ULTRAVIOLET RADIATION

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Ultraviolet radiation (UVR) covers a small
part of electromagnetic spectrum lying
between the visible light and X-ray region.

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Types of UVR

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 Types of UVR
UVA
400 315 nm, near UV
Effects: Erythema without pigmentation
UVB
315 280 nm, middle UV
Effects: Erythema without pigmentation,
formation of vit D, skin tanning (blister/burn)
UVC
280 100 nm, far UV
Kills bacteria, formation of vit. D, skin tanning

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 Production
Therapeutic UV usually produced by the passage
of a current through an ionized vapour often
mercury vapour
at low pressure or high temperatures.
Devices commonly used are either
air cooled (using air circulation with fan),
or
water cooled (using a water jacket surrounding
the burner with continually circulating water).

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 Mercury Vapor Lamp
produced by mercury
vapor lamp
which consists of a
quartz burner tube
containing traces of
argon gas and mercury
under reduced
pressure.
An electrode is inserted
at each end of burner
tube.
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 Mercury Vapor Lamp
The current is applied to the
electrodes,
causes the formation of free
mercury ions and electrons
When free electrons are being
accelerated in the tube, many
collisions with neutral mercury
vapour atoms will occur:
By elastic collisions not
affecting the atom
By knocking an electron off the
atom ionization
By moving an electron to a
higher energy level excitation
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 Fluorescent lamps
These are low-pressure
mercury discharge tubes with
a phosphor coating on inside.
The particular wavelengths
and the amount of each
emitted will depend on the
composition of the phosphor
used. (mixtures of
phosphates, borates, and
silicates.)
This gives a considerable UVA
and UVB output but no UVC.
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Theraktin Tunnel

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 Alpine Lamp
Medium Pressure Mercury
Arc Lamp / high-altitude lamps
wavelength 253nm (short
wavelength) used in treatment
of generalised skin conditions
as acne and psoriasis.
Short UVR react with oxygen in
the air to produce a small
quantity of ozone (O3),
Ozone is toxic at high
concentrations so ventilation
should be adequate around
these lamps.
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 Kromayer lamp
medium-pressure mercury
vapour lamps designed to be
used in contact with the
tissues, both on the skin
surface and in body cavities.
Water-cooled lamps,
wavelength at 366nm give
both UVA and UVB,
used for treating localised
lesions as pressure areas,
ulcers, sheves and sinuses in
open areas.
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 Physiological effects
Immediate/acute effects
1. Erythema
2. Pigmentation
3. Increased skin growth
4. Vitamin D production
5. Esophylactic effect
6. Immunosuppressive effects
7. Effects on eye

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 Erythema
Erythema is reddening
of the skin as a result of
an inflammatory
reaction stimulated by
ultraviolet rays
release of histamine-like
substance
dilatation of the
capillaries and
arterioles and
exudation of fluid into
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 Pigmentation

Pigmentation or tanning of the skin follows

the erythema,
its amount varies with the intensity of the
erythema.
It is due to the increased deposition of the
pigment melanin formed in the basal cell layer
of the skin by the melanoblasts, and migrates
to the superficial layers of the epidermis.

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 Desquamation

Is the casting off of

the cells which have
been destroyed by
the UVR,
Desquamation or
peeling is
proportional to the
intensity of the
erythema
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 Vitamin D production

UVB is able to convert

sterols in the skin, such as
7-dehydro-cholesterol to
vitamin D
vitamin D is required to
assist in the absorption of
calcium and phosphorous
from the intestine to blood
stream.
Suberythemal doses of UVB
are adequate to promote
vitamin D synthesis
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 The Esophylactic effect

The resistance of the body to infection is

increased as a result of stimulation of reticulo-
endothelial system
antibodies against bacteria and toxins.

