ULTRAVIOLET RADIATION Sagar Naik, PT

Ultraviolet Radiation (Notes)

Sagar Naik, PT

.
Ultraviolet radiation is electromagnetic energy, which is invisible to the
human eye, with wavelengths between 10 nm to 400 nm. Ultraviolet radiations behave

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in a similar way to visible radiations in the way they are reflected, refracted or
absorbed, except that they are more strongly absorbed in air, in particular the short-
wavelength ultraviolet. Ultraviolet radiations transmit much more energy than visible
radiations so that they are able to provoke chemical changes and not simply heat at sites
where they are absorbed. Ultraviolet are usually defined in terms of their wavelengths,
extending the violet end of the visible at 390 nm to 400 nm to the soft X-ray region.
The ultraviolet spectrum is divided into three regions:
4a Region

UVA
Wavelength

400 nm – 315 nm
Other names
Biotic
Long UV
Blacklight
Medium UV
UVB 315 nm – 280 nm
Erythemal UV
sio
Abiotic
Short UV
UVC 280 nm – 100 nm
Germicidal UV

Oxygen and stratosphere screen out UVC and much UVB from the
sun’s radiation. Radiations of wavelengths between 200 nm to 100 nm, and sometimes
below, are often vacuum UV because, being rapidly absorbed in air, they can only be
y

effectively passed in a vacuum.

y Radiation: Emission of any waves or particles; usually applied to electromagnetic
spectrum
ph

y Heliotherapy: Treatment by means of the sun’s radiation

y Actinic radiation: Radiations that can cause a photochemical reaction, visible, UVR,
X-ray and near IR
y Actinotherapy: Treatment with actinic radiations
y Phototherapy: Treatment with UVR and visible radiations
y Photobiomodulation: Biological effects of light on tissues

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 ULTRAVIOLET RADIATION Sagar Naik, PT

Ö Production of Ultraviolet Radiations (UVR):

 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.

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D Mercury Vapour Lamp:
 Applying a voltage across a pair of electrodes sealed into a UV transmitting
quartz tube containing a little mercury vapour will cause collisions between
electrons and mercury atoms.
 This causes the formation of free mercury ions and electrons. As these
recombine, a steady current flows with electrons being added at one electrode
and removed at the other.
4a
 This process needs a high voltage to start it but will continue with a lower
voltage and is regulated by limiting the current that is allowed to pass through
the tube.
 As mains alternating voltage is applied the process reverses 100 times every
second.
 When free electrons are being accelerated in the tube, many collisions with
neutral mercury vapour atoms will occur:
sio
y By elastic collisions not affecting the atom
y By knocking an electron off the atom – ionization
y By moving an electron to a higher energy level –excitation
 When these excited electrons return to their normal energy level the energy
they lose is emitted as a photon of a characteristic wavelength for that
particular transition.
 Similarly electrons recombining with ions will give the same effect.
y

 The characteristic photon wavelengths given off by mercury atoms are in the
green-blue-violet end of the visible spectrum and in the ultraviolet.
 The line spectrum produced and its intensity may be modified at different
ph

lamp pressures and by addition of traces of metal halides, such as iodide. It is

also filtered by the quartz or special glass envelope.
D Fluorescent Lamps:
 These are low-pressure mercury discharge tubes with a phosphor coating on
inside.

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 This layer absorbs short UVR, notably the spectral line at 254 nm, which
causes excitation of the phosphor atoms and re-emission at a longer
wavelength, i.e., fluorescence.
 The particular wavelengths and the amount of each emitted will depend on
the composition of the phosphor used. (These phosphor coatings are actually

.
mixtures of phosphates, borates, and silicates.)
 The output of these lamps also varies with their temperatures. Most give an

