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shorter wavelengths, shorter wavelengths

Ultraviolet Therapy penetrate less deeply. Absorption depends on the
thickness of the epidermis and any pigmentation
of the skin. Skin thickening due to lesions will
Introduction result in increased scattering and absorption and
Ultraviolet therapy is a form of treatment thus reduced penetration.
commonly used to treat certain skin disorders. It
consists of irradiation of the patient with the
UVA band of ultraviolet light. The therapeutic Types of ultraviolet radiations
application of ultraviolet (UV) portion of the On the basis of dominant biological effects
electromagnetic spectrum (or UV therapy) has displayed by each region as :
been used for decades, although the recognition
of the therapeutic effect of sunlight, dates back to
ancient times, artificial UV radiation that allows UV - A 315 - 400 nm Encourage wound healing
precise dosing has only been available since last
century with UV-A in 1974, narrowband UV-B in
1984, UV-AB in 1985, and UV-A1 in 1992. UV - B 280 - 315 nm Skin erythematous region

Ultraviolet therapy has been reported to be very UV - C 100 - 280 nm Germicidal region
effective in destroying bacteria and promoting
wound healing and therefore a promising
adjunctive therapy for chronic wounds infected Production of ultraviolet radiation
with resistant bacteria. The sun emits broad spectrum of ultraviolet
radiation, including UV-A, UV-B, UV-C. Both
UV-A and UV-B reach the earth from the sun.
Ultraviolet therapy is commonly used to treat However, UV-C is filtered out by the ozone layer.
conditions like, psoriasis, atopic dermatitis,
vitiligo, mycosis fungoides, and hand/feet
eczema. For therapeutic purposes, some form of generator
is used to emit ultraviolet radiation
Though there is evidence present for
effectiveness of Ultraviolet therapy in the Types of UVR Generators:
management of wounds and other skin
conditions and the significant role
physiotherapists play in its application, anecdotal 1. Mercury vapor lamp: It is a gas-discharge
evidence suggests that this modality is not lamp that uses an electric arc through
vaporized mercury to produce light. These
routinely applied for treatment in regular clinical
are used for the production of ultraviolet
practice. rays for therapeutic purposes. There are
two types of mercury vapor lamp:
 Air cooled medium pressure
Description mercury vapor (Alpene sun
Ultraviolet Radiation (UVR) is a non-ionizing lamp) : It is a U-shaped glass tube
radiation that lies between soft x-rays and visible filled with argon gas at low pressure. A
light in the electromagnetic spectrum. It has a small amount of mercury is enclosed in
the tube. The tube is sealed at both
wavelength of 100 nm to 300/480 nm. The ends. Burner is made up of quartz as
therapeutic part of ultraviolet spectrum are this material allows passage of UVR and
classified by International Commission on can withstand very high temperature.
Radiation (CIE). At the end of glass tubes, electrodes are
placed in metal caps. Step up
transformer is used to apply high
Ultraviolet radiation obeys the law that governs potential difference i.e 400V across two
all the radiations, they may reflect, scatter and metal caps. Step up transformer (400V)
are absorbed by molecular chromophores. The used to apply high potential difference
degree of absorption is generally greater for across the two metal caps. There occurs
ionization of Argon gas that promote

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movement of positive ions and free 2. Theraktin tunnel: The theraktin tunnel is a
electrons which constitute current flow semi-cylindrical lamp, which has four
across the tube. Electrons move Fluorescent lamps mounted inside it, with
towards (+) electrode, positive ions each tube being mounted in its own reflector,
move towards (-) electrode and in a way that even radiation is produced to
collision between moving ions and allow treatment of whole body to evenly
neutral argon causes further ionization occur in two halves.
of neutral argon gas (produce UVR). 3. PUVA apparatus: It is usually used for
Flow of current across the tube treatment of psoriasis, where a large amount
produces heat making vaporization of of UVA, is required. The tubes in PUVA are
liquid mercury (Hg). Hg vapor gets usually mounted in a vertical battery on a
ionized by flow of current causing wall, or four sides of a box surrounding the
further acceleration of flow of patient. This form of ultra-violet radiation is
current. [5] UVR produced by the usually given two hours after the patient has
process of – -Ar Ionization -Hg taken a photoactive drug such as psoralen:
Vaporization -Hg Ionization •This hence the term PUVA (psoralen ultraviolet
process takes about 5mins for the A)[6]
emission of ultraviolet after the burner
is started. •When lamp is turned off,
ions of Ar and Hg recombine so that Dosage of ultraviolet radiation
within the tube everything returns to its therapy
neutral state. [5]
Dosage of ultraviolet radiation therapy depends
 Water cooled mercury vapor lamp
on number of factors like; distance between lamp
(kromayer lamp) : It is a water
cooled UV lamp which eliminate the and the skin, angle at what the radiation touches
danger of burn and absorb IR. The lamp the skin and the time for which skin is exposed to
is surrounded by circulating distilled the radiation.[1] [6]

