PHOTOTHERAPY IN A NUTSHELL

Written by

Elizabeth Buzney, MD, Phototherapy Center, Brigham and Women’s Hospital

When is phototherapy used to treat cutaneous lymphoma?

Phototherapy is the use of ultraviolet light to decrease inflammation in the skin. While phototherapy can be used in the treatment of many inflammatory skin conditions such as psoriasis and eczema, it has also been proven as an effective treatment for cutaneous T-cell lymphoma (CTCL).

When considering phototherapy, it is important to know that there are two forms commonly used: Narrowband UVB and PUVA (oral Psoralens with UVA). When used in the treatment of cutaneous lymphoma, physicians will often start treatment of skin plaques with narrowband UVB.

Phototherapy is an extremely effective treatment for cutaneous lymphoma. It has been reported having a 60-90% effectiveness rate. Remissions have been documented with light therapy after completing a treatment course. Some remissions have been reported as lasting a year or more.

Can I get the same effects that narrowband UVB offers by sitting in the sun?

The simple answer is no.

There is a spectrum of ultraviolet (UV) light. The sun includes all wavelengths across the spectrum, while phototherapy uses only particular wavelengths selected to combat inflammation in the affected skin. Wavelengths selected in narrowband UVB therapy exclude many of the burning rays associated with natural sunlight and also may decrease risk of skin cancer relative to the complete UV spectrum. In the 30 years that narrowband UVB has been available, there has been no reported increased risk of skin cancer associated with this therapy.

Natural sunlight, on the other hand, may increase risk of skin cancer and may not maximize the wavelengths that are most important for cutaneous lymphoma treatment. In order for phototherapy to be most effective, consistency is important. Phototherapy allows for consistent access of the same wavelengths, with consistent increase in UV dose with each treatment. Variability is inevitable with natural sunlight when considering time of day and cloud cover, etc. It cannot be considered a controlled environment.

What about tanning beds?

The same problem can be stated with regard to tanning beds. Tanning beds, like the sun, cannot be considered a safe substitute for phototherapy because of increased risk of melanoma and non-melanoma skin cancer. Cutaneous lymphoma is a chronic problem which must be treated on a long-term basis.  Risk of skin cancer increases with increased tanning bed exposure. Tanning beds do not utilize the wavelengths that are specifically chosen to fight inflammation in the skin.

What are the benefits of narrowband UVB?

Narrowband UVB is optimal phototherapy for many patients for a variety reasons.

  • Reduced risk of skin cancer compared to PUVA is one.
  • It may be performed at home with an approved home unit. PUVA is not an at-home treatment option because of potentially life-threatening burns if not performed correctly.
What should I know about home units?

Narrowband UVB may be a convenient at-home option if approved by a physician for carefully educated patients.

Home phototherapy is optimal if a patient has first shown that their disease responds well to technician-administered, in-office phototherapy. Home phototherapy patients still need to be seen regularly by a physician to ensure that they are responding well to treatment and are receiving the right dose.

Obtaining an at-home unit for Narrowband UVB is dependent on one’s insurance coverage.

Every company provides a different level of coverage, and the process can be frustrating. When considering at-home treatment, first discuss with your doctor to determine if this is a good option for you.

If your physician has approved in-home treatment, there are many things to consider when purchasing a light box.

  • First, you want to make sure that you are getting a box which adequately covers your plaques. Some boxes are very small, providing coverage for only hands or feet. Some are full-body panels. The size of your home box should be determined by the area of your disease involvement, the amount of room in your home to accommodate the box, and cost.
  • Safety features incorporated into the box itself are also extremely important. Each machine is different depending on what the insurance coverage will allow. Safety features may include a key-lock on/off switch, a fail-safe switch, an acrylic safety shield, timers, and physician codes that allow a certain number of treatments before you should return to see your physician.
  • To begin the in-home treatments, your physician will start you on a treatment protocol. It is imperative that you follow the protocol to ensure the correct dose and to minimize risks associated with narrowband UVB treatment.
What is UVB treatment like?

When receiving narrowband UVB therapy for the first time, one can anticipate a warm, bright sensation while standing in front of a panel of light bulbs for several minutes. Patients are required to wear special goggles that are provided for in-office and at-home treatment. Improvement in the skin is generally seen after about two to three months of treatment, with less redness, less scaling, flattening of plaques, and no newly developing plaques. If patients burn due to the treatment, the intensity and/or frequency of the treatment may be reduced. Patients should keep a log of their treatment dose and any issues or challenges experienced. If any negative effects are noticed, it is advised to consult a physician immediately.

Maintenance therapy for narrowband UVB depends on a patient’s individual protocol, but is typically once weekly, decreased from the initial two to three times weekly treatment required for the clearing phase. With narrowband UVB, there is no limit to the amount of times a patient can receive treatment. This is different than PUVA treatments where the number of lifetime treatments are limited because of the associated increased risk of cancer.

Phototherapy is a good treatment option for many people.

In-office or at home units are options to consider depending upon individual circumstances. Talk with your clinical team and ask if this is an appropriate therapy option for the treatment of your cutaneous lymphoma.

My Personal Journey with Cutaneous Lymphoma
Gary Robinson shares his experience living with cutaneous lymphoma and recommendations for those newly diagnosed.

Gary Robinson
Salt Lake City, UT