8/4/2019 uvr 03 - Copy

1/57

Shruti Shah

Agnes Roubin

SYBPTh

8/20/2011 1

8/4/2019 uvr 03 - Copy

2/57

Def:- Ultraviolet radiation is electromagnetic energy, which is

invisible to human eye, with wavelengths between 10nm to

400nm.

Ultraviolet are usually defined in terms of their wavelengths,extending the violet end of the visible at 390nm to 400nm to

the soft X-ray.

8/20/2011 2

8/4/2019 uvr 03 - Copy

3/57

UVR behave in a similar way to visible radiations in the

way they are reflected, refracted or absorbed, exceptthat they are more strongly absorbed in air, in particular

the short-wavelength ultraviolet.

UVR can cause sunburn and tanning on exposure to the

sunlight.

8/20/2011 3

8/4/2019 uvr 03 - Copy

4/57

REGION WAVELENGTH OTHER

NAMES

BIOTIC

UV A 400nm 315nm Long uv

black light.

UV B 315nm280nm Medium UV

Erythemal UV

ABIOTIC

UV C 280nm100nm Short UV

Germicidal UV

8/20/2011 4

8/4/2019 uvr 03 - Copy

5/57

Incandescent sources, like sun, can produce UVR if the

temperature is high enough.

However, it is usually produced by the passage of a current

through an ionized vapour-often mercury vapour. Gases do not conduct current well at normal temperatures and

pressures but can be made to do so at low pressure or high

temperatures.

8/20/2011 5

8/4/2019 uvr 03 - Copy

6/57

It consists of U-shaped glass tube filled with argon at low

pressure. Small amount of mercury is enclosed in the tube and

the tube is sealed from both the ends.

The burner is made of quartz as this material allows thepassage of ultraviolet rays and can withstand very high

temperatures with low coefficient of expansion.

At the ends of the glass tube, electrodes are placed enclosed in

the metal caps across which a high potential difference is

applied in the argon gas.

8/20/2011 6

8/4/2019 uvr 03 - Copy

7/57

A step up transformer is used to apply very high potential

difference i.e. 400volts across the two metal capssurrounding ends of tube to ionize the argon gas.

Once the argon gas is ionized, normal mains voltage

between the electrodes causes positive and negative

particles to move through the burner, constituting an electric

current

8/20/2011 7

8/4/2019 uvr 03 - Copy

8/57

The electrons move positive pole positive ions move negative pole

The collision between moving ions and neutral argon

atom causes further ionization and a glow discharge is

produced. Also, sufficient heat is produced to vaporizethe liquid mercury inside the tube and further ionization

of mercury.

When the lamp is turned off, the ions of mercury and

argon combine so that within tube everything returns to

its neutral state.

8/20/2011 8

8/4/2019 uvr 03 - Copy

9/57

THE TRYDIMITE FORMATION:- some of the quartz changes

to one another form of silica called trydimite due to veryhigh temperature in the burner.

It is harmful to the total output of UV rays as it is opaque

to the rays and the total output of the lamp gradually

decreases as the proportion of trydimite increases at

around 1000hrs of UV rays production that much

trydimite can form that the whole burner need to be

replaced.

A variable resistance is included in the burner circuit as a

method of compensation and resistance is reduced inorder to increase the current .

8/20/2011 9

8/4/2019 uvr 03 - Copy

10/57

This lamp in in the form of u-shaped tube. This lamp is also

known as high altitude lamps or alpine sunlamp.

They emit continuous spectrum of visible and IR radiations. This

precludes placing them close to the skin unless they are cooled. The U-tube of alpine sunlamp is set at the centre of a parabolic

reflector and made of a special aluminium alloy supported on a

strong stand.

8/20/2011 10

8/4/2019 uvr 03 - Copy

11/57

Short UVR reacts with oxygen in free air to form ozone, which

is evident from its smell, even at low concentrations. Ozone is toxic at high concentrations so ventilation should be

adequate around this lamps.

In some modern lamps the burner envelope is modified so that

it does not emit ozone producing ultraviolet below 270nm.

