The Healing Power of Light
Since the earliest of times, when sunlight was the only source, it has been recognized that light can heal. Over time, researchers were able to mimic specific wavelengths in order to safely harness the therapeutic light rays while eliminating the damaging ones. Phototherapy is the use of these therapeutic rays to treat specific skin conditions. Daavlin has been combining this scientific knowledge with technical innovation to lead the phototherapy marketplace since 1981. The use of ultraviolet light in the treatment of photo-responsive skin diseases is safe, highly effective and time tested, making it an essential tool in dermatology offices of the 21st century. Daavlin has consistently led the clinical marketplace with innovations such as integrating dosimetry, built in treatment protocols, a patient database, and EMR compatibility to make the delivery of phototherapy safe for patients and trouble-free for health care professionals.
UVB treatments are administered in a physician’s office, clinic or at home with a home phototherapy device. There are two types of UVB treatments: Broadband and Narrowband. The major difference between them is that Narrowband UVB units emit a more specific or “narrow” range of UV wavelengths. Narrowband UVB is now more frequently used than Broadband UVB.
Narrowband UVB has proven to be the most effective phototherapy treatment option for thousands of psoriasis patients all over the world. With more research being done every day on conditions such as eczema, vitiligo, and mycosis fungoides, Narrowband UVB continues to show its versatility with its promising results.
Why Narrowband UVB is different
- Conventional Broadband UVB lamps emit a variety of wavelengths ranging from 280-330 nm.
- Narrowband UVB virtually eliminates superfluous and harmful UV by emitting only wavelengths 311-312 nm.
- Clinical studies show the peak therapeutic effectiveness of UVB to be within the range of 295-313 nm, but wavelengths below 300 nm can cause erythema or severe burning and increase the risk of skin cancer.
Benefits of Narrowband UVB Therapy
- Eliminating UV in wavelengths below 311 nm permits higher intensities and longer exposure times, so patients can derive the maximum benefit from phototherapy.
- This increased effectiveness permits more aggressive treatment regimens, resulting in a shorter course of treatment.
- Extensive research* confirms that patients not only avoid the danger of serious burning from sub-erythemal exposure, they may also enjoy longer remission periods after treatment.
- Remission periods are similar to those with PUVA therapy and markedly superior to Broadband UVB treatment. Studies show 38-40 percent of Narrowband treated patients require no additional therapy for at least 12 months.
* Philips, A.G., manufacturer of the ultraviolet lamps used in Daavlin’s Narrowband UVB phototherapy cabinets, has amassed an exhaustive library of studies from around the world documenting the therapeutic effectiveness and safety benefits of Narrowband UVB treatment. This information is available upon request from the Daavlin Company.
PUVA combines a Psoralen drug (the product name is Oxsoralen) with exposure to ultraviolet light A (UVA). Psoralen makes the body very sensitive to UVA rays and comes in oral or topical form. It may be used on a short- term basis to bring a severe or disabling case of psoriasis under control. The main long-term side effect of PUVA is the increased risk of skin cancer.
UVA1 (340-400nm) is the range of long wavelength ultraviolet light immediately next to visible light in the electromagnetic spectrum. Consequentally, UVA1 photons have the deepest penetration into the body, but the lowest energy per photon of any type of ultraviolet light. UVA1 has many different biological effects, including up-regulating Collegnase, changing cytokine ratios, and inducing Heme-Oxygenase-1. Typical diseases treated by UVA1 light include sclerotic skin conditions (morphea, scleroderma, graft vs. host) and atopic dermatitis(eczema). UVA1 has been used therapeutically for nearly 20 years, with an excellent safety and effectiveness record.
New to Phototherapy?
What is Phototherapy?
Narrowband phototherapy is a safe and effective treatment for autoimmune skin diseases and is considered a first-line treatment for many conditions such as psoriasis, vitiligo and eczema. It’s safe enough for pregnant women and children to use, and has none of the serious side effects associated with competing biological drug therapies.
How can Phototherapy Benefit my Practice?
Adding phototherapy to your practice not only allows you to treat your patients with photo-responsive skin diseases, but it also offers an additional revenue source.The treatment is very easy to administer and Daavlin’s product line ranges from full-body to hand and foot units to high intensity targeted devices, to offer you a variety of units to fit your needs.
How does Phototherapy Benefit my Patients?
Four out of 10 psoriasis patients are not currently under the care of a physician for their condition. Some of the reasons are the patient’s dissatisfaction with their treatment or progress, and some patients have mentioned dissatisfaction with their physicians because of the lack of attention, emotional support, or empathy. (1)
A majority of the alternative treatments require regular injections and have severe side effects such as serious nervous system disease such as multiple sclerosis, lymphoproliferative malignancies, and new-onset, or exacerbation of, congestive heart failures. (2)
In addition, biologic therapies are contraindicated for many patients, such as pregnant and nursing mothers, patients with liver or kidney disease and coexisting immunocompromising conditions.
