UVR: CHARACTERISTICS

Christian Rey D. Rimando, MSPT, PTRP

Instructor, UST-College of Rehabilitation Sciences
Supervisor, Physical Therapy Internship Program

UVR: CHARACTERISTICS UVR: CHARACTERISTICS

Electromagnetic Spectrum  Frequency of 1.65 x 1015 to 7.5 x 1014 Hz
 Wavelength shorter than visible light but
longer than x-rays
Bands Wavelength Other Name Use
UVA (315) 320 – 400 nm Long-wave UV; Blacklight
Near UV
UVB (280) 290 – 320 nm Middle-wave UV Skin erythema;
sunburn
UVC (200) <100 – 290 nm Short-wave UV; Germicidal
Far UV

UVR: CHARACTERISTICS Factors Affecting UV Penetration

 Method of energy  Intensity of radiation
transmission: Radiation  Wavelength of radiation
(Phototherapy)  Frequency
 Photochemical effect  Power of radiation source
 Reflected, refracted and  Distance of radiation source
absorbed
 Size of area
 Absorbed within the first
1-2 mm (0.22mm) of  Thickness of skin
human skin  Pigmentation of skin
 80-90% absorbed in the
 Exposure duration
dermis

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EQUIPMENTS EQUIPMENTS
MERCURY ARC FLUORESCENT HOT QUARTZ COLD QUARTZ
LAMPS LAMPS  Burner (argon gas and  Quartz tube with
 Small  Long mercury) mercury (ionized vapor)
 Emit radiation at  Emit higher-intensity   pressure &   pressure &
constant intensity radiation temperature temperature
 Used for smaller areas  Used for larger areas  (+) erythema and  Minimal erythema and
 Hot Quartz  Low pressure mercury pigmentation (-) pigmentation
 Cold Quartz discharge tubes with  Applied ≥15” from the  Application at close
phosphor coating inside area proximity
(Theraktin)  Needs 5 min warm-up  No need for warm-up

PHYSIOLOGIC EFFECTS PHYSIOLOGIC EFFECTS

Erythema  Erythema (Skin Redness) Erythema  Delayed pigmentation of the skin
Production  Dilatation of blood vessels due to Production  Increased production and upward
histamine release migration of MELANIN granules and
Tanning  Exposure to UVB or UVA after drug Tanning oxidation of PREMELANIN
sensitization  Skin color affects penetration of UV
Epidermal  Skin redness – prostaglandin Epidermal (Tanning =  Penetration)
Hyperplasia release Hyperplasia

Vitamin D Vitamin D
Synthesis PRACTICAL APPLICATION: Synthesis PRACTICAL APPLICATION:
• Proper Dosage (MED & Duration) • Examine Skin Phototype of Patients
Bactericidal Bactericidal
Effect Effect

PHYSIOLOGIC EFFECTS PHYSIOLOGIC EFFECTS

Erythema  Thickening of superficial layer of Erythema  Converts ingested provitamin D
Production skin Production to active vitamin D
 Thickening of epidermis (stratum  Found to effective treatment for
Tanning corneum) due to cell proliferation Tanning psoriasis
 Occurs usually after 72 hours after
Epidermal exposure to UVR Epidermal
Hyperplasia Hyperplasia

Vitamin D Vitamin D
Synthesis PRACTICAL APPLICATION: Synthesis
• Progressive higher dose needed
Bactericidal Bactericidal
Effect Effect

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PHYSIOLOGIC EFFECTS UVR vs IRR
Erythema  UVC = bactericidal ULTRAVIOLET INFRARED
Production  Also promotes wound healing • Chemical Effect • Physical Effect
• No heat • Absorbed as heat
 Desquamation  slough off dead • Absorbed at 1-2 mm • Absorbed at 3 mm
Tanning skin cells • Luminous sources • Luminous & non-luminous
• Delayed erythema (dark) • Immediate erythema
Epidermal (light)
Hyperplasia • Lasts for several days • Lasts for 20-30 minutes

Vitamin D
Synthesis PRACTICAL APPLICATION:
• Bactericidal effect in open wounds
Bactericidal
Effect

DOSIMETRY Determination of Initial Dose

Parameter Synonym Formula Unit FITZPATRICK SKIN PHOTOTYPE METHOD
Irradiance Intensity or power Measured by mW/cm2  More convenient
(I) density UV sensor on to use
device
 Based on skin
Exposure Treatment time sec color & reaction to sun exposure
Duration (T)
Phototype Skin Color Tanning/Sunburn History
Dose per Amount of energy Dt = I x T* mJ/cm2
Treatment delivered to skin for Type I Lighter White Burns easily; never tans
(Dt) a single treatment Type II Darker White Burns easily; tans minimally
Cumulative Summation of all Dc = Dt J/cm2 Type III Light Brown Burns moderately; tans gradually
Dose (Dc) doses Type IV Moderate Brown Burns minimally; tans well
Type V Dark Brown Burns rarely; tans profusely
*Bunsen-Roscoe Law / Reciprocity Law – inverse
relationship of irradiance and exposure time Type VI Black Never burns; intense tanning

