or lying directly on it. Do not share razors or personal items. 

Avoid touching lesions if you are infected. Do not scratch, pick, or attempt to pop lesions. Shaving should also be avoided. Molluscum lesions should ideally be covered e.g. with a plaster to reduce the risk of transmission. 

Adults with lesions around their genital or perianal region should also avoid sexual contact until these have been treated. 

If you are concerned about any skin lumps or bumps and think you may have molluscum contagiosum, it is best to hold off attempting to treat it yourself (this may worsen the infection!) and see a doctor as soon as possible.

If you would like to find out more about molluscum contagiosum come down to any of our clinics for a consultation.