Ultraviolet Radiaton

Made Hendra Satria Nugraha, S.Ft., M.Fis.

ULTRAVIOLET RADIATION

 Electromagnetic spectrum 2000-4000 Å

 Shortwave UV – extreme UV – far UV – (UV-C) : 2000-
2900 Å (bactericidal)
 Middle UV – sunburn spectrum – (UV-B) : 2900-3200 Å
(tanning effect)
 Near UV – (UV-A) : 3200 - 4000 Å (superficial chemical
changes)
 Clinical setting: UV-B or UV-C (both ranges)
 Beneficial effects: limited absorption (1-2mm of human
skin)
The Depth of Penetration

 The intensity reaching the skin

 The wavelength and the power of the radiation source
 The size of the area being treated
 The thickness and pigmentation of the skin
 The duration of the treatment
 Penetration is deepest for UV radiation with the highest
intensity, longest wavelength, and lowest frequency.
 Thus, UV A penetrates farthest and reaches through
several millimeters of skin, while UV B and UV C
penetrate less deeply and are almost entirely absorbed in
the superficial epidermal layers.
Effect on cells
 80-90% reach epidermis  dermis
 As the UVR is absorbed within the tissue  causes the
energy level of exposed atoms to increase  chemical
excitation (exposed tissue).
 Photochemical event  end product of the UVR
(chemical excitation).
 Affected DNA & RNA synthesis  alterations in protein
& enzyme production  cell inactive (dead).
 DNA synthesis is suppressed for 24-48 hours following
exposure to UVR in the range (2500 – 2700 Å)  then
followed by a period of increased DNA synthesis.
Effects on Normal Human Tissue
 Short-term effect on skin
 Erythema
 Inflammation
 Photosensitization
 Tanning
 Long-term effect on skin
Effects on Normal Human Tissue
 Short term effect on skin
 Human skin consist of two layers : epidermis & dermis.
 Epidermis: avascular & composed mostly of well-organized
layers of keratinocytes. It produce keratin (the fibrous
protein of the skin).
 Dermis: papillary layer (a rich blood supply) & reticular layer
(heavy connective tissue & contains fibroblast, histiocytes, mast
cells).
Erythema
 When human skin is exposed to UVR  the individual
cells react  however, the skin is a protective organ
(covering the human exterior)  an acute inflammatory
reaction.
 The end result of an active inflammation within the skin
are erythema (the reddening of the skin associated with
sunburn), pigmentation (tanning), and increased
epidermal thickness.
Inflammation
 The response of any human tissue to an irritating or
injurious substance.
 It begins several hours after irradiation and peaks 8 to 24
hours following exposure.
 It characterized by local vasodilation and increased
capillary permeability. It caused by (1) the absorption of
UVR by keratinocytes, leading to the release of
substances that diffuse to the papillary dermis and cause
vasodilation or (2) the absorption of UVR by mast cells in
the dermis that in turn release histamine, resulting in
vasodilation.
 At 24 hours the inflammatory process is completed, and
at 30 hours the rebuilding begins. The reparative process
is characterized by increased activity of the keratinocytes
and results in a thickening of the epidermis (hyperplasia).
 The acute effects of UVR exposure can be exacerbated if
certain chemicals or medications are present on the skin
or in the body.
 Photosensitization is a process in which a person
becomes overly sensitive to UVR as a result of the
excitation of a chemical by UVR exposure.
Tanning

 The increase of pigmentation within the skin and is a

protective mechanism by UVR exposure.
 An increase of melanin (the pigment responsible for
darkening within the skin) cause the tan.
 The melanin functions as a biologic filter of UVR by
scattering the radiation, absorbing the UVR, and
dissipating the absorbed energy as a heat.
 The process of tanning is divided into two phases:
immediate and delayed tanning.
 Immediate tanning
 Most often in darkly pigmented individuals
 The darkening of melanosomes
 It begins 1 hour after exposure and it’s hardly noticeable 3 to 8
hours later
 Delayed tanning
 The result of the formation of new pigment (melanin) through
the process of melanogenesis.
 The process is iniated by production of erythema (sunburn)
within the skin. Melanogenesis occurs within the melanocytes
of the basal layer of the epidermis and the end products of this
process are melanosomes (new pigment granules).
 Melanocytes (via nerve cells)  melanosomes  keratinocytes
 periphery
 72 hours after UVR exposure
Effect on Normal Human Tissue