8/20/2011 11

8/4/2019 uvr 03 - Copy

12/57

The Kromayer lamp is a medium pressure mercury vapour

ultraviolet lamp designed to be used in contact with the tissues

and body cavities.

CONSTRUCTION: the Kromayer lamp is a water cooled mercuryvapour lamp which eliminates the danger of burn and absorbs

infrared rays. The high pressure mercury lamp is surrounded by

circulating distilled water so as to absorb infrared rays.

Kromayer lamp can also be used to treat sinuses or deep body

cavities. Direct contact methods can also be used as it minimizesthe danger of burn.

8/20/2011 12

8/4/2019 uvr 03 - Copy

13/57

8/20/2011 13

8/4/2019 uvr 03 - Copy

14/57

Mercury vapour lamp has

disadvantage that it produces

a certain proportion of short

ultraviolet rays. Modern

treatment methods oftenrequire the use of long

ultraviolet rays.

In order to achieve this

fluorescent tubes are used.Each tube is about 120cm

long and made up of glass

which allows the passage of

long UVR.8/20/2011 14

8/4/2019 uvr 03 - Copy

15/57

The inside tube is coated with special phosphor. The

spectrum of each tube depends upon the coating of

phosphor. A low pressure arc is set up inside the tube with the help of

ionization. Phosphor is used to absorb short ultraviolet and

waves are emitted at longer wavelengths.

8/20/2011 15

8/4/2019 uvr 03 - Copy

16/57

THERAKTIN TUNNEL:- the teraktin tunnel is semi-cylindrical

frame work in which 4 fluorescent tubes are mounted in its ownreflector in such a way that even irradiation of a patient is

achieved. Normally fluorescent tubes with a spectrum of 280-

400nm.

8/20/2011 16

8/4/2019 uvr 03 - Copy

17/57

PUVA apparatus :-Irradiation with UVA only, may be performedwith special fluorescent tubes which may be mounted in a

vertical battery on a wall or on four sides of a box totally

surrounding the patient. This form of UV rays are usually given

for two hours after the patient has taken a photo-active drug

such as psoralen , hence the term PUVA( Psoralin-ultraviolet-A)is used.

8/20/2011 17

8/4/2019 uvr 03 - Copy

18/57

The energy transmitted by UVR can be measured to investigate

the output of the ultraviolet lamps and quantify treatment.

The output of a UV lamp is normally specified in terms of its

irradiance, which is the output power per unit time. The standard unit of irradiance in UV lamp is the watts per

square centimeter(W/cm2).

Both the irradiance and the wavelength is quantifiable.

8/20/2011 18

8/4/2019 uvr 03 - Copy

19/57

A device called photometer is used to measure the irradiance

and by using filters the output over specific wavelength rangescan be measured.

The radiant exposure is the irradiance multiplied by the time

of exposure(in seconds). The units of radiant exposure are thus

joules per square(J/cm2).

Radiant exposure (J/cm2) = Irradiance (W/cm2) time of

exposure(sec).

Irradiance = power delivered per unit area(W/cm2).

8/20/2011 19

8/4/2019 uvr 03 - Copy

20/57

TEST DOSE:- individual patients reaction to the UVR is used to

access the test dose.

Calculation of test dose by air cooled lamp:- A suitable

area of forearm is used for calculation of test dose. The skin is washed to remove any dust or grease.

Three differently shaped holes are cut with a material which

is resistant to the passage of UVR.

8/20/2011 20

8/4/2019 uvr 03 - Copy

21/57

The size of the middle hole is about 2cm2cm with the hole on

one side larger and on the other side smaller. A number of people are tested to find out average E1 time and

distance by seeing a erythema reaction.

The term E1 first degree eythema and minimal erythemal

dose refer to the response used to define a dose. They are

also used to define the subsequent t/t doses.

8/20/2011 21

8/4/2019 uvr 03 - Copy

22/57

By knowing average E1 (time and distance) for particular lamp

, the duration of E2, E3 and E4 doses can be calculated.

E2 time =E1 time 2.5

E3 time = E1 time 5 E4 time = E1 time 10

Also by inverse square law half the distance requires quarter

the time for having the same effect.

