Phototherapy Treatment Protocols

Steven R. Feldman, Michael D. Zanolli

• Publisher: CRC Press
• Year: 2016
• ISBN:
  9781315351025
• Edition: 3
• Topic: Medicine
• Subtopic: Dermatology

This is a step-by-step manual of protocols for ultraviolet light therapy in the dermatologist's office. It provides technical information for UVB, PUVA, outpatient daycare, RePUVA, UVA/UVB combination, hand and foot therapy, scalp treatments, and hydrotherapy. It contains examples of patient education handouts, consent forms, laboratory flow sheets, forms for insurance companies, tools for the quantitative measurement of psoriasis severity, and more.

Psoriasis

ULTRAVIOLET B PHOTOTHERAPY BY MINIMAL ERYTHEMA DOSE

PATIENT INSTRUCTIONS

1. All patients designated for the ultraviolet B (UVB) by minimal erythema dose (MED) protocol will have the routine introduction to the Phototherapy Treatment Center (PTC) facility.

2. All patients designated for the UVB by MED protocol will have the basic introduction to phototherapy equipment and safety procedures.

3. Reinforcement of the need for eye protection and covering of the genital area in males is required.

4. All patients with the diagnosis of psoriasis will be told to apply mineral oil to the involved areas of the skin prior to the delivery of UVB.

5. Patients are to stand in the center of the light cabinet with their arms at rest. A step stool may be used for the patients to stand on when recommended by the physician.

6. A handheld timer will be set by the phototherapy technician for each treatment session. The time will correspond to the estimated time of the treatment session duration, and the timer will either be given to the patient to have with them during the treatment session or be kept by the technician during the treatment. The time will correspond with the amount of time calculated for their dose of UVB for that treatment.

7. Instruct patients to come out of the light box when the lights have gone out or within 10 seconds of the alarm of the safety (handheld) timer. Inform patients that the light-box doors are not locked and demonstrate their operation.

8. The list of current medications will be placed in the patient’s chart and reviewed by the phototherapist. Questions concerning the current medications will be addressed by the attending physician.

9. All patients will be told of the possible complications of UVB phototherapy specifically including

a. Sunburn reaction

b. Corneal burn if the eyes are unprotected

c. Photoallergic dermatitis (including drug reaction)

d. Freckling of the skin

e. Aging of the skin

f. Possible increase in risk of skin cancers

10. Patients will be told that additional unprotected sun exposure should be avoided on the days they receive UVB. Sunblock (SPF 15) should be used on any sun-exposed areas for the remainder of that day.

11. All patients will be given the brochure on UVB phototherapy from the National Psoriasis Foundation.

PROTOCOL

1. Obtain a signed consent form after the patient has been given the tour of the PTC and basic phototherapy education concerning UVB phototherapy. The patient should be given time for questions.

2. Obtain an MED using the standard procedure. See the section “Procedure for Determination of the MED for UVB.”

3. Have the patient undress completely and apply mineral oil to areas of psoriasis prior to the treatment. Male patients should wear an athletic supporter unless otherwise directed or permitted by the attending physician.

4. Eye protection in the form of UV goggles must be worn by all patients when inside the phototherapy unit.

5. The irradiance (mW/cm²) of the UVB light inside the unit should be recorded on a once-a-month basis using the standard method of the manufacturer of the phototherapy unit. Record this irradiance on the phototherapy record sheet or keep an irradiance logbook for the equipment used in patient care.

6. The initial UVB dose (mJ/cm²) will be based on the patient’s MED determination at 24 hours from the delivery of the test doses. The MED will be included in the phototherapy treatment record.

Initial UVB = 50% of the MED

(If the patient’s MED is higher than the highest dose of UVB delivered in the MED determination testing, then a dose of 50% of the highest test site will be used as the initial dose.)

7. The manual method for calculation of the time (seconds) to set the UVB control panel to deliver the dose from #6 is the following equation: (The measurement of the irradiance can be obtained from the logbook kept on a weekly basis.)

Time (seconds) = Dose (mJ/cm²) ÷ Irradiance (mW/cm²)

8. The duration of a treatment or total dose of UVB to be delivered can often be calculated by the ultraviolet (UV) light unit by following the manufacturer’s instructions in the operations manual and inputting the correct information on the control panel prior to the delivery of the treatment.

9. Set the time (or dose) on the control panel of the UV light unit and on the additional safety timer kept in the light unit or by the technician. In some phototherapy units, the session duration is dependent on the dose measured by an internal photometer, and the time must be estimated by the technician.

10. Verify that the UV light unit is set on UVB.

11. Turn on the fan and have the patient stand in the center of the UV light unit with their arms at rest. Double-check that they are wearing UV goggles as eye protection.

12. Instruct the patient to come out of the UV light box when the lights go out or if they become uncomfortable during the treatment either from burning or stinging of the skin. Inform the patient that the light-box doors are not locked.

13. Start the treatment.

SUBSEQUENT TREATMENTS

14. The frequency of UVB using MED light treatments for the diagnosis of psoriasis is 3–5 times a week unless otherwise ordered by a physician. If less than 3 times a week has been ordered by a physician, then special instructions for the advancement of the dose of UVB light must accompany the request.

15. On subsequent visits, the patient will be asked about redness, light pink color, and tenderness of the skin the previous night, and this information will be put into the phototherapy record.

16. If the skin is a light pink color, the phototherapist should keep the dose the same as the previously delivered treatment dose.

17. If the skin is red, the phototherapy technician will ask that the patient be seen by the attending physician who will make the decision for adjustment in the UVB treatment.

18. Increase the dose (mJ/cm²) of the UVB light by the amount as follows, and add it to the previous dose delivered to the patient if the treatment has been within 3 days:

Treatments 1–10	Increase by 25% of the MED.
Treatments 11–20	Increase by 10% of the MED.
Treatments 21–X	Increase as ordered by physician.

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