UVB therapy (broadband and narrowband)
- Herbert Hönigsmann, MD
Herbert Hönigsmann, MD
- Professor of Dermatology, Emeritus Chairman
- Medical University of Vienna
Broadband ultraviolet B (UVB) radiation (280 to 320 nm), with or without topical tar, has been used for the treatment of moderate to severe psoriasis for decades. In the early 1980s, the observation that wavelengths around 311 nm were more effective than broad-spectrum UVB in clearing psoriasis led to a major advancement in phototherapy with the development of fluorescent lamps emitting selective UVB spectra in the range of 311 to 313 nm (narrowband UVB) [1,2].
Narrowband UVB has since become the type of phototherapy most frequently used for the treatment of psoriasis and a wide range of skin diseases, including atopic dermatitis, vitiligo, early stages of mycosis fungoides, and pruritic disorders (table 1) [3-5].
This topic will discuss the mechanism of action, treatment protocols, indications, and adverse effects of UVB therapy. PUVA therapy, UVA-1 therapy, and targeted phototherapy are discussed separately. The use of UVB for the treatment of specific skin conditions are discussed in the dedicated topics.
●(See "UVA1 phototherapy".)
- Fischer T. UV-light treatment of psoriasis. Acta Derm Venereol 1976; 56:473.
- Parrish JA, Jaenicke KF. Action spectrum for phototherapy of psoriasis. J Invest Dermatol 1981; 76:359.
- van Weelden H, De La Faille HB, Young E, van der Leun JC. A new development in UVB phototherapy of psoriasis. Br J Dermatol 1988; 119:11.
- Honig B, Morison WL, Karp D. Photochemotherapy beyond psoriasis. J Am Acad Dermatol 1994; 31:775.
- Herzinger T, Berneburg M, Ghoreschi K, et al. S1-Guidelines on UV phototherapy and photochemotherapy. J Dtsch Dermatol Ges 2016; 14:853.
- Weichenthal M, Schwarz T. Phototherapy: how does UV work? Photodermatol Photoimmunol Photomed 2005; 21:260.
- Garmyn M, Yarosh DB. The molecular and genetic effects of ultraviolet radiation exposure on skin cells. In: Photodermatology, Lim HW, Honigsmann H, Hawk JLM. (Eds), Informa Healthcare USA Inc., New York 2007. p.41.
- Hönigsmann H. Phototherapy for psoriasis. Clin Exp Dermatol 2001; 26:343.
- Nickoloff BJ. Cracking the cytokine code in psoriasis. Nat Med 2007; 13:242.
- Bhana S, Lloyd DR. The role of p53 in DNA damage-mediated cytotoxicity overrides its ability to regulate nucleotide excision repair in human fibroblasts. Mutagenesis 2008; 23:43.
- Raj D, Brash DE, Grossman D. Keratinocyte apoptosis in epidermal development and disease. J Invest Dermatol 2006; 126:243.
- Walters IB, Ozawa M, Cardinale I, et al. Narrowband (312-nm) UV-B suppresses interferon gamma and interleukin (IL) 12 and increases IL-4 transcripts: differential regulation of cytokines at the single-cell level. Arch Dermatol 2003; 139:155.
- Berneburg M, Röcken M, Benedix F. Phototherapy with narrowband vs broadband UVB. Acta Derm Venereol 2005; 85:98.
- el-Ghorr AA, Norval M. Biological effects of narrow-band (311 nm TL01) UVB irradiation: a review. J Photochem Photobiol B 1997; 38:99.
- Rana S, Byrne SN, MacDonald LJ, et al. Ultraviolet B suppresses immunity by inhibiting effector and memory T cells. Am J Pathol 2008; 172:993.
- Schwarz T. The dark and the sunny sides of UVR-induced immunosuppression: photoimmunology revisited. J Invest Dermatol 2010; 130:49.
- Cafardi JA, Pollack BP, Elmets CA. Phototherapy. In: Fitzpatrick's Dermatology in General Medicine, 8th Edition, Goldsmith LA, Katz SI, Gilchrest BA, et al. (Eds), 2012.
- Tanew A, Radakovic-Fijan S, Schemper M, Hönigsmann H. Narrowband UV-B phototherapy vs photochemotherapy in the treatment of chronic plaque-type psoriasis: a paired comparison study. Arch Dermatol 1999; 135:519.
- Yones SS, Palmer RA, Garibaldinos TT, Hawk JL. Randomized double-blind trial of the treatment of chronic plaque psoriasis: efficacy of psoralen-UV-A therapy vs narrowband UV-B therapy. Arch Dermatol 2006; 142:836.
- Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol 2010; 62:114.
- Ibbotson SH, Bilsland D, Cox NH, et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop Report. Br J Dermatol 2004; 151:283.
- Beani JC, Jeanmougin M. [Narrow-band UVB therapy in psoriasis vulgaris: good practice guideline and recommendations of the French Society of Photodermatology]. Ann Dermatol Venereol 2010; 137:21.
- Spuls PI, Tuut MK, van Everdingen JJ, et al. [The practice guideline 'Photo(chemo)therapy and systemic therapy in severe chronic plaque-psoriasis']. Ned Tijdschr Geneeskd 2004; 148:2121.
- Boztepe G, Karaduman A, Sahin S, et al. The effect of maintenance narrow-band ultraviolet B therapy on the duration of remission for psoriasis: a prospective randomized clinical trial. Int J Dermatol 2006; 45:245.
