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ORIGINAL ARTICLE
  
Year : 2002  |  Volume : 68  |  Issue : 3  |  Page : 140-141

Med estimation for narrow band UV-B on type IV and type V skin in India.

Ganesh S Pai, Vimala Vinod, Veena Krishna 
 Department of Dermatology, Kasturba Medical College, Mangalore, India

Correspondence Address:
Ganesh S Pai
Department of Dermatology, Kasturba Medical College, Mangalore
India

Abstract

With an aim to determine minimum erythema dose of narrow band UV-B, 30 subjects, 20 with type IV skin and 10 with type V skin were subjected to graded incremental doses of 311-Narrow band UV-B phototherapy cabiner by Daavlin. Barely perceptible erythema 24 hours after exposure was taken as MED. 33.3% developed erythema at 745mj, 26.6% at 620mj, 23.3% at 1075mj, and 10% at 1290mj. The average MED for narrow band UV-B exposure for type 1V skin was 600mj, [range 5515-755mj] and for type V skin 1100mj{range 8951290mj} Better therapeutic response can be obtained by giving approximately 360-450mj as initial irradiation dose for type 1 V skin and 600-825mj for type V skin.



How to cite this article:
Pai GS, Vinod V, Krishna V. Med estimation for narrow band UV-B on type IV and type V skin in India. Indian J Dermatol Venereol Leprol 2002;68:140-141


How to cite this URL:
Pai GS, Vinod V, Krishna V. Med estimation for narrow band UV-B on type IV and type V skin in India. Indian J Dermatol Venereol Leprol [serial online] 2002 [cited 2020 Sep 26 ];68:140-141
Available from: http://www.ijdvl.com/text.asp?2002/68/3/140/12542


Full Text

 Introduction



Narrow band UV-B 311 nm is being effectively by used in the treatment of various skin disorders. Determining MED helps in administering appropriate initial irradiation dose there by enhancing therapeutic efficacy. Based on clinical trials comparing PUVA and Narrow band UV-B utilizing TL-01 lamps, TL-01 should be considered the first line treatment for psoriasis.[1] TL-01 lamps have a relatively monochromatic spectrum of emission at 311+2 nm and have a reduced incidence of burning episodes, increased efficacy and longer remissions which are distinct advantages over conventional broad band UVB sources.[2] General advantages include safe use in children and pregnant women, no need for post treatment eye photoprotection, no drug-induced nausea and absent drug costs. 311-nm narrow band UV-B is also widely used as an effective modality of therapy for atopic dermatitis,[3] vitiligo,[4] and photodermatoses.[5]

As MED reaction becomes the primary basis for comparing therapeutic efficacy, other outcome comparisons eg: relative safety or toxic effects must be considered as a function of MED.[6] In the absence of established data in literature regarding irradiation regimens, determining MED for different skin types helps administering appropriate initial doses.

 Materials and Methods



Spectra 311 narrow band UVB phototherapy cabinet containing 16 TL-01 lamps with a built in 2001TM dose control system was used to determine MED. Of the 30 subjects included in the study, 20 subjects [11 males and 9 females] had type IV skin and 10 subjects [3 males and 7 females] had type V skin.

Those with history of photosensitivity, any intake of systemic antibiotic or antiinflammatory drugs during the study and any inflammatory skin disorders like psoriasis, atopic dermatitis were excluded from the study. The preferred MED test site was the upper back where the template containing 8 windows [1.5 x 1.5] was put. The rest of the body was covered and photoprotective glasses were used. All of them were subjected to a test dose ladder of 300, 360, 430,515, 620, 745, 895, 1075, 1290, 1550mj/cm2 of 311 nmUV B radiation.

 Results



Barely perceptible erythema 24 hours after exposure was taken as MED. Of the 20 subjects with type IV skin 20[33.3%] developed erythema at 745mj, 8[26.6%] at 620mj, 2[3.3%] of them developed erythema at 360mj and 515mj respectively. Of the 10 subjects with type V skin, 7[23.3%] developed erythema at 1075mj and 3[10%] at 1290mj.

The average MED for narrow band UVB exposure for type IV skin was 600mj [range 515-755] and for type V skin 1100mj [range 895-1290mj].

 Discussion



In our study, we noticed erythema as early as 3-4 hours in 66.6% of the subjects, associated with mild tenderness in individuals with type IV skin. Average MED has been mentioned as 1000mj [range 400-1200mj/cm2]. Though the average MED for type IV and type V skin falls within this range there can be individual variations as seen in one individual who developed erythema at 360mj. It has been noted that individuals with fair skin had MED that was higher or equal to those with more darkly pigmented skin.[6] On the contrary in our study we found that subjects with fair skin developed erythema much earlier and at a lower dose than needed by individuals with type V skin. Therapy protocols should now be tailored to start the initial doses at 360-450mj for type IV skin 600-825mj for type V skin and gradually stepped up by 20% depending on the patients erythema response.

References

1British Photodermatology Group. An appraisal of Narrow Band [TL-Ol] phototherapy. British photodermatology group workshop report [April 1996]. Br J Dermatol 1997;137:327-330.
2Van Weelden H, Boart de la Faille H, Young E, et al. A new development in UVB phototherapy of psoriasis. Br J Dermatol 1998;119:11-19.
3George SA, Bilsland DJ, Johnson BE, et al. Narrow Band [TL-Ol] UVB air conditioned phototherapy for chronic severe adult atopic dermatitis. Br J Dermatol 1993;128:49-56.
4Wiete Westerhof. Treatment of vitiligo with UVB radiation Vs topical psoralen plus UV-A. Arch Dermatol 1997;133:1525-1528.
5Collins P, Ferguson J. Narrow band [TL-Ol] phototherapy an effective and preventive treatment for photodermatoses. Br J Dermatol 1995;132: 956-963.
6Todd R Coven, Lauren H Burrack, Patrica Gilleau, et al. Narrow band UV-B produces superiorclinical and histopathological resolution of moderate to severe psoriasis in patients compared with Broadband UV-B. Arch Dermatol 1997;133:1514-1522.

 

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