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optimal output with the outside of the tube at about 40°C. Such tubes are
familiar as standard fluorescent lighting tubes.
 The tubes used for ultraviolet treatment in physiotherapy are identical in size
and shape but have a special phosphor coating in the tube that makes it
produce a continuous spectrum between 250 nm to 280 nm and 380 nm and
lines in the blue and green visible. This gives a considerable UVA and UVB
output but no UVC.
4a
 For whole body treatments long fluorescent tubes can be mounted in semi-
cylindrical tunnels, bed and canopy arrangements or figurations for local
treatments.
 The theraktin tunnel, consisting of four 120 cm length tubes mounted in a
semicircular assembly, which can be raised or lowered over a couch or
wheeled into position, has been much used by physiotherapists.
 However, it gives low irradiance and is inclined to give uneven skin exposure,
sio
especially at the sides of the trunk.
 The same type of tube is used to produce large amounts of UVA radiation for
use in the treatment of psoriasis in conjunction with a psoralen sensitizer as
PUVA treatment.
 In these the phosphor coating is different and leads to emission from 315 nm
to 400 nm and several lines in the blue and green visible region.
 A reflecting layer is applied between the glass envelope and the phosphor
layer over more than half the circumference of the tube along its length.
y

 This ensures that the radiations are largely directed forwards and when several
of these tubes are packed together side by side they provide an approximately
ph

uniform emission.
 A number of tubes (48 in one type) are fixed in the walls of a treatment
cabinet in which the patient stands to receive all-round body irradiation.
 All these fluorescent lamps emit visible radiation giving a bluish-white light
when the tube is operating but it must be realized that the visible emission has
no relation to the ultraviolet being emitted.

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 All fluorescent tubes have a slight fall in output during their working lives.
This is trivial for fluorescent lighting tubes but the ultraviolet lamps use less
stable phosphors so that their useful life is usually limited to about 1000 hours.
 Forced air-cooling or air conditioning achieves a more stable output from
the lamp and increased patient comfort.

.
D Medium –Pressure Mercury Arc Lamp (Alpine Sunlamp):
 This lamp is a form of U-shaped tube. This lamp is also known as high-

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altitude lamps or Alpine sunlamp.
 They emit a continuous spectrum of visible and infrared radiations. This
precludes placing them close to the skin unless they are cooled.
 The U-tube of the Alpine sunlamp is set at the centre of a parabolic reflector
and made of a special aluminium alloy supported on a strong stand.
 As a U-tube it acts more like a point source of radiation.
 The stand because there is counterweight system and can be adjusted at two
4a
pivotal points as well as rotated about the vertical stand to allow it to be
suitably positioned. It is usually applied at a distance of 45 or 50 cm.
 All mercury vapour lamps contain a small quantity of the inert gas argon to
facilitate starting up the lamp and help control electron mobility. It also
helps to prolong the life of the metal electrodes.
 In order to start up the medium-pressure burner a high voltage is applied to
metal caps fitted outside the quartz envelope by means of a separate step-up
sio
autotransformer.
 Pressing a button on the control panel applies a charge of 400 V or so to the
metal caps, causing ionization of the argon atoms.
 The high charge displaces on outer orbital electron from several argon atoms,
leaving them as positive ions.
 The presence of sufficient free positive ions and electrons allows the flow of a
convection current in which positive ions gain electrons from the negative
y

electrode and electrons move to the positive at the (lower) mains voltage.
 The small quantity of mercury – which is a drop of liquid at normal
temperature – is rapidly vaporized due to the heat generated by the passage
ph

of current.
 Mercury atoms of the vapour become ionized, giving the spectral emission,
which takes about 5 minutes.
 Short UVR react with oxygen in the air to produce a small quantity of ozone
(O3), which is evident from its smell, even at low concentrations.

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 Ozone is toxic at high concentrations so ventilation should be adequate

around these lamps. The time-weighted average threshold limit for exposure
to ozone is 0.1 ppm by volume in air.
 In some modern lamps the burner envelope is modified so that it does not emit
ozone-producing ultraviolet below 270 nm.