8/20/2011 22

8/4/2019 uvr 03 - Copy

23/57

1. The cut out paper or lint is applied to patients forearm and

the body is screened. The middle hole receives the calculated

E2 dose.

2. The small hole receives an exposure slightly longer than E2and the larger hole receives an exposure slightly shorter .

3. The procedure is carefully recorded in patients t/t card.

8/20/2011 23

8/4/2019 uvr 03 - Copy

24/57

All three holes are given to the patient to record when the

eythema appears, how severe it is and how long it lasts.

CALCULATION OF TEST DOSE BY THERAKTIN TUNNEL:- Same

procedure is used to calculate the test dose as mentionedabove, however larger holes of about 4cm 4cm are used and

placed on the abdomen. The rest of the body is screened.

8/20/2011 24

8/4/2019 uvr 03 - Copy

25/57

CALCULATION OF TEST DOSE BY KROMAYER LAMP:- Since the

kromayer lamp is used in contact with the skin, the test dose is

calculated by using very small holes, i.e. 0.25cm 0.25cm and

the exposure time needs to be very short.

8/20/2011 25

8/4/2019 uvr 03 - Copy

26/57

Degree of

eythema

Approx.

latent

period

Appearan

ce

Approx

duration

of

erythema

Skin

edema

Skin

discomfort

Desquam

ation of

skin

E1 6 12 hrs Mildly pink

8/4/2019 uvr 03 - Copy

27/57

1. Patient :

A test dose having been completed, the nature and effects of

the treatment are explained.

2. Apparatus :

A suitable plinth is kept in position so that the Theraktin tunnel

or the lamp can be placed a standard distance (usually 50cm)

from the area to be treated.

8/20/2011 27

8/4/2019 uvr 03 - Copy

28/57

3. Setting up :

If a general body treatment, the patient undresses completely,puts on ultraviolet goggles.

Limbs must not shade one another or the trunk.

If using a tunnel, the distance between the patient and the

tubes is measured. The position of the patient must be repeatable from one

treatment to next.

If the treatment is localized, the area should be exposed and

the patient should wear protective goggles.

8/20/2011 28

8/4/2019 uvr 03 - Copy

29/57

4. Instructions and warning :

The patient is asked to keep still and not touch the tunnel orthe lamp.

5. Application :

The UVR source is switches on for appropriate time for therequired dose.

If a lamp is used it should be turned on for at least 5 minutes

before the treatment to stabilize the output.

6. Progression :

This has 4 separate components. These are :

8/20/2011 29

8/4/2019 uvr 03 - Copy

30/57

8/4/2019 uvr 03 - Copy

31/57

8/20/2011 31

8/4/2019 uvr 03 - Copy

32/57

The well-known acute effects of the sun, i.e., sunburn, are really

the effects of UVB radiations.

Ultraviolet radiations are largely absorbed in the outer layer

of the skin so that the direct effects are limited to those on theskin and the eyes.

The penetration depth of UVC is approximately 40 50m,

while 10% of UVB and 40% 50% of UVA penetrates to the

basal layer.

8/20/2011 32

8/4/2019 uvr 03 - Copy

33/57

The degree to which these effects occur depends on:

1. The amount of UVB energy applied2. The radiant exposure

3. The reactivity or sensitivity of the skin of the subject

These effects can be considered in two groups:1. The immediate or acute effects occurring within hours, days, or

weeks

2. The long-term chronic effects noted only after years.

OR1. Local effects

2. General effects

8/20/2011 33

8/4/2019 uvr 03 - Copy

34/57

1. Erythema :

An erythema or redness of skin appears sometime after

application of the UVR. This is often after a matter of hours and

is called the latent period. Over some hours the erythemaincreases and then fades during the subsequent hours or days.

The redness caused by UVR is uniform, not mottled, and there is

a distinct edge at the junction with an unexposed area.

Damage to cells causes release of histamine like substance from

the dermis and the epidermis. The greater the quantity of the

chemical, the sooner and fiercer is the reaction.

8/20/2011 34

8/4/2019 uvr 03 - Copy

35/57

A gradual diffusion of this chemical takes place until sufficientamount has accumulated around the blood vessels in the skin to

make them dilate. This accounts for latency of erythema. Although after sufficient exposure to UVA some immediate

erythema may occur.

