Narrowband Ultraviolet B Radiation (NB-UVB) phototherapy treatment for your skin condition

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What is this information about?

This information is about narrowband ultraviolet B radiation (NB-UVB) treatment for your skin condition. It explains: 

• what NVB-UVB radiation is 
• what NB-UVB treatment involves 
• the benefits of NB-UVB therapy  
• other therapies that you may be able to have if you choose not to have NB-UVB therapy 
• the consent process 
• what you should, and should not, do on the days of your treatment 
• what happens when you are having your NB-UVB treatment sessions 
• the side effects you could get from NB-UVB treatment and how to get help for them if you need it 
• how you should look after your skin when you are on a course of NB-UVB treatment 
• who you can contact for further information or support.

Why have I been given this information?

You have been given this information because your dermatology doctor or Dermatology Specialist Nurse thinks that NB-UVB treatment would be a good treatment for your skin condition. They have sent (referred) you to the Phototherapy Unit (unit that specializes in treating skin conditions with light therapy) at Southlands Hospital for treatment. 

Reading this information will help you to know what to expect from your treatment. Following the advice in it will help to make sure that your treatment works as well as possible and is as safe as possible. It will also help to keep you comfortable during the period you are having treatment. 

If you have any questions or concerns after you have read this information, please speak to the doctor or nurse caring for you. 

What is ultraviolet B radiation (UVB)?

Ultraviolet (UV) rays are produced by the sun. It has been known for thousands of years that natural sunlight can help to treat some skin disorders. 

They cannot be seen by the human eye, but UV rays are an important part of sunlight. Two sorts of UV light reach us from the sun.  

• UVA. These rays can enter our skin. They cause it to darken or tan. 
• UVB. These rays are mostly absorbed the top layer of our skin (the epidermis). They cause sunburn. 

NB – UVB radiation is used to treat skin conditions that are caused by overactive immune cells in the skin. It reduces their activity which is an anti- inflammatory effect. 

A small section of the UVB wavelength (311-312nm) is better for treating skin conditions. This is called narrowband UVB (NB-UVB) or sometimes TLO1. 

You may hear UVB therapy called phototherapy, light treatment, or light therapy. 

What does NB UVB treatment involve?

The treatment is given in the phototherapy room by specialist trained nurses. 

• You will need to undress and stand in a phototherapy cabinet. The cabinet contains fluorescent tubes that produce UVB rays. Each machine is screened off to make sure your treatment is given in private. You will be the only patient in the room. You will be given protective goggles to wear during treatment and at times a face shield.  
• The cabinet will be turned on and you will be given the dose of NB-UVB that we have worked out is right for you.   
• This is repeated twice a week, on Monday & Thursday afternoons at a time we will give you. Your slot will be sometime between 2pm and 4pm. You will need to come for around 12 weeks and have about 24 sessions.

Your skin may feel warm during treatment, but it will not hurt. 

How might NB-UVB treatment help me?

NB-UVB should help to improve your skin condition. We may suggest you try it if you have already tried steroid ointment and cream, but these have not made your condition much better. Sometimes we use NB-UVB treatment alongside other treatments. This could include treatments that you have already tried. This is more usual towards the start of your course of NB-UVB treatment. 

Most people find their skin improves after 18 to 24 treatments. It can remain clear for some months, or sometimes longer. The number of treatments needed and how well they work is different for everybody. It also depends on the skin disease that you have.

How good is NB-UVB compared to other sorts of phototherapy?

• For many skin conditions you are more likely to have a longer period where your skin condition disappears or improves. 
• For many conditions, narrowband UVB is as good as PUVA (a different type of phototherapy). NB-UVB has fewer side effects.  
• Having NB-UVB treatment may mean you do not need to use tablet or injection treatment to manage your skin condition. This means you will not get side effects from them. 

Will NB-UVB treatment cure my skin condition?

No. NB-UVB treatment will not cure your condition, but it can improve or clear it for a time and mean that your symptoms get better. You may need to have it again in the future if it has improved your condition.

Are there any other treatments that I might be able to have instead of NB-UVB

Your skin specialist thinks that NB-UVB is the best treatment for you. There may be other treatments that you could have. This depends on what condition you have or how severe your condition is, or your ability to attend the phototherapy clinic twice a week. Other treatments include: 

• PUVA (Oral Psoralen Ultraviolet A radiation) treatment. In PUVA treatment your skin is made sensitive to light by tablets that you take. It is then treated with UVA radiation. 
• systemic medication (medicines that you take that work throughout your whole body). These are oral medications (medicines such as a tablet or liquid that you take by putting them in your mouth and swallowing them). 
• creams or ointments. These might be used alone or at the same time as NB-UVB treatment. 
• injected medicines 

Your skin specialist will explain other treatments you might have, or more information can be found on The Psoriasis Association website. 

Do ask your skin specialist to tell you more about any of the treatments if you are not sure what they involve or whether they may be right for you. 

Asking for your consent

Before you have your treatment, we must tell you (inform you) why we think you need it. We will explain: 

• what the benefits of having the treatment might be 
• what the risks of having the treatment might be 
• whether there are any other treatments for your condition and how suitable they might be for you 
• what might happen if you decide not to have treatment. 