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 Immunosuppressive Effects:

UV destroys Langerhans cells and stimulates

the proliferation of suppressor T cells.
(T cells are regulatory in that they inhibit
antibody production)
This immunosuppressive effects may
contribute to the development of skin cancer.
In short, UV radiation induces a state of
relative immunosuppression that prevents
tumor rejection.
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 Effects on eye

Strong doses of UVB and C radiation to the eyes can lead

to conjunctivitis and photokeratitis results in irritation
of the eye, a feeling of grit in the eye, watering of the
eye and aversion to light (photophobia)
In severe cases intense pain and spasm of the eyelid may
be present. This is also known as snow blindness
While UVB and C are absorbed in the cornea, UVA can
pass through to be absorbed mainly in the lens of the
eye.
The strong doses of UVA may lead to formation of
cataracts.
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 Physiological effects
Long term/chronic effects

1. Solar elastosis or aging

2. Cancer

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 Solar Elastosis & Ageing
Prolonged exposure of UVR lead to
premature ageing of the skin; this is
especially so in the fair-skinned.
decreased function of sebaceous and sweat
glands
loss of elastic tissue
The skin becomes wrinkled, dry, and leathery.

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 Cancer

skin cancers, basal cell and squamous cell

carcinomas.
Carcinogenesis is a danger, as these rays may
have an effect on DNA and thus on cell
replication.
shorter ultraviolet waves should be avoided
and courses of treatment should not exceed
four weeks.

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 UVR dosage
Skin response to UVR depends upon:

1. Quantity of UVR energy applied to the skin

2. Biological responsiveness of skin

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 UVR dosage
1. Quantity of UVR energy applied to the skin
which depends upon:
a) Output of the lamp
b) Distance between the lamp and the skin
c) Angle at which radiation fall on the skin
d) Time for which radiations are applied on
the skin

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 UVR dosage
2. Biological responsiveness of skin:

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Erythemal response

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 Test Dose

30 sec. 60 sec. 90 sec.

A minimal dose (MED) is the length of the ultraviolet

exposure required to produce a mild erythema, which
appears within 6 to 8 hours and still just visible after 24
hours.

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 Test Dose
Test applied Monday Tuesday
11.00 am 3 pm 7 pm 11 pm 7 am 11 am
Monday

Look at the areas at the times shown and place a tick in the box if any redness is seen.
If no redness is seen put a cross

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 Calculation of dosage
E1 is determined from the skin test and the other
erythemal dosages can be calculated as follows:

Suberythemal 75% of E1.

E2 = 2.5 x E1.
E3 = 5 x E1.
E4 = 10 x E1.
Double E4 = 20 x E1.
E4 & Double E4 are used on open wounds.
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 Progression of UV dosage
Doses can be progressed as follows:
Suberythemal previous dose plus 12.5%.
E1 previous dose plus 25%.
E2 previous dose plus 50%.
E4 previous dose plus 75%.
Dosages used on open wounds are not
progressed because there is no epidermis to
thicken.
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 Alteration of the intensity with distance

To irradiate a smaller area the source is moved

nearer to the patient but the time of exposure
must be altered to maintain the same
intensity in accordance with the law of inverse
squares.

Now time = Old time x (new distance)2

(Old distance)2

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 Therapeutic uses
Psoriasis Protection for
1. Goeckerman regimen hypersensitive skin
2. Ingram/Leeds regimen
Vitamin D deficiency
3. Photochemotherapy
Acne Vulgaris Mild hypertension
Eczema Pruritis
Chronic Psychological benefits
infection/wound Non infected wounds
Vitiligo Intact skin

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 Psoriasis
a skin condition, which
presents localized plaques
in which the rate of cell
turnover from the basal
layer through to the
superficial layer is too rapid.
The aim of ultraviolet
irradiation is to decrease
the rate of DNA synthesis in
the cells of the skin and
thus slow down their
proliferation
(immunosuppressive effect
of UVR).
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 Psoriasis
Goeckerman Regimen:
This consists of coal tar applications 2 to 3 times a
day with general (total body) UVB radiation given
once a day as a suberythemal or E1 dose.
Ingram or Leeds Regimen:
The patient has a coal tar bath before being
irradiated with a minimal erythema dose of UVB;
the psoriatic lesions are covered with dithranol.
Next day the dithranol is cleaned off and the process
is repeated.
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 Psoriasis
Photo chemotherapy :
Psoralen-type drug is given to the patient some 2 hours
previously, to make him/her sensitive to UVA radiations,
This will produce an erythema at lower intensities than
normal.
The drug 8-methoxy-psoralen is used making the patient
highly reactive to UVA once it has been absorbed, for some 6
8 hours.
As the peak of PUVA erythema occurs at 48 72 hours,
treatment should be given twice a week until clearance.
This should be approximately 12 18 exposures.