Erythema reaches maximum intensity between 8 to 24 hoursafter exposure but may take several days to resolve

completely. It is produced by wavelengths shorter than 315nm.

8/20/2011 35

8/4/2019 uvr 03 - Copy

36/57

2. Pigmentation (tanning) :

Pigmentation of the skin occurs as a result of both the formation

of melanin in the deep region of the epidermis and themigration of melanin already formed into more superficial

layers.

Melanin pigmentation of the skin is of two types : 1. constitutive

and 2. facultative

8/20/2011 36

8/4/2019 uvr 03 - Copy

37/57

The skin type system is used widely to choose a starting dose of UVR.The categories of skin type system are :

Group 1 always burns, never tans

Group 2 always burns, sometimes tansGroup 3 sometimes burns, always tans

Group 4 never burns, always tans

Group 5 moderate racial pigmentation (e.g. Asian skin)

Group 6 marked racial pigmentation (black skin)

The increased melanin content of the skin affords protection bypreventing UVR reaching the lower layers of the epidermis where thedividing keratinocytes are situated.

8/20/2011 37

8/4/2019 uvr 03 - Copy

38/57

3. Hyperplasia (increased skin growth) :

Stimulation by UVR provokes increased keratinocyte cell

turnover so that the skin grows more rapidly for a time,leading to shedding of the most superficial cells at an earlierstage in their development than usual so that they remain inpieces, or even sheets, and can be peeled off.

This begins to occur after around 72 hours of exposure, is a

result of increased rate of division of basal epidermal cells. This adaptive process occurs with all skin types and is a major

factor that protects those who tan poorly.

It occurs generally in UVB exposure. The peeling ordesquamation varies with the intensity of the applied UVradiation.

Both these protective effects fade over 4-6 weeks if there isno further UV application.

8/20/2011 38

8/4/2019 uvr 03 - Copy

39/57

4. Vitamin D production :

UVB is able to convert sterols in the skin, such as 7-dehydro-

cholesterol to vitamin D which, after changes in the liver andkidneys, is able to facilitate the absorption of calcium from the

intestine.

The UVB radiations are most effective for vit. D production in

the 280nm and 300nm regions. Suberythemal doses of UVB are adequate to promote vitamin

D synthesis.

5. Immunosuppressive effects : An UVR appears to trigger immunosuppressive effects, both

locally and systemically.

8/20/2011 39

8/4/2019 uvr 03 - Copy

40/57

This occurs because UVB destroys Langerhans cells and

stimulates proliferation of suppressor T cells.

When organisms invade the skin, macrophage like Langerhans

cells gather some of the pathogen and transport it to the lymph

nodes, which send out specific killer T cells.

Suppressor T cells inhibit antibody production and suppress

action of other T cells.

This immunosuppressive effect is believed to be the protective

response to prevent an autoimmune attack on the skin cells that

have been altered by UVR.

These effects may contribute to the development of skin cancer.

8/20/2011 40

8/4/2019 uvr 03 - Copy

41/57

1. Solar elastosis and ageing :

Chronic exposure to sunlight

can result in the appearance of

the skin often referred to as

premature ageing or actinic

damage.

The clinical changes associated

with skin ageing include a dry,

coarse, leathery appearance,laxity with wrinkling, and

various pigmentary changes.

8/20/2011 41

8/4/2019 uvr 03 - Copy

42/57

2. Cancer :

The three most common forms of skin cancer listed in order of

seriousness, are : basal cell carcinoma, squamous cell

carcinoma and malignant melanoma.

Carcinogenesis is a danger if long exposure to UVB and C

occurs, as these may have an effect on DNA and thus cell

replication. Therefore, prolonged exposure should be avoided and courses

of treatment should not exceed four weeks.

8/20/2011 42

8/4/2019 uvr 03 - Copy

43/57

1. Photokeratitis and conjunctivitis :

These are usually due to acute exposure to UVB and UVC.

Conjunctivitis is an inflammation of the membrane that lines the

insides of the eyelids and covers the cornea, oftenaccompanied by erythema of akin around the eyes.