We tell you these things to help you to decide whether the treatment is the best thing for you and whether you want to have it. The final decision about whether to have the treatment is yours. 

Once you know about the treatment, we will ask you whether you agree to have it (consent to it). It is important that you understand what you are agreeing to. If you do not understand anything about the treatment do ask. 

We will ask you to sign a consent form with your skin specialist and again at your pre-assessment when we see you to check how you are and whether it is safe for you to have the treatment. 

What do I need to know about parking at Southlands Hospital?

As you will need to come to the hospital often for your treatment and parking may be a concern for you. You do have to pay to park at the hospital, but you can park for free on the roads near the hospital. 

What things must I do, and not do, on the day of my treatment?

On the day of your treatment, 

Do not: 

• wear perfumes, deodorants, aftershave, lotions, or any other cosmetics, including make-up before your treatments (you can wear them afterwards). 
  • These may have things in them which make your skin react more to light or contain sun-screen. This can mean you get coloured patches of skin when you have PUVA treatment. The patches can take months to fade. 
  • Some medicines and ointments can also cause you to get these patches. For this reason, tell us if you start taking any new medicines while you are having your treatment. 
• drink alcohol before your treatment 
• put any creams or ointments onto your skin before you go into the PUVA cabinet or sit at the PUVA light machine other than a moisturiser. Be aware:
• you should use a water-based moisturiser such as E45 or Diprobase. You should put this on more than two hours before your treatment. Two hours before your treatment is best. Moisturiser can help your skin to take in the ultraviolet rays and help your treatment. Always use the same moisturiser.  
• Do not use an oil-based moisturiser. These can cause your skin to burn and stop the PUVA treatment from working.   
• If you are not sure which moisturisers are safe to use, ask one of the Phototherapy Nurses.

Do: 

• remove any jewellery or body piercings before your treatment

What should I do, and not do, during the whole period that I am having treatments?

During the whole period that you are having PUVA treatments 

Do not:  

• get too much sunshine on your skin even through window glass. This is so that you help to avoid getting a reaction which is like sunburn. Make sure you: 
  • cover up with loose fitting clothes with long sleeves and wear a hat. This is most important on sunny days and especially if you do not have much hair on your head. 
  • wear a sunscreen cream or lotion. It should have a sun protection factor (SPF) of at least 30 (50 is best) and have 4 or 5 stars on the bottle. This will protect you from UVB and UVA rays. 
  • Re-apply your sunscreen often and put it on at least 20 minutes before you go outside. It is very important to re-apply sunscreen after you have been swimming or if you have been sweating a lot. 
• sunbathe or use a sunbed 
• get a new tattoo 
• have any cosmetic treatments 

Do: 

• tell us if you wish to or have had haircut or if any of your skin that is not usually exposed to sunlight does become exposed for any reason. 

What should I do when I arrive for my treatment?

Please sit in the dermatology waiting area. You do not need to check in at main reception. You will be called in when it is time for your appointment.  

Do I have to come for a pre-assessment any appointments before my course of treatments start?

Yes. You will need to come one appointment before your treatment starts. 

This is a pre-assessment on a Wednesday afternoon. An appointment letter with the date and time will be sent to you in the post. The pre-assessment is to check that it is safe for you to have NB-UVB therapy and for you to be able to ask any questions and consent to treatment. 

At your pre-assessment we will check how your skin reacts to UVB rays using a light. This is called a MED test. It lets us work out the safe starting dose of NB-UVB for your treatment. We will give you further information about the MED test.  

When will I start my treatments?

24 hours after your MED test you will have an appointment so that we can see how your skin reacted to the MED test and start your treatments. 

If for any reason we have not been able to do your MED test your Phototherapy Nurse will ask you how your skin reacts to being in the sun so that they can work out the dose of NB-UVB that we should use for your first treatment. If you have had UVB treatment in the last year we can use the MED test reading from that.

How long will my treatments take?

Your treatment will take around 15 minutes. This includes time for you to get changed. The exact time that you will be in the treatment cabinet depends on things such as your skin type (how light or dark your skin is) and the skin condition that you have.  

It may only take a few seconds to give you your first dose of UVB. We will check the amount of NB-UVB that you have had. If you have not been harmed by this dose, your next dose will increase slightly. This means your treatments are likely to take longer over the course of your sessions.

Can I have my treatments if I am feeling unwell?

Do tell a member the phototherapy team staff as soon as possible if you feel unwell on the day of your treatment. This includes having a fever (high temperature), feeling dizzy or feeling sick (nausea). It may not be safe for you to be in the treatment cabinet if you are feeling unwell. 

Can I have my treatments if I am planning to be pregnant or there is a chance that I could become pregnant during the time I am having treatments?  

Yes. It is usually possible to have your treatments but please do tell us if you may be pregnant or are planning a pregnancy. We advise you to take the recommended pre-pregnancy folic acid supplements.

What happens during my treatment?

The Phototherapy Nurse will call you from the waiting area when the treatment room is ready for you to use. Be aware, we do our best to keep to your appointment time, but sometimes there may be a delay. Please ask one of the nurses if you are concerned about your waiting time. 