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 Acne Vulgaris:
This is a chronic
inflammatory condition
of the pilosebaceous
unit especially affecting
the face, chest, and
back.
Using UVR is aiming to
produce desquamation
to open the blocked
pores and hair follicles.
usually E2 are used
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 Eczema:

an inflammatory response
in the skin, with associated
oedema, itching with
redness, scaling, vesicles,
and exudation of serum on
the skin.
It may be caused by contact
dermatitis, atopic eczema.
It is often these who can
benefit from mild ultraviolet
treatment.

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 Infected Wound

treated with high doses of ultraviolet

radiation.
A Kromayer lamp is successful in inhibiting
bacterial colony growth.
The doses given must be an E4.

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 Non-Infected Wounds
the aim of ultraviolet radiation is to stimulate
the growth of granulation tissue and thus
speed up repair.
Can be used in surgical incisions, pressure
areas, venous and arterial ulcers.
UVA, E3 dose is sufficient.

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 Incipient pressure areas
UVR may be used to
prevent pressure areas from
breaking down and
stimulate the growth of
epithelial cells and to
destroy the surface
bacteria.
E1 dose progressed daily
using the Kromayerlamp.
In areas such as the heels or
the elbows where the skin is
thicker, an E2 may be used.
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 Vitiligo

an autoimmune disease in
which destruction of
melanocytes in local areas
causes white patches to appear
on the skin.
Both UVA and B stimulate
melanocyte activity
UVA seems to provoke a darker
and long-lasting tan although
the protective effects do not
seem to be so marked
UVB provokes more thickening
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Protection for Hypersensitive Skin
Polymorphic light eruption is the commonest
of photodermatoses
increased tolerance to sunlight can be
achieved by a course of UVB
start with a very low dose and gradually
progressing.

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 Vitamin D Deficiency
Vitamin D3 is formed in skin by the action of
UVB and C on 7-dehydrocholesterol.
natural sunlight can also be curative for
vitamin D deficiency diseases

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 Mild Hypertension
The general (whole body) suberythemal
doses of UVB can significantly lower blood
pressure
it is believed to be due to calcium regulating
hormones associated with increased vitamin D
production.

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 Pruritus
The intractable and serious itching that can
occur due to raised bile acid level in biliary
cirrhosis or uraemia.
can successfully treated by suberythemal
whole-body UVB either alone or in
combination with the drug cholestyramine.

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 Psychological Benefit
patients expect to feel better and
the consequent tanning makes them look
better.

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 Contraindications to UVR
Acute skin conditions acute eczema, dermatitis, lupus
erthematosis(auto-immune disease) and herpes simplex
an existing ultraviolet Erythema.
Skin damage due to ionizing radiations deep X-ray
therapy.
Photo allergy allergic reaction to ultraviolet radiation.
Acute febrile illness whole-body treatment should be
avoided.
Recent skin grafts.

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 Dangers
Shock: the machine should be earthed and the main power cord
insulation intact.
Eyes: it is important to protect the eyes of both patient and
therapist from scattered and reflected radiations. The patient
should wear goggles even when not facing the source of radiations.
The physiotherapist should be aware of the cumulative effect of
UVR through the day.
Over dosage: to avoid long exposure to UVR, use an accurate timing
device especially for periods over about 1 minute. Overlap of doses
may lead to burn.
In case of an accidental overdose infrared radiation may be given
to the area in an attempt to increase local circulation and thereby
disperse the histamine-like substance that produces the erythema.
Sensitization: a number of drugs and some foods in few patients
can alter the effect of UVR and cause sensitivity.
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 References
1. Electrotherapy Explained by Low and Reed
2. Textbook of Electrotherapy by Singh Jagmohan
3. http://faculty.ksu.edu.sa/68417/RHS%20321/ULTRAVIOLET%20%20RADI
ATIONS%20(2).pdf
4. http://www.aarogya.com/conditions-and-
diseases/specialties/physiotherapy/4823-electrotherapy.html?start=2
5. Ultraviolet Radiation by Sagar Naik. physio4all
6. Ultraviolet germicidal irradiation: current best practices by Stephen B.
Martin, Jr. et al. ASHRAE Journal, August, 2008

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