Determination of Initial Dose Determination of Initial Dose

FITZPATRICK SKIN PHOTOTYPE METHOD MINIMAL ERYTHEMAL DOSE METHOD
 Recommended UV Dosing (mJ/cm2) based on Skin  UV-induced erythema – varies on each individual
Phototype  Dose of UV radiation that will produce a barely
Phototype BBUVB NBUVB detectable erythema about 8-24 hours after exposure
Initial Dose Progression Initial Dose Progression  DOSE-RESPONSE ASSESSMENT:
Type I 20 5 130 15  Suberythemal Dose (SED)
 Minimal Erythemal Dose (MED)
Type II 25 10 220 25
 First Degree Erythema (E1)
Type III 30 15 260 40
 Second Degree Erythema (E2)
Type IV 40 20 330 45
 Third Degree Erythema (E3)
Type V 50 25 350 60
Type VI 60 30 400 65
Treatment
3-5 treatments per week
Frequency

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Determination of Initial Dose Determination of Initial Dose
MINIMAL ERYTHEMAL DOSE METHOD MINIMAL ERYTHEMAL DOSE METHOD
 Degrees of Erythema:  Degrees of Erythema:

Dosage Latent Period Appearance Duration Dosage Edema Discomfort Desquamation Dose
SED No erythema SED No erythema
MED 6-12 hrs Mild pink <24 hrs MED X X X 1
E1 6 hrs Definite pink; blanching 2 days E1 X Slight soreness Powdery 2.5
E2 3 hrs Very red; not blanching 3-5 days E2 Some Hot & painful Thin sheets 5
E3 <2 hrs ‘Angry’ red 7 days E3 Blister Very painful Thick sheets 10

Determination of Initial Dose DOSIMETRY

MINIMAL ERYTHEMAL DOSE METHOD GUIDELINES IN ALTERING INTENSITY
 Summary of Dosimetry:  Inew = (Iold / Dold2) X Dnew2

Dosage Dose Progression Frequency BSA

 For Cold Quartz (Kromayer lamp), the lamp is applied
SED 12.5% Daily 100%
1 inch away from the wound
MED 1 25% Daily; every other day 50-100%
 For Hot Quartz lamp, the lamp is initially applied at
E1 2.5 50% Every other day <20%
60-80 cm distance
E2 5 75% 2x/week 4%
E3 10 NA 1x/week <25 cm2
 Distance is altered when duration has reached the
maximum of 5 minutes

INDICATIONS INDICATIONS
 Subacute and Chronic Psoriasis  Non-infected Open Wounds
 PUVA (Psoralen + UVA)  Such as surgical incisions, pressure / venous / arterial
 Usually, E1 is used ulcers
 E2 for heels and elbows  Granulation tissue: no treatment or suberythemal
dose to MED only, no progression
 Decubitus ulcers affecting the epidermis/dermis:
 Cystic Acne / Acne Vulgaris E1/E2
 E1 for face, neck and chest  Surrounding skin – MED daily
 E2 for back and shoulders

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INDICATIONS INDICATIONS
 Infected Open Wounds  Counter-irritation for pain relief (E3 applied that
 Thin yellowish slough – E2 daily and the discomfort masks the pain)
unprogressed  Alopecia – UVB at E1 or E2
 Definite green or yellow slough – E3 daily
 Vitamin D deficiency
and unprogressed
 Black slough – E3 daily  Uremic pruritus – SED UVB

 Surrounding skin – MED daily

CONTRAINDICATIONS PRECAUTIONS
 Over the Eyes  Photosensitivity or Photoallergy
 Skin Cancer  Photosensitizing medications
 Pulmonary Tuberculosis  Psoralen – sensitizing agent
 Cardiac, Kidney or Liver disease
 Sulphonamides & tetracyclines – antibiotics
 Griseofulvin – antifungal
 Systemic Lupus Erythematosus
 Phenothiazine – trnaquilizer
 Fever
 Chlorthiazide – diuretic
 Taking birth control pills
 Recent x-ray therapy
 No dose of UV should be done until the effects
of the previous treatment have disappeared

ADVERSE EFFECTS UV OVERDOSE

 Burning  IRR for 20 mins every hour for 6-8 hours
 Premature aging of skin (actinic damage)
 Carcinogenesis Documentation:
 Eye damage (photokeratitis, conjunctivitis,  Date
cataracts)  Lamp used
 Distance
 Exact area treated (specify patient position)
 Time
 Reaction obtained

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TREATMENT CONSIDERATIONS Steps in Determining Dosage:
 Phototesting for the determination of MED
Determine the
 Time of appearance (last to appear) Evaluative; use of erythrometer
MED
 Time of disappearance (first to disappear)
 Characteristics / description
For initial treatment; the computed
Calculation of dosage Determine the
 dose will be used for the initial
dosage
session
 Area of application
 Progression
Progress as Compute for the progression of the
necessary dosage (NOTE: maximum of 5 min)