Contraindications to Ultra-Voilet Radiation

 

CONTRAINDICATIONS TO ULTRA-VIOLET RADIATION

Intolerance for sunshine

Certain people do not respond well to UV treatment because they have photosensitivity.

In-depth X-ray

Patients who have deep X-ray therapy develop a localized hypersensitivity to UV light, and they are not treated with UV light for three months after the procedure.

Erythema

The patient's reactivity to UV light is significantly boosted if their skin still exhibits an erythema from UV or infra-red light. Thus, exposure to UV light should be avoided until the erythema has cleared up. Skin ailments UV radiation may make some skin disorders worse, including lupus erythematosus, herpes simplex, and eczema.

ULTRA-VIOLET IRRADIATION DANGERS

Allowing ultraviolet light to enter the eye can lead to conjunctivitis. When the lamp is on, the physiotherapist always wears protective eyewear to avoid this. Additionally, the patient receives goggles or cotton wool screening for his eyes. While UVA is absorbed by the lens and is linked to the development of cataracts, UVB and UVC are absorbed by the cornea. This emphasizes that anytime ultra-violet light is utilized, both the patient and the therapist should wear safety goggles.

Overindulgence

This shouldn't happen if a precise method is applied. Nevertheless, a variety of circumstances could lead to the patient being administered a higher dosage than they were during an earlier session. Among them are:
(a) switching to a bulb with a higher output;
(b) bringing the lamp closer to the patient, or the other way around, to provide
a stronger dosage;
(c) altering the patient's medication schedule;
(d) incorrect temporal strategy.
Regretfully, the symptoms of an overdose do not show up right once, and once erythema develops, there is not much that can be done. However, infrared therapy may be applied to the area in an attempt to promote local circulation and therefore remove the histamine-like chemical that causes the erythema, if an accidental overdose is suspected right away.

Methods of Implementation

Test quantity

A test dosage is given to each patient in order to gauge their response to UV light. Whether using an air-cooled lamp, a Kromayer lamp, or a Theraktin tunnel, the method is essentially the same. Only the times and distances are different.

Air-cooled light source

For the test dose, a suitable area of skin is chosen, such as the flexor portion of the forearm, and it is cleaned to get rid of grease. Three holes of varying shapes are sliced into a UV-resistant substance, such as lint or paper. The central aperture should be roughly 2 centimeters by 2 centimeters, with one side's opening measuring larger than the other. The average El time and distance for each lamp should be prominently displayed, derived on averaged reaction tests conducted on multiple subjects. Testing with the erythema reaction necessary at the intended distance is a smart idea. The duration of the E2, E3, and E4 dosages can be computed using the average El of the light in the following way:
For instance, if treating acne calls for an E2 dose at 50 cm and the lamp's known El is one minute at 100 cm, the amount of exposure time needed can be computed as follows. El (60 seconds at 100 cm) equals 15 seconds at 50 cm since the inverse square law states that a fourth of the distance equals a quarter of the time needed to achieve the same result.

E2 time=El time × 2½

E3 time=El time x 5

E4 time=El time × 10

E2 Dosage Response Tracking System

The duration of an E2 dose at 50 cm is calculated by multiplying the El time by 2½, resulting in 37½ seconds. The patient's forearm is covered with the cut-out test paper or lint, and the remainder of the body is screened. If the patient reacts to sunshine on average, the predicted E2 dose is administered to the center hole. The larger hole (a) receives a somewhat shorter exposure than the small hole (c), which is significantly longer than that of E2.
The patient is given a drawing of the three holes and asked to mark on it the date, severity, and duration of the erythema. This technique is meticulously documented on the patient's card. Next, additional dosages will be determined by the patient's response.

Theraktin Tunnel

Although the test method is quite similar to the one previously described, bigger holes (4 cm x 4 cm) are typically used and placed on the abdomen, with the remainder of the body being screened as well.

The Kromayer lamp

Because the exposure intervals for dosage testing only need to be extremely brief, very small holes such as 0.25 cm x 0.25 cm are employed when the Kromayer lamp is in contact with the skin. Standard El dose periods for contact and 10 cm are frequently helpfully recorded on the Kromayer lamp.

Enhancing UV Dosage Measurement Precision

It should be noted, nevertheless, that test dosages are a gauge of the "damage" that ultraviolet light has produced and they also reveal a patient's response to the radiation. The patient's real exposure to ultraviolet radiation is not measured, and this could be a more accurate approach to characterize dose by providing a figure for the patient's exposure to ultraviolet energy in centimeters across a range of wavelengths. This entails using specific devices to measure the output of generators and will enable a retrospective examination of the effects of cumulative UV exposure on skin. Test doses will still be required, but they will serve as a safety precaution to identify patients who respond to ultraviolet radiation more severely than expected. But doing so will need a significant shift in how physiotherapists use ultraviolet light.

localized therapy with the air-cooled light

Therapy of the face will be covered only for descriptive purposes; many of the principles apply to local therapy of any portion of the body.