Phototherapy provides an alternative to patients that is painless, safe, effective, and can be administered to children and pregnant women, but it is not always as well known to the general population. There is an opportunity to expand physician services targeting all patients (especially the patients that shy away from the more drastic medications available) to treat them through the use of phototherapy.
For decades, statistics have shown consistently high rates of clearance for Narrowband UVB phototherapy and it has a median clearance time of only 4-5 weeks. That is twice as fast as Enbrel, Stelara, Humira or Remicade. In addition, patients who stop using phototherapy seldom suffer from the flares or rebounds that are common with other treatments.
It’s also very affordable and the administration of phototherapy by their known physician can be comforting to those using phototherapy for the first time. Phototherapy may also be prescribed for home use and the one-time cost of a home unit is reasonably priced.
Other treatments such as biological drug therapies can cost more than the price of the average car each year, putting them out of range for some patients.
Keep in mind, your patients’ safety is important to us. We comply with all FDA regulations and ISO requirements regarding medical devices. Daavlin’s facility is ISO 13485 approved and all of Daavlin’s devices have been reviewed and cleared by the FDA as Class II medical devices.
Compare the Safety of Phototherapy vs. Biological Drugs for the Treatment of Skin Disease
To view detailed information from the chart above, click here.
Truth about Biological Drugs
For the treatment of psoriasis, phototherapy is the leader in both effectiveness and speed of clearance. Narrowband UVB and PUVA (Psoralen + UVA) are safe, work extremely well, and are twice as fast at clearing patients with moderate to severe psoriasis.
PUVA (Psoralen + UVA): 90%3
Daavlin Narrowband UVB: 82%9
Remicade® (Infliximab): 80%8
Humira® (Adalimumab): 62%7
Enbrel® (Etanercept): 47%-49%5
Raptiva®(Efalizumab): 32%6(Removed from market 06/09 due to severe side effects)
From this quick comparison it is obvious that only Remicade® (Infliximab) approaches the clearance rates of phototherapy. Besides it’s high cost, nearly $20,000 per patient per year, Infliximab has a lengthy list of side effects and typically takes several months of treatment to show results.
Median Time to Reach Clearance:
PUVA (Psoralen+UVA): 4 weeks4
Narrowband UVB: 5 weeks3
Remicade® (Infliximab): 8 weeks8
Humira® (Adalimumab): 8 weeks7
Enbrel® (Etanercept): 8 weeks5
Raptiva®(Efalizumab):10 weeks6(Removed from market 6/09 due to severe side effects)
From the raw data above, it should be apparent that not only is phototherapy more effective than competing biological drugs, it works nearly twice as fast. In addition, of the biologics, only Enbrel® (Etanercept) is approved for pediatric use in the treatment of psoriasis. In comparison, Narrowband phototherapy is approved and has a long track record of safe pediatric use.
When evaluating the effectiveness of phototherapy, literature reports clearance1rates as high as 94% for PUVA2, though most PUVA studies show clearance rates closer to 90%. For Narrowband UVB phototherapy using Philips /01 lamps, literature shows slightly less effectiveness3 than PUVA, with a clearance rate typically in the 70% to 80% range.
However, using Daavlin equipment and Daavlin’s suggested MED-based protocols, clinical studies have consistently shown even better results with an 82% clearance rate.9 When used with topical drugs, phototherapy combination treatments are even more effective, with reports of up to a 93% clearance rate with a Narrowband UVB + Etretinate combination. The bottom line: Daavlin Phototherapy works faster and better for your patients.
- Promotional literature can be a confusing mix of different numbers when trying to compare the effectiveness of psoriasis treatments. Some studies use the PASI (Psoriasis Area and Severity Index ) system, while others use a physician assessment of clearance (sPGA) or disease resolution. In the studies that use both metrics, psoriasis clearance is considered to be at least a 75% decrease in PASI score. Since few practitioners use the PASI analysis clinically, clearance rate (sPGA) seems like a more useful comparison tool.
- Comparison of clinical efficacy and cost effectiveness of psoralen plus ultraviolet A light phototherapy (PUVA) versus PUVA plus sunlight (PUVASOL) therapy in chronic plaque psoriasis in Indian patients Journal of the American Academy of Dermatology, Volume 60, Issue 3, Pages AB153-AB153
- Palmer, et al. Photoadaptation during Narrowband Ultraviolet-B Therapy Is Independent of Skin Type: A Study of 352 Patients Journal of Investigative Dermatology (2006) 126, 1256–1263
- Yones, et al. 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 Jul;142(7):836-42.
- ENBREL® Physician Package Insert. Available here
- RAPTIVA® Prescribing Information. Available here
- HUMIRA® Prescribing Information. Available here
- REMICADE® Prescribing Information. Available here
- Suberythemogenic narrow-band UVB is markedly more effective than conventional UVB in treatment of psoriasis vulgaris, Walters, et al. Journal of the American Academy of Dermatology, Volume 40, Issue 6, June 1999, Pages 893-900