ULTRAVIOLET RAYS

UVR

KEY POINTS!

Ultraviolet Rays are electromagnetic rays lying in

between visible light and X-ray

UVA (290 nm 390 nm)

UVB ( 180 nm 290 nm)

Erythema reddening of the skin

Desquamation- is the casting off of dead cells from the

surface of the skin

UVR for Treatment

f

( 0.8 x - 20 x Hz)

Wavelengths: therapy 180 390 nm

UVA ( long rays ): 290 390 nm

UVB ( short rays ): 180 290 nm

Therapeutic Purposes: UVR ( Mercury Vapor Lamps

)

Production of UVR

The therapeutic UVR are produced by mercury

vapour lamp which consists of a QUARTZ BURNER
TUBE evacuated from air and containing traces of
argon gas and mercury under reduced pressure.

An electrode is inserted at each end of burner

tube. The current is applied to the electrodes, the
mercury vapour and the passage of electrons
through the vapour establishes the UVR.

UVR Apparatus:

1)

Air-cooled lamps:

Ex. Hanovia Alpine Sun Lamp

Hanau Hohensonne
Birtcher
Generally

recommended for
the treatment of
GENERALISED SKIN
CONDITIONS ;

- Generally produces UVB

Air-cooled lamps

wavelengths: 253 nm (UVB /short wavelengths)

Although some rays down to the 184 nm level are also produced.

Treatment of generalised skin conditions such as

-Acne, psoriasis

The Birtcher is designed for the treatment of more localised lesions

such as pressure areas and ulcers.

2. Water cooled Lamps

Kromayer

- produces UVB and UVA (336nm )

Wavelenght: 366 nm level

UVA and UVB rays are produced

Treatment for: localized lesions

Ex. Pressure areas and ulcers

3. Flourescent Tube

Ex. Theraktin Lamp generally produces UVA ( 290 350

nm ) long wavelengths

Treatment for: psoariasis affecting large body areas

Local Effects/ Therapeutic effects

A. Erythema first observable effect of ultraviolet irradiation, wont be visible for an
hour but will reach its maximum in about 24 hours.
-This stimulates the triple response of dilation of capillaries and arterioles and
exudation of fluid in to the tissues
-produced with wavelengths of 240nm to 300nm
B.Pigmentation increased deposition of melanin formed in the basal layer due to
UVR. UVR accelerate the production of melanin by stimulating the production of the
enzyme tyrosinase in the melanoblast.
C.Desquamation casting off of dead cells
D.Growth of epithelial cells the cells in the basal layer proliferate to replace the
cells in the epidermis which were damaged or destroyed by the UVR.
-major effect used in the treatment.
E.Antibiotic effects destructive effects of UVR include the destruction of viruses,
bacteria and other small organism found on the skin. The effect if produced by using
UVB rays ( short wave). Second major effect required in the treatment.

General Effects
A.Formation of Vit. D
-accelerated by ultraviolet radation.
-Vit. D is required to assist in the absorption of calcium and phosphorus.
-UVB
B.Esophylactic Effects
-enhanced resistance of the body from infection.
-result of stimulation of reticulo-endothelial system. The cells of which
ingests bacteria and pathogens.
C.Variation in Response to UltraViolet rays.
D.Natural protection against Ultraviolet rays.

Indications:

Acne

Psoriasis

Incipient Pressure areas

Non- infected open wounds

Infected open wounds

Counter- irritation

Dermatological Conditions

Hypersensitivity to sunlight

Febrile Disorders

Condraindications:

Dosage of Ultraviolet Rays

A.MED/MINIMAL ERYTHEMAL DOSE
-mild erythema
Appears:6 8 hours
Disappears: 24 hours
B.E1/FIRST DEGREE ERYTHEMA DOSE
-pigmentation
A: 6- 8 hours
D: 24 hours
Note: A & B for total body area/ maybe on daily basis

Dosages of Ultraviolet Rays

C.E2/SECOND DEGREE OF ERYTHEMAL DOSE
-mild sunburn, powdery desquamation , definite pigmentation
A:4-6 hours
D:48 hours
-given to 20% of total body area every second day
D.E3/THIRD DEGREE ERYTHEMAL DOSE
-marked erythema,severe sunburn, subsequent pigmentation and desquamation
- (+) edema and tenderness
A:2-4 hours
D:72-96 hours
-250cm2 of normal skin everythird or fourth day, twice a week.

