Narrowband UVB Phototherapy
Massachusetts Dermatology Associates offers its patients on the North Shore, MA customized NBUVB light treatments targeted to specific body areas. We are the only practice on the North Shore of Massachusetts to offer full body, hand & foot, and scalp treatments.
What is Narrowband UVB (NBUVB) phototherapy treatment?
NBUVB phototherapy treatment involves the exposure of skin to a special kind of ultraviolet light that has been shown to be helpful for many patients with psoriasis, eczema, vitiligo, itch, and other conditions.
What are the benefits of narrowband UVB phototherapy treatment?
Many patients experience significant improvement of their skin conditions. In particular, NBUVB phototherapy treatment is helpful in the following:
- Psoriasis treatment
- Eczema treatment
- Vitiligo treatment
- Itch treatment
- Treatment of other light-responsive conditions
Are there potential risks or side effects of NBUVB phototherapy treatment?
Possible risks with phototherapy treatment:
- Some redness and dryness of the skin is to be expected. A reaction similar to a sunburn is another risk of treatment. Over the long-term this can lead to premature aging of skin
- Possible increased risk of skin cancer, although it is generally believed that NBUVB therapy results in fewer skin cancers than other forms of ultraviolet light therapy
- Cataracts if eye protection is not worn during treatment
Are there alternatives to NBUVB for psoriasis treatment?
Patients with moderate to severe psoriasis who have failed topical therapy have other options including other types of light therapy (e.g. PUVA) as well as immune modifying therapies such as methotrexate, Enbrel, Humira, and Stelara. The advantage of NBUVB therapy over these other therapies for psoriasis treatment is that for most patients it has a better safety profile.
Are there alternatives to NBUVB for eczema treatment?
There are other options for eczema treatment in moderate to severe cases in patients who have failed topical therapies. These options include immunosuppressive agents such as cyclosporine, methotrexate, mycophenolate mofetil, and azathioprine. NBUVB for eczema treatment has a better safety profile than these immune modifying eczema treatments.
Are there any patients who should NOT undergo NBUVB phototherapy treatment?
Patients with a history of photosensitivity, lupus, porphyria, or other light sensitive disorders risk severe health complications with NBUVB treatment. Tell your doctor if you might have one of these conditions.
What key things should I know about the logistics of NBUVB treatments?
- You should plan to come in for treatment three times weekly for the first 2-3 months of treatment. After your condition is under better control, we can consider reducing the number of weekly treatments.
- NBUVB is not a cure. It usually takes about 30-35 treatments to get many skin conditions under control, rarely fewer and often more. Once control is achieved, you will still need to come in for regular light treatments at fixed intervals.
- It will be your responsibility to make sure you have updated valid referrals (with a sufficient number of visits) from your primary care physician. Note that without a valid referral, we cannot continue treatments. If your referral expires, you will be asked to sign a waiver indicating that you know you are responsible for paying the costs of any treatments given without a referral. Our policy is to allow patients a total of 3 treatments beyond the expiration of a referral as a grace period while the next referral is in process.
Will my insurance cover narrowband UVB treatment?
- Most patients in MA do not have difficulty in getting NBUVB treatment covered by insurance (an exception is Tufts which typically does not allow coverage for patients with vitiligo). Some patients have copays that need to be paid at each visit.
- To be certain that your particular plan covers your phototherapy treatment and for more details about copays, we strongly recommend that you call your insurance company and verify coverage of the following codes:
- For psoriasis treatment (Diagnosis code = L40.0; Procedure code = 96910)
- For eczema treatment (Diagnosis code = L20.89; Procedure code = 96910)
- For pruritus (itch treatment) (Diagnosis code = L29.8; Procedure code = 96910)
- For vitiligo treatment (Diagnosis code = L80; Procedure code = 96900)
It is the day of my phototherapy treatment. What do I need to know?
- Immediately before and during phototherapy treatment:
- Do not apply sunscreen, calcipotriene / Dovonex / calcitriol, or LacHydrin on the day of treatment to areas you wish to treat
- For patients who are not receiving full body treatment and are using only the hand/foot or Levia device: apply sunscreen to face/neck and other exposed areas that you do NOT wish to treat before treatment (for UV protection)
- For full body treatments only: If you are a male, cover your genitals (with underwear–or a sock if you are treating the groin area). If you are a female and your treatment includes the breasts, cover nipples with either a Band-Aid or zinc oxide cream.
- Tell the NBUVB technician if you have any changes in your medications (including over the counter meds) during the course of your treatments. Some medications can increase toxicity of the light leading to burns. Any medication that bears a warning label about easy burning in natural sunlight will cause enhanced burning while receiving artificial light
- COVER AREAS CONSISTENTLY DURING EACH TREATMENT. IF YOU EXPOSE A NEW AREA THAT HASN’T ACCLIMATED TO THE LIGHT, YOU RISK A POTENTIALLY SERIOUS BURN.
- Apply a thin film of petrolatum or mineral oil immediately before treatment (for eczema treatment, psoriasis treatment, but NOT for vitiligo treatment or itch treatment)
- After your treatment:
- Consistency is very important for effective treatments. If you frequently miss treatments, you can expect less satisfying results and possibly treatment failure
- In order to have your skin condition managed optimally, you will need to be seen regularly by the dermatologist who is treating you. If you fail to follow-up with the ordering physician, we will be unable to continue treating you with NBUVB.
- Given the possibility of an increased rate of skin cancer, you are encouraged to see your dermatology provider at least once yearly for full skin checks.
- Before and after treatment, you should avoid additional exposure to sunlight during the course of your treatment. Especially on the day of treatment, additional sun exposure could lead to severe sunburn.
– There are some patients with conditions such as psoriasis, eczema, chronic itch, and vitiligo, who find themselves unable to improve adequately with topical creams or oral treatments that we prescribe for them. In these cases, often there is a decision point. Most of the time, this decision is whether to start the patient on immunosuppressive medications, such as Enbrel, Humira, Stelara, or Prednisone, which may be effective, but which carry a risk of serious infections and/or potentially even the development of internal cancers.
– The alternative that’s presented to many of these patients is to try light therapy with what we call narrow band ultraviolet beam. This is a newer generation of light therapy, which is safer and more effective than those that came before. It utilizes a very narrow wavelength of ultraviolet light that harnesses the most therapeutic aspects of sunlight and concentrates them on the affected skin. The light is able to modify the behavior of immune cells in the skin to stop skin inflammation. So what are the benefits?
– We see improvement in many cases well beyond what is possible with topical creams, and approaching similar levels of efficacy to the immunosuppressive medications. Downsides. Patients are required to come in two to three times per week, and improvement often takes several weeks.
– Most insurance plans cover phototherapy, but patients should verify with their insurances and determine whether copays may be required at each visit.
– We have three phototherapy devices. The first is a full body unit for treating large surface areas. We also have a hand and foot unit, designed specifically for treating hands and feet. And finally, we have a targeted phototherapy unit called Levia, which is great for the scalp and for smaller targeted areas. If you have psoriasis, eczema, chronic itch, or vitiligo, ask your dermatologist if phototherapy could be helpful for you.