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Phototherapy – Light Treatment Explained

Phototherapy is a medical treatment that uses controlled light to treat skin conditions, mood disorders, and neonatal jaundice. It is applied in dermatology, psychiatry, and neonatology.

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Things worth knowing about "Phototherapy"

Phototherapy is a medical treatment that uses controlled light to treat skin conditions, mood disorders, and neonatal jaundice. It is applied in dermatology, psychiatry, and neonatology.

What is Phototherapy?

Phototherapy, also known as light therapy, is a medical procedure that uses controlled exposure to specific wavelengths of light for therapeutic purposes. Depending on the indication, ultraviolet light (UV-A, UV-B), visible light, or specific light spectra may be used. Phototherapy is applied across various medical disciplines, including dermatology, psychiatry, and neonatology.

Indications and Areas of Use

Phototherapy is used for a wide range of medical conditions:

Dermatology: Treatment of psoriasis, atopic dermatitis (eczema), vitiligo, and other inflammatory skin disorders.
Psychiatry / Neurology: Treatment of seasonal affective disorder (SAD), non-seasonal depression, sleep disorders, and circadian rhythm disturbances.
Neonatology: Treatment of neonatal jaundice (hyperbilirubinemia) using blue light to break down bilirubin in the skin.
Other applications: Adjunctive treatment of vitamin D deficiency, chronic pruritus, and pain management.

How Does Phototherapy Work?

UV Light Therapy (Dermatology)

UV phototherapy treats skin conditions through targeted irradiation with ultraviolet light. Key types include:

Narrowband UV-B (311 nm): The most commonly used form in dermatology. UV-B radiation slows abnormal skin cell growth and modulates the immune response in the skin.
UV-A therapy (PUVA): A combination of UV-A radiation and a photosensitizing medication called psoralen. This combination selectively destroys abnormally proliferating skin cells.
Broadband UV-B: An older form, largely replaced today by narrowband UV-B therapy.

Light Therapy (Psychiatry)

In psychiatric light therapy, the patient sits in front of a special light therapy lamp delivering at least 10,000 lux – typically each morning. The bright light influences the release of melatonin and serotonin, thereby regulating the circadian rhythm (the body's internal clock). The recommended duration is generally 20 to 30 minutes per day.

Blue Light Therapy (Neonatology)

Newborns with elevated bilirubin levels are treated under special blue fluorescent lamps or using fiber-optic light blankets. The blue light converts bilirubin deposited in the skin into a water-soluble form that the infant can excrete through urine and stool.

Procedure and Treatment Course

Phototherapy is usually performed on an outpatient basis in a medical practice, dermatology clinic, or at home with appropriate devices. Key aspects of the treatment include:

Treatment sessions begin with short exposure times that are gradually increased.
The eyes and sensitive body areas are protected using goggles or coverings.
Irradiation schedules are individually tailored by the treating physician.
In PUVA therapy, psoralen must be taken orally or applied to the skin before each session.

Efficacy and Scientific Evidence

The effectiveness of phototherapy is well established for numerous indications:

For psoriasis and atopic dermatitis, narrowband UV-B therapy shows significant improvement in the majority of patients.
For seasonal affective disorder, light therapy is considered a first-line treatment with response rates of up to 80%.
For neonatal jaundice, blue light therapy is the standard of care and highly effective.

Side Effects and Risks

Phototherapy is generally well tolerated but may cause the following side effects depending on the method used:

UV therapy: Skin redness, itching, dryness, and with long-term use an increased risk of skin damage and premature skin aging. PUVA therapy may also cause nausea due to the psoralen medication.
Light therapy (psychiatry): Headaches, eye irritation, insomnia if used too late in the day, and rarely manic episodes in patients with bipolar disorder.
Blue light therapy: Mild skin irritation and increased transepidermal water loss in newborns are possible.

Contraindications

Not all patients are suitable candidates for phototherapy. Possible contraindications include:

Photosensitive conditions (e.g., lupus erythematosus)
Use of photosensitizing medications (e.g., certain antibiotics, diuretics)
History of skin cancer (for UV therapy)
Unstable bipolar disorder (for psychiatric light therapy)

References

World Health Organization (WHO) – Ultraviolet radiation and health. Available at: https://www.who.int/news-room/fact-sheets/detail/ultraviolet-radiation
Menter A. et al. – Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with phototherapy. Journal of the American Academy of Dermatology, 2019; 81(3):694-730.
Wirz-Justice A. et al. – Chronotherapeutics for Affective Disorders. A Clinician's Manual for Light and Wake Therapy. 2nd edition, Karger Publishers, 2013.

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