What are the aims of this leaflet?
This leaflet has been written to help you understand more about UVA1 phototherapy for your skin condition. This leaflet explains this treatment in detail, including its risks, benefits and alternatives. If you have any questions or concerns, please speak to the doctor or nurse caring for you.
What is phototherapy?
Natural sunlight has been known to be beneficial in certain skin disorders for thousands of years. Phototherapy is a specialised treatment, delivered by the Phototherapy Unit at your hospital. It is carefully regulated to ensure patient safety and has proven to be a very effective treatment for many different skin diseases. The ultraviolet part of the radiation produced by the sun (UVR) is used in phototherapy. Although it can’t be seen, UV radiation is an important part of sunlight and is divided into ultraviolet A (UVA) and ultraviolet B (UVB) wavelengths. UVA rays go deeper into the skin than other types of UVR and can cause the skin to tan. UVB rays do not penetrate as deeply but can cause the skin to burn. In phototherapy we use carefully calculated doses of UV light to minimise this risk.
What is UVA1?
UVA1 means Ultraviolet A. UVA is made up of UVA1 and UVA2. UVA1 is the type of UVA which goes deepest of all into the skin.
Are there any other types of phototherapy?
The other phototherapy treatments are PUVA (psoralen + UVA, where UVA radiation is combined with a chemical called psoralen that increases the effect of UVA on the skin) and UVB. The choice of phototherapy treatment depends upon what the problem is with your skin.
What skin conditions are treated with UVA1 and why am I having this treatment?
This treatment is the most suitable treatment for your skin condition. It is often recommended after you have tried ointments and creams without success but before trying tablet medication. UVA1 phototherapy is used to treat skin diseases where the skin thickens, including scleroderma and morphoea. It is also sometimes used in the treatment of other skin diseases (including atopic dermatitis, chronic urticaria and polymorphic light eruption). Most patients find their skin has improved after about 50 treatments and remains clear for three to four months or sometimes longer, though the successfulness of the treatment varies from one patient to another and from one skin disease to another.
The Treatment process: What can I expect on my first treatment?
At your first visit you will need to have a light test, which assesses your skin’s tolerance to UVA1. This is needed to calculate your safe starting dose. You will need to come back 24 hours afterwards so the phototherapy team can examine the site where you had the light test. They will then be able to start your treatment. Your first treatment in the phototherapy machine will only happen after your light test is completed.
What happens during treatment?
The phototherapy nurses will examine your skin on each visit and ask you some questions before you enter the machine. They will give you goggles to protect your eyes, which you must wear at all times during your treatment. They will show you how to lie down in the machine in the correct position to make sure that all your skin is exposed evenly each time. You will usually be asked to remove all your clothing, although you can keep your underwear on if this area of skin is not affected. Men must either wear dark underwear or cover their genitalia whilst in the booth. If you wear underwear, please make sure it covers the same area on each visit. If an area of skin that has previously been covered is exposed to the UVA1 treatment, it may burn.
You will be in the UVA1 machine for up to 45 minutes. The amount of UVA1 you receive will be closely monitored and the dose will be increased with each treatment as long as you have tolerated the previous treatment. The machine is quite bright and you may feel warm if you need to stay in the booth for a long time. You can let the nursing staff know if it feels uncomfortable.
How long do treatments last?
This depends on your skin condition and varies from person to person. Treatments are generally given 3-5 times a week for 12 weeks. The total length of a treatment course will depend on your response and the specific skin condition being treated, but may be up to 50 treatments.
Important points to remember before and during your treatment:
You need to commit to attending the phototherapy department 3-5 times per week. Attending regularly helps to achieve better results from your treatment.
Reduce exposure to the sun’s rays to minimise the risk of sunburn: Cover up with long sleeved clothes particularly on sunny days. You may also wear a hat. Use a sunscreen with a sun protection factor (SPF) of a least 50 that protects against UVA and UVB rays and re-apply it regularly. Please do not sunbathe or use a sunbed during the whole course of your treatment.
Let your team know if you have a haircut or, for any other reason, any areas of skin become newly exposed during the course of treatment. If you wear clothing during treatment it is important that you wear the same clothing or the exact same style for every treatment of the course.
Before you start UVA1 treatment the doctor will check the medicines that you are taking. If any medications you are taking (including anything you are taking over-the-counter) are changed during UVA1 treatment, please let the nursing staff know before they start your next treatment. This is because some tablets can affect the way this treatment works.
On the day of your treatment:
Do not wear perfumes, deodorants, aftershave lotions or other cosmetic products before your treatment. Some of these contain substances which make your skin more sensitive to light. This can cause patchy discolouration of the skin and take some months to fade. You can use them after each treatment.
For the same reason please let us know if you have started any new medications or creams whilst having treatment as some can make your skin more sensitive to light.
On treatment days please do not apply any creams or ointments to your skin before you go in the machine apart from an appropriate moisturiser. You may wish to moisturise beforehand using a water-based moisturiser as this helps your skin to absorb the ultraviolet light. Please speak to your nursing team for more information on this.
Do not use oily creams as these could cause burning or prevent the UVA1 from being absorbed.
What are the risks with UVA1 phototherapy?
Your doctor or nurse will discuss the possible complications of this treatment with you in more detail, but you need to be aware of the following:
Effects that could happen during your course:
It is likely that you will get a mild sunburn reaction at least once during your course. If you get any severe sunburn-like reactions then you should contact the phototherapy unit which you are attending, unless they have given you other details about what you should do to get advice. If there is any delay in getting further advice then if you have a steroid ointment at home it would be appropriate to apply this as well as moisturisers.
You may get a spotty, itchy rash during your course (prickly heat): about one out of 10 people do.
Depending on your natural skin colour, if you skin goes brown easily in sunlight, you may develop a dark tan.
Your skin may become dry and itchy.
Cold sores. This may affect one in 30 people. Tell your nurse if you notice early signs of tingling or a painful bump developing on your lip. If you have a history of cold sores they will apply sunblock to lips.
Deterioration of the disease being treated. This may occur instead of improvement and your doctor will advise you of the risk of this happening.
Risks associated with multiple courses:
People who have a lot of sunlight exposure have an increased risk of cancer. In the UK approximately one out of 10 of us will develop skin cancer. It is unclear whether the risk from UVA is higher than that from sunlight.
It is usual practice to be asked to attend your local clinic for a specific skin cancer review once you have received more than 200 UVA treatments.
It is also possible if you need many treatments that you may develop sunlight induced skin changes with wrinkling and skin discolouration, similar to that of the ageing process or produced by cigarette smoking.
Where can I get more information about UVA1 phototherapy?
The process of phototherapy can generate lots of questions, and sometimes also thoughts and feelings about your skin condition. The list below contains information about some of the Patient Support groups that provide support during, and information about, the process of phototherapy.
In addition, the nursing staff of your Phototherapy unit are more than happy to answer questions about your course of treatment or anything that arises from the treatment.
This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.
This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel
BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED MARCH 2020
REVIEW DATE MARCH 2023