.
D Kromayer Lamp:
 The Kromayer lamp is a medium-pressure mercury vapour ultraviolet lamp

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designed to be used in contact with the tissues, both on the skin surface and
in body cavities.
 This is achieved by enclosing the emitting tube in a water jacket which cools
it and filters out the infrared which would otherwise cause a heat burn, but
allowing the visible and ultraviolet to pass.
 A pump and cooling fan are incorporated into the body of the Kromayer lamp
in order to cool the water. After use, the water circulation should be continued
4a
for 5 minutes after the burner is switched off in order to cool the lamp.
 At the front of the Kromayer head the water circulates between two quartz
windows, which allow the ultraviolet to emerge.
 If a sinus is to be treated an applicator of quartz is fixed to this window via a
special attachment. These applicators convey the ultraviolet rays to their tip by
total internal reflection, but as they are often long they inevitably absorb some
ultraviolet and therefore a considerably longer dose must be given.
sio
Ö Measurement of Ultraviolet Radiation:
 The energy transmitted by ultraviolet radiation can be measured to investigate the
output of the ultraviolet lamps and quantify treatment.
 Photodiodes are most widely used, as they are rugged and relatively cheap.
Coupled to a suitable electronic circuit they register the photon emission and with
added filters can determine the output of different wavelengths.
y

 The measurement is of the power of the radiation or intensity of radiation at a

specific point (more popularly called irradiance) measured in watts per square
meter or watts per square centimeter.
ph

 The amount of energy applied is the irradiance (in W/cm2) multiplied by the
time of exposure (in seconds) giving a dose or radiant exposure (in joules/cm2).
Radiant exposure = Irradiance ± Time of exposure
(J/cm2) (W/cm2) (sec)

Ö Physiological Effects of Ultraviolet Radiations:

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 The well-known acute effects of the sun, i.e., sunburn, are really the effects of
UVB radiations.
 Under normal physiological conditions it takes huge doses of UVA to provoke
any kind of reddening and UVC is not normally found in significant quantities in
the sun’s radiation reaching the earth’s surface.

.
 Ultraviolet radiations are largely absorbed in the outer layer of the skin so that
the direct effects are limited to those on the skin and the eyes.

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 The penetration depth of UVC is approximately 40 – 50 μm, while 10% of UVB
and 40% – 50% of UVA penetrates to the basal layer.
 These effects can be considered in two groups:
y The immediate or acute effects occurring within hours, days, or weeks
y The long-term chronic effects noted only after years

Relation
Degree Approximate

E1

E2
of
erythema
4a
Approximate
latent period

6 –12
hours

6 hours
Appearance

Mildly
pink
Definite
pink-red
Blanches
duration of
erythema

< 24 hours None

2 days
Skin
oedema

None

Slight
None soreness
Skin
discomfort
Desquamation
of skin

None

Powdery
to dose
causing
E1

2.5
on Irritation
sio
pressure
Very red
Does not Hot and In thin
E3 3 hours 3 – 5 days Some 5
blanch on painful sheets
pressure
Angry Very Thick
E4 < 2 hours red
Week Blister
painful sheets
10
y

D Immediate & Acute Effects of UVR on the Skin:

 An erythema, or reddening, appears sometime after the application of the
ultraviolet. This is often a matter of hours and is called the latent period. Over
ph

some hours the erythema increases and then fades during the subsequent hours
or days.
 Oedema and irritation of the skin are evident if the application of ultraviolet
is sufficiently intense, as well as desquamation (peeling) of the superficial
epidermis.

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 If the same dose of UVB is repeated after these changes have recovered it
provokes a less strong reaction due to the pigmentation (tanning) and skin
thickening that occurs.
 This protective pigmentation and thickening can last 30 – 40 days and occurs
not only as a result of a single erythematous exposure but also after a series of

.
exposures each insufficient to provoke visible reddening, hence called
suberythemal doses.