- Lebwohl M, Martinez J, Weber P, DeLuca R. Effects of topical preparations on the erythemogenicity of UVB: implications for psoriasis phototherapy. J Am Acad Dermatol 1995; 32:469.
- Hofmann UB, Eggert AA, Bröcker EB, Goebeler M. Calcitriol vs. dithranol in combination with narrow-band ultraviolet B (311 nm) in psoriasis. Br J Dermatol 2003; 148:779.
- Carrozza P, Häusermann P, Nestle FO, et al. Clinical efficacy of narrow-band UVB (311 nm) combined with dithranol in psoriasis. An open pilot study. Dermatology 2000; 200:35.
- Behrens S, Grundmann-Kollmann M, Schiener R, et al. Combination phototherapy of psoriasis with narrow-band UVB irradiation and topical tazarotene gel. J Am Acad Dermatol 2000; 42:493.
- Goktas EO, Aydin F, Senturk N, et al. Combination of narrow band UVB and topical calcipotriol for the treatment of vitiligo. J Eur Acad Dermatol Venereol 2006; 20:553.
- Ada S, Sahin S, Boztepe G, et al. No additional effect of topical calcipotriol on narrow-band UVB phototherapy in patients with generalized vitiligo. Photodermatol Photoimmunol Photomed 2005; 21:79.
- Green C, Lakshmipathi T, Johnson BE, Ferguson J. A comparison of the efficacy and relapse rates of narrowband UVB (TL-01) monotherapy vs. etretinate (re-TL-01) vs. etretinate-PUVA (re-PUVA) in the treatment of psoriasis patients. Br J Dermatol 1992; 127:5.
- Lebwohl M, Drake L, Menter A, et al. Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol 2001; 45:544.
- Asawanonda P, Nateetongrungsak Y. Methotrexate plus narrowband UVB phototherapy versus narrowband UVB phototherapy alone in the treatment of plaque-type psoriasis: a randomized, placebo-controlled study. J Am Acad Dermatol 2006; 54:1013.
- Kircik L, Bagel J, Korman N, et al. Utilization of narrow-band ultraviolet light B therapy and etanercept for the treatment of psoriasis (UNITE): efficacy, safety, and patient-reported outcomes. J Drugs Dermatol 2008; 7:245.
- Wolf P, Hofer A, Legat FJ, et al. Treatment with 311-nm ultraviolet B accelerates and improves the clearance of psoriatic lesions in patients treated with etanercept. Br J Dermatol 2009; 160:186.
- Calzavara-Pinton PG, Sala R, Arisi M, et al. Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis. Br J Dermatol 2013; 169:130.
- Wolf P, Hofer A, Weger W, et al. 311 nm ultraviolet B-accelerated response of psoriatic lesions in adalimumab-treated patients. Photodermatol Photoimmunol Photomed 2011; 27:186.
- Gambichler T, Tigges C, Scola N, et al. Etanercept plus narrowband ultraviolet B phototherapy of psoriasis is more effective than etanercept monotherapy at 6 weeks. Br J Dermatol 2011; 164:1383.
- Hönigsmann H. Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis. Br J Dermatol 2013; 169:4.
- Richard EG, Hönigsmann H. Phototherapy, psoriasis, and the age of biologics. Photodermatol Photoimmunol Photomed 2014; 30:3.
- Inzinger M, Legat FJ, Hofer A, et al. Short- to intermediate-term follow-up in patients treated with the combination of 311-nm ultraviolet B phototherapy and biological agents. Br J Dermatol 2014; 171:915.
- Mehta D, Lim HW. Ultraviolet B Phototherapy for Psoriasis: Review of Practical Guidelines. Am J Clin Dermatol 2016; 17:125.
- Köllner K, Wimmershoff MB, Hintz C, et al. Comparison of the 308-nm excimer laser and a 308-nm excimer lamp with 311-nm narrowband ultraviolet B in the treatment of psoriasis. Br J Dermatol 2005; 152:750.
- Levin E, Nguyen CM, Danesh MJ, et al. An open label pilot study of supraerythemogenic excimer laser in combination with clobetasol spray and calcitriol ointment for the treatment of generalized plaque psoriasis. J Dermatolog Treat 2016; 27:210.
- Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD. Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment of vitiligo: a review. J Am Acad Dermatol 2009; 60:470.
- Welsh O, Herz-Ruelas ME, Gómez M, Ocampo-Candiani J. Therapeutic evaluation of UVB-targeted phototherapy in vitiligo that affects less than 10% of the body surface area. Int J Dermatol 2009; 48:529.
- Aubin F, Vigan M, Puzenat E, et al. Evaluation of a novel 308-nm monochromatic excimer light delivery system in dermatology: a pilot study in different chronic localized dermatoses. Br J Dermatol 2005; 152:99.
- Archier E, Devaux S, Castela E, et al. Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:22.
- PRINCIPLES AND MECHANISMS
- Effects on DNA
- Effects on the immune system
- DEVICES FOR BROADBAND AND NARROWBAND UVB
- CLINICAL INDICATIONS FOR UVB THERAPY
- DOSIMETRY AND TREATMENT PROTOCOLS
- Determination of the initial dose
- Treatment initiation, frequency, and dose increments
- Maintenance therapy
- Combination therapies
- TARGETED PHOTOTHERAPY WITH 308 NM DEVICES
- SAFETY MEASURES
- SHORT- AND LONG-TERM ADVERSE EFFECTS
- SUMMARY AND RECOMMENDATIONS