Dosages Of Ultraviolet Rays

E.E4/FOURTH DEGREE ERYTHEMAL DOSE
-intense Erythema
-(+) edema and exudation of fluid into the tissue
-Blister formation
A:2-4 hours
D: 1 or more than a week.
-25cm2 of normal skin, ULCER!

Calculation Dosage

Basis for any calculation of UV dosage is E1

E2 = 2 x E1
E3 = 5 x E1
E4 = 10 x E1
Suberythemal dose
E1 = for patients less than 2 yrs old
2/3 E1 = 2 6 yrs old

E1 is determined by performing skin testing

The two significant units in measurement:
-Length of time
-distance from the source of Ultra Violet ray to the patient.

Examples: Calculation

If the E1 of the patient is 25 s at a distance of 100 mm, calculate for E3 at

100 mm.

If the E1 of the patient is 1s in contact, calculate the E4 in contact (I/C)

Progression

Each dose must be progressed to reach the same effective level of UV at each
treatment because when UV is applied to normal sikin, it causes reactions
which thicken the superficial layers.Doses are progressed as follows:

E1 is progressed by 25% of the preceding dose

E2 is progressed by 50% of the preceding dose
E3 is progressed by 75% of the preceding dose
Example: If the E1 is 30 s at 450 mm, find the second progression (P2E1)?

Alteration of Intensity with distance

The law of inverse squares states that , as the distance between the source
and the patient increases. The intensity decreases in proportion to the square
of the distance. Kromayer/ air cooled lamps.
New Time (NT)= oldtime (ot) x (newdistance)2
Old distance)2

Using the Kromayer: 25mm constant Distance

Example: using the kromayer, if the E1 of the patient is 1 I/C find the E1 at
100mm.?
Using the air cooled lamp, if the E1 at 900 mm is 60 s, find the E1 at 450mm.
Combined:Using the Kromayer: if the E1 I/C is 1 s, find the E3 at 100mm.

Example:
The dose given yesterday was the second progression of an E1 at 900, where E1 is
60 s at 900mm. What dose was given and what time will be necessary for treating
today if the dose is progressed and the distance changed to 450mm.

Selection of Dosage Level

The dosage level is selected according to the effects required for the
treatment of the presenting condition. However it is not recommended that
large areas be exposed to high doses of ultraviolet rays.

-An E1 or MED may be given to the TOTAL BODY AREA

-An E2 may only be given to up to 20% of the total body area
-An E3 may only be given up to 250cm2 of normal skin
-An E4 may only be given to an area of up to 25 cm2 of normal skin, but is
usually only given to non-skin areas where the size of the area is not important.

Frequency of Treatment:

The frequency of treatment depend upon the level of erythema produced.

Successive doses of ultraviolet must never be given to normal skin whil the
erythema produced by the preceding dose is still visible.

-An E1/MED may be given daily

-An E2 should be given every second day
-An E3 should be given every third or fourth day ( twice weekly)
-An E4 may only be given once a week
However, when treating non-Skin areas such as pressure ulcers, all doses may be
given daily as there is no erythema produced.

Effect Of Desquamation

When desquamation occurs, the natural protection

developed against the ultraviolet rays is lost to a varying
extent. Depending on the amount of desquamation. In
order to prevent damage to the newly exposed skin, the
successive dose should be reduced. As a general rule,
after desquamation the dose is reduced to the original
erythema level and progressed again at each successive
treatment.

Application using air cooled lamps