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 The degree to which these effects occur depends on:
y The amount of UVB energy applied
y The radiant exposure
y The reactivity or sensitivity of the skin of the subject
 During the recovery period after strong applications some itching of the skin
may occur.
1) Erythema due to UVR:
4a
 The redness caused by ultraviolet radiation is uniform, not mottled, and
there is a sharp distinct edge at the junction with an unexposed area.
 This indicates that it is capillaries in the dermis that primarily dilate and
not the arterioles.
 Since UVB and C are largely absorbed in the epidermis it is considered
that the reaction is due to the release of chemical substances.
 Histamine substances are invoked especially during the early
sio
development, as are certain prostagladins, which may be released from
epidermal keratinocytes as well as prostacyclin from epidermal cells in
the blood vessels of the dermis.
 Another important cutaneous vasodilator, nitric oxide, also contributes to
the maintenance of erythema due to UVB.
 The histamines, kinins, and other agents associated with the inflammatory
response are released from mast cells and probably other sites in the
y

dermis.
 A gradual diffusion of this chemical takes place until sufficient has
accumulated around the blood vessels in the skin to make them dilate.
ph

This accounts for the latency of the erythema.

 The greater the quantity of histamine-like chemical produced, the sooner
and fiercer is the reaction.
 The erythema appears to differ somewhat depending on the ultraviolet
wavelength. The effectiveness of the radiation in provoking erythema
increases with deceasing wavelength.

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 The mechanism producing erythema due to short UVC may be different

from that due to longer UVB.
 The erythema due to UVA seems to be rather different in several respects.
y There is some immediate erythema merging into a much later
developing erythema, which may last several days.

.
y It is considered that UVA may directly affect blood vessels in the
dermis.

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y It takes about 1000 times the dose of UVA to give an erythema
equivalent to that of UVB.
2) Pigmentation:
 Pigmentation of the skin occurs as a result of both the formation of
melanin in the deep region of the epidermis and the migration of melanin
already formed into more superficial layers.
 This process takes a little time and is usually noticeable about 2 days after
4a
exposure.
 In already pigmented individuals some immediate tanning may occur
within as little as 10 minutes of exposure, due to darkening of existing
melanin by photo-oxidation.
 Pigmentation is strongly stimulated by erythema-producing UVB at about
300 nm and also, to a lesser extent, by longer wavelengths in UVA and
even into the visible.
sio
 Thus sunbeds, which emit UVA and visible radiations, are able to induce a
tan without the erythema, although an erythema will occur at sufficiently
high doses or if the patient has taken a sensitizer.
 The increased melanin content of the skin affords protection by
preventing UVR reaching the lower layers of the epidermis where the
dividing keratinocytes are situated. This protective effect is aided by the
skin thickening that also occurs.
y

3) Increased Skin Growth:

 Stimulation by ultraviolet radiation provokes increased keratinocyte cell
ph

turnover so that the skin grows more rapidly for a time, leading to
shedding of the most superficial cells at an earlier stage in their
development than usual so that they remain in pieces, or even sheets, and
can be peeled off.
 This peeling or desquamation varies with the intensity of applied
ultraviolet radiation.

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 As the skin recovers the growth continues so that the final result is skin
thickening, which adds to the protection due to pigmentation.
 Both these protective effects fade over 4 – 6 weeks if there is no further
ultraviolet application.
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 and kidneys, is able to

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facilitate the absorption of calcium from the intestine.
 The UVB radiations most effective in producing vitamin D are in the 280
and 300 nm regions.
 Suberythemal doses of UVB are adequate to promote vitamin D synthesis
but otherwise healthy individuals living in higher latitudes may have
insufficient vitamin D in winter, as may the bed-bound both in hospital and
at home.
4a
5) Immunosuppressive Effects:
 An ultraviolet radiation appears to trigger immunosuppressive effects, both
locally and systemically.
 This occurs because UVB destroys Langerhan’s cells and stimulates the
proliferation of suppressor T cells.
 When organisms invade the skin, the macrophage-like Langerhans cells
gather some of the pathogen and transport it to the lymph nodes, which
sio
send out specific killer T cells.
 Suppressor T cells are regulatory in that they inhibit antibody production
and suppress the 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
ultraviolet radiation.
 It is uncertain whether an enzyme released as a consequence of DNA
y

damage in the cell, or some photoreceptor chemical – such as urocanic

acid found in the epidermis – is the responsible agent.
 Immunosuppressive effects may contribute to the development of skin
ph

cancer.
6) Effects on the Eye:
 Strong doses of UVB and C radiation to the eyes can lead to conjunctivitis
and to photokeratitis.
 This results in irritation of the eye, a feeling of grit in the eye, watering of
the eye and aversion to light (photophobia).
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 ULTRAVIOLET RADIATION Sagar Naik, PT