water to absorb IR. A pump and a

cooling fan are organized into body of
lamp to cool water. After using, water Degree of erythema post ultraviolet therapy is the
circulation should be continued for 5 deciding factor of the dose;
minutes and then burner is switched off
to cool lamp. At the front of lamp’s
head, water is circulated between two 1. Dose E1 - causes mild pink appearance of
quartz window, which allows UV to the skin which lasts for up to 24 hours with
emerge. Advantage- direct contact no presence of skin edema or discomfort. E1
method- (safe as circulating water is also called as MED - Minimal erythema
absorb IR). [5][6] dose. It is the smallest dose of ultraviolet
radiation to result in erythema that is just
1. Fluorescent lamps: One major problem detectable by eye.
with the mercury lamp is that it produces a 2. Dose E2 - is 2.5% of E1 and causes definite
certain proportion of short ultra-violet rays milk red appearance of the skin that
and modern treatment regimen requires the blanches on pressure which lasts for up to 2
use of long-wave ultra-violet without the days with no edema but slight soreness and
short wave to avoid side effects, hence irritation of the skin and powdery skin
various types of fluorescent tubes have been desquamation.
designed. Each fluorescent tube is about 120 3. Dose E3 - is 5% of E1 and causes very red
cm long and made of a type of glass that skin appearance with no blanch of skin on
allows long-wave ultra-violet to pass. The application of pressure, it lasts for 3 to 5
inside of the tube is coated with a special days. Post dosage some some edema is
phosphor and the spectrum of each present at the area of application, also the
fluorescent tube depends on the type of application area feels hot and painful with
phosphor coating. Here, if any short thin sheet like desquamation of skin.
ultraviolet radiation is produced it is 4. Dose E4 - which is 10% of E1 and leads to
absorbed by the phosphor and is re-emitted angry red appearance of the skin which lasts
at a longer wavelength. [6] Depending upon for a week. It also leads to formation of
which particular phosphor is used, the blisters on the skin which is very painful. It
output of the tube may be part UVB and part also causes thick sheet like desquamation of
UV-A or UV-A, as in the PUVA apparatus, skin.
but accurate control of the emitted
wavelength is possible.

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Calculation of dosage: Therapeutic use of ultraviolet

radiation therapy
 E1 is determined from the skin test and the other
erythemal doses are calculated as follows:
 Suberythemal - 75% of E1
 Psoriasis

 E2 = 2.5×E1
 Acne vulgaris

 E3 = 5×E1
 Eczema

 E4 = 10×E1
 Chronic infection

 Double E4 = 20×E1
 Vitiligo

 E4 and double E4 are used on an open wound

 Treatment of vitamin D deficiency
 Pruritus
Physiological effects of
ultraviolet radiation therapy Contraindications of Ultraviolet
radiation therapy
1. Erythema because of dilation of the
capillaries and arterioles.  Irradiation of the eyes
2. Pigmentation or tanning of the skin
 Skin cancer
3. Desquamation or Increased skin growth
4. UVB can convert sterols in the skin to  Pulmonary tuberculosis
vitamin D, therefore increasing the  Cardiac, kidney and liver disease
production of vitamin D in the body.
5. Prophylactic effect starts in the body as the
 Systemic lupus erythematosus
resistance of the body to infection is  Fever
increased because of the stimulation of
reticuloendothelial system.
6. Ultraviolet radiation destroys Langerhan’s
Danger of Ultraviolet therapy
cell and stimulates the proliferation of
suppressor T cells, these immunosuppressive
effects may contribute to the development of  Burn
skin cancer.  Premature skin aging
7. Strong dose of UVB and C radiation to the
eyes can lead to conjunctivitis and  Carcinogenesis
photokeratitis which in turn results in  Damage to eyes
Irritation of the eye, a feeling of grit in the
eye, watering of the eye and aversion to light.
 over dose of ultraviolet therapy
(photophobia). A strong dose of UVA may  Shock
also lead to the formation of cataracts.
8. Prolonged exposure of UVR lead to,
premature ageing of the skin, this is
especially so in the light -skinned people. It
(Next Session for Lab)
also decreases function of sebaceous and
sweat glands. The skin becomes wrinkled,
dry and leathery.
9. Cancer: Carcinogenesis is a danger, as these
rays may influence the DNA and thus effect
cell replication. Squamous cell carcinomas
are a serious side effect. Hence, Shorter
ultraviolet waves should be avoided, and
course of treatment should not exceed four
weeks. [1][2]

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