Principles

1. Using a test dose, the patient's response to UV light should already have been determined.
2. The patient's face is cleansed to get rid of creams and maximize UV penetration.
3. The patient receives an explanation of what will happen. Next, he is sat in a chair with cushions stacked up on a table behind him to fully support his head.
4. Since the patient's lips, eyelids, and earlobes have extremely thin skin and are sensitive to ultraviolet light, he applies a thin layer of petroleum jelly an efficient screening agent to these locations.
5. Using clips or a bandage, the patient's hair is pulled back as far as possible so as not to conceal any skin on the forehead. This maximizes surface exposure and keeps previously unexposed areas from burning when the next dose is administered.

Facial UV Exposure Procedure Guidelines

1. The patient and the department decide on a suitable neckline, and the patient may leave a garment in the department to wear throughout treatment. As an alternative, you can utilize dressing towels up to a convenient location around your neck. When doses are increased in the future, it's crucial to make sure that no newly exposed skin
2. A cotton string wrapped around the head is used to secure a tiny piece of cotton wool that is placed over the intersection of the eyelids. Cotton wool can prevent conjunctivitis by preventing UV rays from entering the eye.
3. The number of exposures is chosen once the face's form is evaluated.
4. The more typical treatment of two oblique exposures will be explained for the ensuing process points.
5. The patient's head is protected with a dressing towel, and the remainder of their body is screened with a blanket.
6. The lamp is positioned near the patient and centered on one side's zygomatic arch after having been on for five minutes. The burner's location is set to ensure that the bulk of rays reach skin at a 90° angle for optimal absorption, and the burner's distance of 50 cm is measured precisely.

Methods of universal radiation

A PUVA box, a Theraktin tunnel, or an air-cooled lamp can all be used for general irradiation.
general illumination using a light that cools with air Given that it generates shorter UVB rays, this lamp is probably not the ideal source of UV radiation for a general dose. But occasionally, it's the only resource available. With pillows supporting them and just goggles on, the patient is placed in an oblique side-lying position (modesty may require the use of extremely short briefs). The lamp may be easily aligned in this position.

Optimizing UV Exposure Techniques

Either the entire front or the full back may be exposed, with the lamp precisely placed over the midpoint of the screened patient so that the entire surface is exposed simultaneously.
An alternative approach is the "fractional" method. The midpoint of the body, which separates the body into an upper and lower half, is defined as the line connecting the anterior and posterior superior iliac spines. After giving each half the necessary amount of time to heal independently, the other half is screened.

Theraktin tunnel radiation for general purposes

This method emits only a small percentage of UVB rays and is arguably the simplest technique to provide a general UV dose. Half of the El dose that was determined by testing the patient under the Theraktin is then administered. Once more, the patient lies supine on a pedestal wearing just safety goggles. The patient is exposed to radiation for the proper amount of time once the tunnel is lowered to the proper distance from the plinth (sometimes pre-set using ropes and chains). The patient is told to roll over so that the opposite surface of his body is exposed once one has been treated. The dosage is raised gradually, either by one minute per session or by 12.5% from one treatment to the next. Radiation in general using a PUVA box The box could be made up of a cabinet with fluorescent tubes mounted on the walls that mostly transmit visible and UVA light.

PUVA Therapy Dosage Adjustment

The amount of UV energy (in J cm) that the patient will receive is determined in large part by his skin type. Psoralen medications are taken two hours before exposure, and in the skin, this medication reacts with the UVA rays produced. The patient is started on a minimum phototoxicity dose that was previously established by test dosing; this dose only results in a slight erythema after 72 hours of exposure. The less sensitive individuals progress by 1 J cm-2, and the UV-sensitive patients by 0.5] cm-2 per session. After a month of treatments on alternate days, a maintenance dose may be administered on a monthly basis. A photometer must be used to regularly inspect the device's output. Because PUVA does not require messy creams and may be given as an outpatient, it has the potential to yield spectacular improvements and is well-liked by patients. Its favorable advantages must be weighed against the fact that skin cancer creation has not yet been demonstrated to be 100% safe.

Focal point of care

Using a Kromayer lamp, focal treatment is often administered to an ulcer or infected wound. However, with the development of more effective de-sloughing agents and local antibiotics, the significance of UV in the treatment of these illnesses is diminishing.

UV Therapy for Bed Sores

The following protocol could be employed, for example, if UV is to be applied to a bed sore:

Before beginning therapy, all sanitary measures are followed and the bed sore is meticulously cleaned using a prescribed process.

1. A sterile cloth with a hole cut in it is used as a UV-resistant screen to cover the bed sore all the way to the edge. The standard skin and eyes of the physiotherapist and patient are protected with the usual measures.

1. After the Kromayer lamp has warmed up for the entire five minutes, its front face is cleaned with the proper solution and it is ready for use.

1. To lower the chance of infecting the entire treatment head, the lamp's front is held as close to the bedsore as possible without making direct contact. 

1. A minimum E4 dosage is administered. In actuality, treatment could be administered at a fixed distance of, say, 4 cm, but maintaining this for an extended treatment period is challenging.

1. The lamp is cleaned once more and the sore is redressed if needed after the treatment.