Promising new drug-free treatment for chronic skin conditions

By: Minnesota Spokesman-Recorder
Originally posted 9/24/2003
By Dr. Charles E. Crutchfield
Contributing Writer

Approximately five million Americans suffer from psoriasis — a condition where the skin gets thick and scaly — with about 150,000 new cases diagnosed each year. In addition, about two percent of the U.S. population is diagnosed with vitiligo — a condition in which patches of skin have no pigmentation. Both chronic skin conditions are notoriously difficult to treat, frustrating both patients and physicians. A new treatment, however, is showing extremely promising results in the battle against these persistent diseases: phototherapy Russell C. is one of my patients who has suffered from vitiligo for more than 15 years, has chocolate-brown skin, and exhibited porcelain-white patches on his cheeks, eyelids and arms. He was very frustrated, because everywhere he went people asked him what was wrong with his skin. Finally, after 15 years of unsuccessful treatment, he went through a course of narrow-band phototherapy. Since receiving the therapy, he has completely re-pigmented his face, and he’s absolutely delighted. For him, it was a life-changing experience.

As far as psoriasis patients, we’ve had several patients who have tried all kinds of topical and systemic medications, and for some, this is the first time they’ve been clear in 10 or 15 years.

One patient, John S., said he lives near one of the Minneapolis lakes, and this is the first time in 15 years that his legs have been clear enough that he can actually wear shorts and walk around the lake without embarrassment. People who suffer from these skin diseases, as well as atopic dermatitis (eczema), dry, thick dark patches of inflamed skin, and parapsoriasis, a rash on the skin that turns into skin cancer about five percent of the time, have often run the gamut of treatments and are sometimes told, “There’s nothing more we can do for you.”

However, phototherapy, using narrow-band ultraviolet-B (UVB) waves, has had great success in keeping these conditions at bay. It is a cutting-edge technology that has been available in Europe for about 10 years and is now making its way to the United States.

Narrow-band UVB phototherapy is a highly effective therapy that does not involve any type of medication, so there are no drug-to-drug interactions or medicinal side effects about which to be concerned. This treatment is ideal for patients who are taking multiple medicines and don’t want to have interactions or are leery of taking long-term medicines. It is mainly used in the treatment of psoriasis, vitiligo, atopic dermatitis and parapsoriasis. Up to 30 percent of psoriasis sufferers also exhibit symptoms of arthritis; often the arthritis symptoms improve when the patient’s skin improves. With this new treatment, patients are clearing up at a surprising rate.

The phototherapy unit is basically a light booth, very similar to a tanning booth, completely enclosed with light bulbs going all the way around. Patients, wearing protective eyewear, stand in the booth for anywhere from one to 15 minutes. Each time a patient comes into the clinic, the amount of exposure is increased by just a few seconds.

This wavelength of light, the UVB wavelength, penetrates in a much more shallow manner than previously used UVA waves, which penetrate much deeper and are associated with a long-term increased risk of developing skin cancer. Because of that, many physicians are wary of committing patients to extensive UVA therapy. The UVB wavelength does not carry the same risks.

While phototherapy is proving to be an effective, less invasive and less time-consuming treatment on its own, sometimes the results are enhanced when used in combination with other treatment methods.

The vast majority of patients are extremely pleased with the results from narrow-band UVB phototherapy treatment. Most patients who suffer from psoriasis and vitiligo have been through several types of treatments, and they are always hungry for something new. And this is something both new and effective, so they are pleased with the results. The only downside is that insurance companies don’t always cover the treatment. Insurance companies cover phototherapy for 80 to 90 percent of psoriasis patients, and 60 percent of vitiligo patients. Another minor drawback is the time it requires. Patients need to come into the office two to three per week for treatments. The average patient needs 20-40 treatment sessions, which is about a 10-week commitment. This type of treatment needs to be administered by someone knowledgeable in the use of phototherapy, because improper settings can cause a mild phototoxic, sunburn-type reaction. While this treatment has shown amazing results, the therapy is not perfect — for psoriasis it works about 90 percent of the time, for vitiligo about 60 to 70 percent of the time, and for atopic dermatitis it is effective about 80 percent of the time. Though it is by no means perfect, as narrow-band UVB phototherapy treatment becomes more widely known, physicians will be able to offer new hope to patients that have long suffered from these uncomfortable, embarrassing and sometimes painful skin conditions.

Charles E. Crutchfield, III, M.D. is a clinical assistant professor of dermatology at the University of Minnesota and runs his own practice, Crutchfield Dermatology, in Eagan.