• The nurse will check your skin and ask you some questions before you start your treatment. Do tell your nurse if you have started taking any new medicines or using new creams since your last session. This includes things that you have bought from a pharmacy or other shop.  
• We usually ask you to remove all your clothes. If you have areas of your skin that are not affected by your skin condition, we will ask you to keep these covered. 
  • Men must wear dark underwear or cover their genitals with a dark sock or a jock-strap while they are in the treatment cabinet 
  • If you do wear underwear or clothing in the cabinet do make sure it covers the same areas on each visit. You can do this by wearing the same style. 

• Before you get into the treatment cabinet, we will give you goggles to protect your eyes. We will tell you how to stand in the cabinet to make sure that the UVA can get to the areas of your skin that need it.  
• After we have worked out the dose of NB-UVB that you need you will go into the cabinet and we will turn it on. 

How does having NB-UVB therapy feel?

The light inside the cabinet is bright and you may feel warm.  

Do:  

• Close your eyes when you are in the cabinet and the NB-UVB light is on. 
• tell us if the heat or the amount of time you have to stand up for is too much for you or you feel unwell.

What happens at the end of each treatment session?

You will get dressed and the nurse will arrange a time for your next treatment session with you. You can then go home.

How often will I need to have treatment?

This depends on your skin condition. Most people have two treatments a week for 12 weeks so they have 24 treatments in total.  

We do not do treatments on bank holiday Mondays. Sessions are added at the end of your treatment if you miss one because there is a bank holiday Monday in your treatment period. 

What side effects could I get from having NB-UVB therapy?

As with most treatments there can be side effects from NB-UVB treatment. We will talk with you about what the side effects (complications) may be in more detail. They can include:

Your skin can sometimes become itchy and dry. 

•  Your skin condition could get worse for a short time.  

•  You may get uneven colour or tanning of your skin. 

• Your skin may burn. This can happen with NB-UVB as it can with sunlight.  We will try to avoid this, but some tanning and redness of your skin is likely. This may look different in black or brown skins. Burns may be mild to severe. Severe burns are unlikely but can cause redness, pain, and blistering. 

•  Some people can get polymorphic light eruption. This is an itchy rash due to sunlight. It is rare for people to get this. 

• As with too much sun exposure, long term use of UVB (many months to years) may age your skin and increase your risk of developing skin cancer. This increased risk is very slight at first but increases after about 300 to 500 treatments. 

•  If you do not wear the protective goggles in the cabinet, there is a chance that you may get a sunburn like reaction to your eyes. This happens within a few hours after treatment. It may also increase the chance that you will get eye cataracts in the future. 

•  You may get cold sores due to NB-UVB exposure if you have the cold sore (herpes simplex) virus. This happens to around one in thirty people. Tell the phototherapy nurse if you have had cold sores before and if you notice early signs of tingling or a painful lump developing on your lips. 

•  If you have rosacea or have had cold sores which, can be made worse by the sun, we will shield your face during treatment. We will also ask you to apply an SPF lip balm or block. You can buy this at any supermarket. 

NB-UVB is often a good treatment for people with skin problems but may not be right for you. There may be many reasons for this including for example, if you have very fair skin or if your condition gets worse in the sunlight. 

How should I care for my skin after my treatment?

After your treatment you may get: 

• Dry skin.
  • You may want to apply your moisturiser or other creams and ointments after your treatment. You can do this straight after your treatment in your 30 minute appointment slot. Most people prefer to do this when they get home.
  • NB- UVB can make your skin feel dry so you may find it more comfortable to apply moisturiser four to five times a day. 
• Redness (this may appear darker in black or brown skin). 
  • If you get sunburn after your treatment, please treat your skin as you usually would after sunburn with regular moisturisers. It is usual to have slight redness from 8 to 24 hours after your treatment. This usually fades quickly and is not sore. 

Do tell the Phototherapy Nurses if you have a skin reaction to your treatments so that we can adjust your dose of UVB if we need to.

Will I have any more appointments after my treatment sessions have finished (follow up appointments)?

You will usually have a follow up with a doctor or nurse three months after your treatment, or sooner if you are having problems. 

What must I do if I need to cancel my appointment?

It is vital that you phone us as soon as you know that you won’t be able to get to your appointment. If you know in advance that you can’t get to one of your appointments, let us know. 

Please contact the Phototherapy Room. See the pages at the end of the leaflet for contact number. Leave a message if no answer. 

What should I do if I think I am going to be late for my appointment?

Do phone us if you think you are going to be more than 15 minutes late for your appointment. Leave a message if your call is not answered. This can help you to avoid having a wasted trip to the hospital if we are unable to fit in your appointment because you are late. 

Where can I find further information?

• National Eczema Society 
• The British Association of Dermatologists (sun awareness) 
• NHS Advice (sunburn)
• The Psoriasis Association 
• The British Association of Dermatologists PUVA patient information leaflet 
• The Vitiligo Society 

Who should I contact if I have any questions or concerns about my treatment after I have read this information?

If you have any questions or concerns about your treatment, please contact the Dermatology department.