 Long-term Effect on Skin

 Premature aging of the skin & skin cancer
 Premature aging
 Dryness, cracking, a decrease in the elasticity of the skin, solar
elastosis (it results from a change in the epidermis-alteration in
the skin’s elastic fibers).
 Skin cancer
 Most common malignant tumor found in humans  associated
with solar UVR.
 Damage to DNA is suspected as the cause of skin cancer , but
the exact cause is yet unknown.
Effect on Eyes
 UVR exposure of the eyes causes an acute inflammation
called photokeratitis.
 It is a delayed reaction occuring from 6 to 24 hours after
exposure, but occasionally develops within 30 minutes.
Systemic Effects
 Photosynthesis of vitamin D following irradiation of the
skin by UVR in the UV-B range.
 UV-B range
 This activates a biochemical pathway that travels from the
skin to the liver and kidneys and results in vitamin D
being delivered to bones, intestines, various organs, and
muscles.
 Vitamin D is responsible for regulating calcium and
phosphorus.
 UVR can be used as a treatment for disorders of calcium
and phosphorus metabolism, such as rickets and tetany.
Ultraviolet Generators
 Carbon arc lamp
 Fluorescent lamp
 Xenon compact arc lamp
 Mercury arc lamp (safe, effective, easy to operate)
 If using an arc lamp, the lamp have to warm up for 5 – 10
minutes to reach full power before turning it toward the
patient.
 A fluorescent lamp will reach full power and can be used
within 1 minute of being turned on.
 Arc lamps are generally small and emit radiation of a
consistent intensity, whereas fluorescent lamp are long and
emit higher intensity radiation in the middle than at the ends.
 Single arc lamps  treating small areas such as the hand.
 Array arc lamps  larger area
 Fluorescent tube  not recommended
Ultraviolet Treatment Techniques
 Determining the minimal erythemal dose
 Positioning the lamp
 Video
 UV Procedure (P. 385 – 386)
 The lamp and reflector must kept clean by wiping with methyl
alcohol
Determining the minimal erythemal dose
 The effectiveness of the lamp to determine the skin
sensitivity to UVR of the patient to be treated.
 MED (the exposure time needed to produce a faint
erythema of the skin 24 hours after exposure).
 Ask patient about photosensitizing drugs.
 The area of the test should have pigmentation similar to
the area to be treated.
 The forearm is a common choice for the test site.
 Positioning the lamp
 The inverse square law (24 – 40 inches or 60 – 80 cm)
 The cosine law
 Suberythemal Dose  area tested that reveal no
erythema 24 hours after testing.
 Minimal Erythemal Dose  erythema at 24 hours.
 E1  at 48 hours if erythema still present.
 E2  erythema persists from 48-72 hours.
 E3  if the erythema lasts past 72 hours after testing.

 E1 = 2,5 X MED
 E2 = 5 X MED
 E3 = 10 X MED
Clinical Application for Ultraviolet
 Psoriasis
 PUVA Therapy
 Disturbances of Calcium and Phosphorus Absorption
 Pressure Sores
 Sterilization
 Diagnosis
Dosymetry for the Treatment of Psoriasis
with UVR
 Using UVB
 E1 dose  increase 10% to 40% each treatment  treatment is
given once or twice a day
 Using PUVA
 Oral psoralens  2 hours after ingestion of the drug
 When the psoralent is delivered topically, the UVR exposure is
provided immediately after the patient has soaked in a bath of weak
psoralen solution for 15 minutes.
 PUVA treatment are usually given 2 or 3 times a week to allow time
for the erythema of one treatment to resolve before the next
treatment is applied.
 The treatment is generally applied to the whole body, and is usually
started at 40% to 70% of the MED and increased by 10% to 40%
each week in order to maintain the response. Evaluate in 6 weeks!
 (Ex. Hypopigmentation post inflammation)
 Adverse effect of PUVA
 Short-term nausea and vomiting, which last for 1 – 4
hours after ingestion of the psoralen.
 Prolonged high dose PUVA therapy can also result in skin
damage, including hyperpigmented and nonmalignant
lessions.
 Increase epithelial cell turn over
 Epidermal cell hyperplasia
 Granulation tissue formation
 Increasing blood flow
 Killing bacteria
 Increase vitamin D by the skin
Contraindication and Precaution
 Contraindication
 Irradiation of the eyes
 Skin cancer
 Pulmonary tuberculosis
 Cardiac, kidney, and liver disease
 Systemic lupus erythematosus
 Fever
 Precautions
 Photosensitizing
medication use
 Photosensitivity
 Recent x-ray therapy
 No dose of UVR should
be repeated until the
effects of the previous
dose have disappeared.
References:
 Prentice, WE. 2002. Therapeutic Modalities for Physical
Therapists. McGraw-Hill: USA
 Cameron, MH. 2003. Physical Agents in Rehabilitation:
From Research to Practise. Elsevier: USA
 Nussbaum, EL. et al. 2013. Ultraviolet-C Irradiation in The
Management of Pressure Ulcers in People With Spinal
Cord Injury: A Randomized, Placebo-Controlled Trial.
Physical Medicine and Rehabilitation Journal: USA