Page 0: Page 1: ULTRAVIOLET RADIATION Edmund L. Benaojan, MM, PTRP Page 2: Ultraviolet Radiation Near UV (long UV)/UVA: 290-400 nm Far UV (short UV)/UVB: 180-290 nm UVA: 320-400 nm UVB: 290-320 nm UVC: 200-290 nm Freq: 0.8 x1015-20 x1015 Hz DOP: < 1 mm Page 3: Equipments for Artificial UVR A. Mercury Vapor Lamp 1. Hot quartz – both UVA and UVB 2. Cold quartz – UVB Advantages: -safer and easier to control the output -Arc intensity is small -No need to warm up the lamp B. Fluorescent Tubes -290-350 nm -Psoriasis affecting large body areas -Theraktin lamp Page 4: High Pressure Mercury Vapor Lamps B. Air Cooled Lamps -253 nm -Uses LOW voltage but high intensity -30-110 volts -5 amperes Generalized skin conditions Hanovia Alpine Sun Lamp, Hanau Hohensoone, BIRTCHER Page 5: High Pressure Mercury Vapor Lamps Water Cooled Lamps 366 nm High voltage, low intensity -3,000 V -15 mA More localized lesions and sinuses/shelves in open areas Kromayer lamp 366 nm Local and open lesions Radiating area is small (approx 3 inches diam) Page 6: INFRARED Physical Effect Absorbed as heat Absorbed at 3 mm Luminous and nonluminous Immediate erythema Lasts < 1 hour Mottled Dark, reddish homogenous (tanning) Occasional tolerance UVR Chemical Effect No heat Absorbed at 1 mm Luminous sources Delayed Lasts several days Sharply defined Light pink, Peeling Page 7: Physiologic Effects Erythema-promotes wound healing Pigmentation (tanning) -tyrosinase Bactericidal effect Psoriasis Antirachitic effect Esophylactic effect Increase production of antibodies Exfoliation (desquamation) Page 8: Wavelengths and Specific Effects RANGE 250-297 300-400 240-300 360-390 APPLICATION ERYTHEMA PIGMENTATION ANTIRACHITIC PUVA EFFECT RED TANNING METABOLIC PSORIASIS Page 9: Dosages SUBERYTHEMAL DOSE (SED) - No evidence of erythema MINIMAL ERYTHEMAL DOSE (MED)/E1 - Mild erythema appearing in 6-8 hrs, disappears in 24 hrs - (+) pigmentation - Fine desquamation E2 - Erythema in 4-6 hours and disappears in 48 hrs - Definite pigmentation and POWDERY desquamation E3 -MARKED erythema in 2-4 hours lasting 72-96 hrs (+) edema and tenderness -Marked pigmentation and FLAKY desquamation - 250 cm2 E4 - Erythema within 2-4 hours lasting for a week or months - (+) blister formation - 25 cm2 Page 10: Dosages MED=E1 E2 = 2.5 x E1 E3 = 5 x E1 E4 = 10 x E1 PROGRESSION E1= 25% of preceding dose E2= 50% of preceding dose E3= 75% of preceding dose Formula: P1Ex = Ex + Y% Ex Calculating distance of Exposure and Progression nt = ot (nd)² (od)² / Page 11: CALCULATION OF PROGRESSION If the E1 of the patient is 30 seconds at a distance of 200 mm, calculate the E3 at 200 mm E3 = 5 x E1 = 5 x 30 = 150 sec at 200 mm If the E1 of the patient is 30 seconds at a distance of 200 mm, find the second progression (P2E1) P1E1 = E1 + 25%(E1) = 30 + .25( 30) = 30 + 7.5 = 37.5 seconds P2E1 = P1E1 + 25%(P1E1) = 37.5 + (.25)(37.5) = 46.88 seconds Page 12: If the E1 at 600 mm is 60 seconds, find the E1 at 400 mm nt = ot (nd)² (od) ² / nt = 60 (400)² (600) ² nt = 60 (16) 36 nt = 26.67 seconds Page 13: Factors Determining the Degree of Erythema -Individual patient sensitivity -Intensity of radiation source -Distance of lamp to target -Angle of incidence of radiation at skin -Duration of exposure -Skin texture Flexor surface vs extensor surface Blondes and redheads Children (half dosage only) Page 14: Indications Wounds Psoriasis Goeckerman Regimen (TUVAB) PUVA (Psoralen + UVA) Leeds Regime Ulcers – pressure ulcers Uremic Pruritis Jaundice (hyperbilirubinimia) Page 15: Precautions/Contraindications Photoophthalmia Photosensitizing drugs Overdosage of UVR: Infrared exposure Skin sensitivity -Fair skin -Areas of “thin” skin Diseases caused by light - Urticaria solaris Extremes Age and Debilitating Illness Systemic Lupus Erythematosus Fever Cardiopulmonary Condition Eyes (295 nm= cornea absorption) Page 16: Assignment If the E1 of the patient is 90 seconds at a distance of 300 mm, calculate the E3 at 300 mm If the E2 of the patient is 90 seconds at a distance of 300 mm, find the second progression (P2E2) If the E1 at 400 mm is 90 seconds, find the E1 at 200 mm Make your own erythrometer Page 17: ENDOLAMP 474 UVB (5%) and UVC (74%) Cold quartz lamp Controls: On/off switch Stop switch Start switch Time Switch (min and sec) Time Display (min and sec) Holder for Hand unit Hand unit Page 18: Recommendations for Application  Never touch the lamp with the fingers -Hot (60 deg C) -Acids and impurities on skin absorbs UV and burned into the quartz -Shortens life span of lamp  Work in a well-ventilated room UV: O2 ? ozone  Lamps should not be directed to the eyes Page 19:  CASE STUDY A 74 y/o female w/ a 20-yr hx of RA has a large superficial wound on her lower leg. Her persistent use of oral steroids has compromised her immune response. This wound has been present for at least 6 mos despite good standard wound care and wound surface measurement have increased recently. Page 20:  Target tissue: bacteria located in the superficial layer of the wound bed  Modality of choice: UVR, 180-250 nm (UVC), 180 sec  Precautions: Wear protective eyewear Page 21: