Ultraviolet (UV) Phototherapy is the use of specific wavelengths of the sun’s natural spectrum for the treatment of photo responsive skin disorders such as psoriasis, vitiligo, and atopic dermatitis (eczema); and for the treatment of Vitamin D deficiency. Phototherapy devices create either the short wavelength Ultraviolet-B (UVB) rays or the longer rays of Ultraviolet-A (UVA). UV light produces biological reactions within the skin that lead to clearing of the lesions. UVB is the only waveband of light that produces Vitamin D in human skin.

Using sunlight or “heliotherapy” to treat skin diseases has been around for over 3,500 years. Modern Phototherapy began when Niels Finsen developed a lamp in 1903 that emitted chemical rays used to treat tuberculosis, this earned him a Nobel Prize. The benefits of UV phototherapy for psoriasis were recognized by the medical community as early as 1925 by a study of the effects of natural sunlight on psoriasis patients. Fluorescent devices to produce UV light for the treatment of psoriasis have been in use for over 60 years and today there is a phototherapy clinic in most cities, usually in a hospital or a dermatologist’s office.

The best way to determine if UVB Phototherapy will work for you is to first get a proper diagnosis from your physician, and, if warranted, to take treatments at a phototherapy clinic near you to see if it is effective but your response to natural sunlight is usually a good indicator. Does your skin condition get better in the summer? Have you ever deliberately taken sun exposure to improve your skin? Do you take vacations to sunny climates to clear your skin?

The practitioner will make the assessment with you based on the following criteria's; skin type, the skin condition or deficiency you are treating, stage, and how acute and/or chronic it is. The treatment times will vary based on the above criterias and the duration of the session can be as low as seconds to a maximum of 6 minutes at a time. Below are some additional information on specific conditions: For psoriasis, the initial treatment time is based on the patient’s skin-type (light to dark skin). During the “clearing” phase, treatments are taken 3 to 5 times per week with every second day being ideal for many. After significant clearing is achieved, the “maintenance” phase begins; treatments are taken anywhere from three times per week to not at all, with treatment times reduced accordingly. For vitiligo, treatments are usually taken twice per week, never on consecutive days. Treatment times are usually less than those for psoriasis. For atopic dermatitis (eczema), treatments are usually taken 2 or 3 times per week, never on consecutive days. Treatment times are in between 2 to 6 minutes long. For Vitamin D deficiency, to quickly restore Vitamin D blood levels treatments every second day are ideal for many patients. For ongoing Vitamin D maintenance, UVB doses less than the maximum can be quite effective. We have a strong proponent of low dose UVB-Narrowband phototherapy for Vitamin D and general health.

Typically, some remission is evident after only a few weeks, while more advanced clearing requires two to six months and sometimes up to a year for the worst cases. Once the skin has significantly cleared (or re-pigmented in the case of vitiligo), treatment times and frequency can usually be reduced.

However, when only UVB is used and UVA is excluded, many decades of medical use have proven that these are only minor concerns. Indeed, UVB phototherapy is drug-free and safe for children and women that are pregnant. When these relatively minor risks of UVB phototherapy are weighed against the risks of other treatment options, often involving strong prescription drugs or even injections, UVB phototherapy is usually found to be the best treatment option, or at least the treatment option that should be tried after topical drugs such as steroids and dovonex have proven minimally effective. and the skin maintained in its healthy condition for many decades. A bonus is that every UVB treatment makes large amounts of Vitamin D in the skin for general health benefits as well.

Vitamin D can be obtained by humans in six ways: • By exposing bare skin to UVB radiation in natural sunlight, when available. • By exposing bare skin to UVB radiation created by artificial light sources (UVB phototherapy). • By consuming food that naturally contains Vitamin D, such as: eggs, chicken livers, salmon, sardines, herring, mackerel, swordfish, and fish oils, such as halibut and cod liver oils. (Note that there are now recommendations to not use cod liver oil because it contains very high amounts of Vitamin A). • By consuming food fortified with Vitamin D: milk (100 IUs per 250 ml glass in Canada), margarine. • By taking oral Vitamin D supplements: Vitamin D tablets. • By taking Vitamin D injections by hypodermic needle or intravenously.

Mortality maps for diseases related to Vitamin D show a strong correlation with the amount of environmental ultraviolet B (UVB) available from natural sunlight. Those living at higher latitudes receive less natural UVB and therefore have greater risk. During the winter months, regions such as Canada and Northern Europe receive practically zero UVB. This is because the sun’s rays strike the earth at a shallower angle, geometrically causing the rays to travel a longer path through the earth’s atmosphere and ozone, filtering out nearly all the UVB. Consequently, most people living far away from the equator have the lowest amount of Vitamin D at the end of the winter, after months of depletion. The risk of Vitamin D deficiency is compounded for those with dark skin because their skin pigment acts like a filter, reducing the amount of UVB delivered to the biologically active skin beneath. Black skin can require five to ten times longer UVB exposure to create the same amount of cutaneous (in the skin) Vitamin D as a white person. Other groups with greater risk of Vitamin D deficiency include: all people over the age of 50 because Vitamin D absorption decreases with age, people in religious groups that keep fully clothed for all outdoor activities, and obese people because their excess fat retains their Vitamin D.

A human can use 1000 to 3600 International Units (IU) of Vitamin D per day, so there is a need for constant intake to maintain the target concentration. If UVB is not available, the only other options are to get Vitamin D orally, or for the most severe cases, by needle. Food provides only a limited amount of the daily requirement, for example in Canada, milk has only 100 IUs per 250 ml glass. Oral Vitamin D dosing suggestions are seasonal and range from; 400 IU/day for those over 50 years of age per Canada’s Food Guide, 1000 IU/day year-round per the Canadian Cancer Society, and up to 2000 and 4000 IU/day depending on risk factors per other organizations.

The only method to determine Vitamin D status is by a blood test for precursor Vitamin D known as any of: “25-hydroxy-Vitamin-D” “25(OH)D” “25D” or “Calcidiol”. (IMPORTANT: This is not to be confused with a similarly named test for activated Vitamin D known as any of: “1,25-dihydroxyVitamin-D” “1,25(OH)2D3” “1,25D3” or “Calcitriol”). 25-hydroxy-Vitamin D tests are available in Canada at LifeLabs, but a physician’s requisition is required, and full or partial payment by the patient.

If most of a person’s skin area is exposed to UVB light, and the skin receives enough UVB such that it gets just under the state of mild sunburn, known as “suberythema” or one Minimal Erythema Dose (1 MED), it can produce the equivalent of up to 25,000 IU of oral Vitamin D. However, it is not advisable to regularly take 1 MED because that dose is too close to be burning (erythema), and such a large dose is not necessary if instead regular lower doses are taken; but this does show that getting Vitamin D using UVB light is much more effective than getting Vitamin D through diet or supplements.