There is sensation of gritty eyes and often photophobia,

lacrimation and blepharospasm.

8/20/2011 43

8/4/2019 uvr 03 - Copy

44/57

Photokeratitis is an inflammation of the cornea that can result in

severe pain.

The acute symptoms of visual incapacitance last from 6-24hours.

Almost all discomfort disappears within 2 days and rarely does

result in permanent damage.

Photokeratitis8/20/2011 44

8/4/2019 uvr 03 - Copy

45/57

2. Cataract :

UVA irradiation can lead to cataract formation, and for this

reason adequate eye protection should be worn during

treatment.

8/20/2011 45

8/4/2019 uvr 03 - Copy

46/57

1. Psoriasis

2. Acne vulgaris

3. Eczema4. Infected wound

5. Vitiligo

6. Protection for hypersensitive skin

7. Treatment for vitamin D deficiency8. Treatment for mild hypertension

8/20/2011 46

8/4/2019 uvr 03 - Copy

47/57

9. Treatment for pruritus

10. Non-infected wounds

11. Intact skin

12. Pressure sores

13. Alopecia

14. Rickets

15. Counter irritation effect

16. Physiological benefit

8/20/2011 47

8/4/2019 uvr 03 - Copy

48/57

8/20/2011 48

8/4/2019 uvr 03 - Copy

49/57

8/20/2011 49

8/4/2019 uvr 03 - Copy

50/57

8/20/2011 50

8/4/2019 uvr 03 - Copy

51/57

8/20/2011 51

8/4/2019 uvr 03 - Copy

52/57

Skin develops an increased sensitivity to UVR following ingestion

or topical application of a number of different substances.

This has 2 important implications :

1. Prior to erythema testing the therapist must record all thecurrent medications and clean the skin of any topical

substances not required for test or treatment.

2. Care needs to be exercised if a patients drug regimen has

been altered during the course of UV treatment.

The commonly encountered topical and systemic photosensitizers

are :

1. Diuretics e.g. furosemide

8/20/2011 52

8/4/2019 uvr 03 - Copy

53/57

2. Anticancer drugs e.g. methotrexate

3. Antidepressants e.g. tricyclics

4. Antifungals e.g. griseofluvin

5. NSAIDs e.g. ibuprofen, naproxen, celocoxib

6. Antibiotics e.g. sulphonamides, tetracyclins

7. Retinodis e.g. used in conjunction with UVR treatment8. Hypnotics e.g. sulphonalm

9. Coal tar used as a sensitizer to UVR psoralens

10. Cold therapy

11. Aspirin and derivatives12. Strawberry

13. Eosin

8/20/2011 53

8/4/2019 uvr 03 - Copy

54/57

Acute skin condition acute eczema, dermatitis and an existing

UV erythema

Skin damage due to ionizing radiations deep x-ray therapy

Systemic lupus erythematosus can be triggered. Photoallergy allergic reaction to UVR

Acute febrile illness whole body treatment should be avoided

Recent skin grafts

Known cases of tumors

8/20/2011 54

8/4/2019 uvr 03 - Copy

55/57

1. Eyes :

Eyes of the patient should be protected as there is danger of

conjunctivitis formation or cataract to occur

UVB and UVC are absorbed by the cornea but UVA isabsorbed by lens and is implicated in the form of cataract.

The therapist should also wear protective goggles.

8/20/2011 55

8/4/2019 uvr 03 - Copy

56/57

2. Overdose :

There are a number of factors due to which the patient can

receive overdose during treatment. Too long exposure

Moving the lamp closure to the patient

Changing the lamp

Use of sensitizers

Using a lamp with stronger output

Poor technique

Previously protected skin being irradiated at subsequenttreatments

The effects of overdose do not appear for sometime.

But if overdoes is suspected, infrared radiation may be givento the area in an attempt to increase blood circulation anddisperse histamine-like substance that produces erythema.

8/20/2011 56

8/4/2019 uvr 03 - Copy

57/57

Dr. Sagar Naik (PT) notes

Sheila Kitchen

Jagmohan

Low and Reed Clayton 9th edition

Wikipedia.org

Google images

8/20/2011 57