 In severe cases intense pain and spasm of the eyelid may be present. This is
also known as ‘snow blindness’ when it arises due to solar UVB and C
reflection from the snow.
 It can also occur due to reflection from sand and from using welding arcs
without eye protection.

.
 The condition usually recovers in about 2 days without permanent
damage but the eye, unlike the skin, does not develop tolerance to

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ultraviolet radiation.
 Although all UVB and C radiations will produce these effects the most
damaging seem to be those of 270 nm.
 While UVB and C are absorbed in the cornea, UVA can pass through to
be absorbed mainly in the lens of the eye.
 The strong doses of UVA may lead to formation of cataracts.
D Long-term Chronic Effects of UVR on the Skin:
4a
1) Solar Elastosis & Ageing:
 Prolonged exposure over many years to strong solar radiation can lead to
premature ageing of the skin; this is especially so in the fair-skinned.
 The skin becomes wrinkled, dry, and leathery and there is decreased
function of sebaceous and sweat glands with loss of elastic tissue.
 Such changes are most often seen in those who have spent much of their
working lives in strong sunlight, such as farmers, fishermen, or other
sio
outdoor workers.
2) Cancer:
 Exposure to high levels of ultraviolet radiation over many years also
increases the risk of certain skin cancers, basal cell and squamous cell
carcinomas.
 Carcinogenesis is a danger if long exposure to UVB and C occurs, as
y

these rays may have an effect on DNA and thus on cell replication.
 Prolonged exposure of the patient’s skin to the shorter ultraviolet waves
should be avoided and courses of treatment should not exceed four weeks.
ph

Ö Therapeutic Uses and Indications of UVR:

D Psoriasis:
 Psoriasis is a skin condition, which presents localized plaques in which the
rate of cell turnover from the basal layer through to the superficial layer is
too rapid.

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 The epidermal transit time is reduced to about 5 days so that the keratinocytes
do not change in the usual way. They keep their nuclei and tend to stick
together forming the plaques.
 There is also increased mitosis and dilatation of the dermal capillaries, which
accounts for the redness.

.
 The aim of ultraviolet irradiation is to decrease the rate of DNA synthesis in
the cells of the skin and thus slow down their proliferation

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(immunosuppressive effect of UVR).
1) Goeckerman Regimen:
This consists of coal tar applications 2 to 3 times a day with general (total
body) UVB radiation given once a day as a suberythemal or E1 dose.
2) Ingram or Leeds Regimen:
The patient has a coal tar bath before being irradiated with a minimal
erythema dose of UVB; the psoriatic lesions are covered with dithranol. Next
4a
day the dithranol is cleaned off and the process is repeated. The aim is to
produce a minimal erythema by using an initial dose of 80% of MED and
increasing by 15% – 20% each time until an erythema occurs. Thus courses
of whole-body UVB treatment are successfully employed for psoriasis,
although several regimens involving adjuncts are in use, e.g., fish oil therapy.
3) Photochemotherapy for Psoriasis:
Psoriasis can be treated with radiations of UVA accompanied by a
sio
sensitizer. If a psoralen-type drug is given to the patient some 2 hours
previously, he or she will become sensitive to UVA radiations, which will
produce an erythema at lower intensities than normal. The drug 8-methoxy-
psoralen is used making the patient highly reactive to UVA once it has been
absorbed, for some 6 – 8 hours. Topical applications of psoralen are also used.
Irradiation during this time leads to an erythema similar to, but not identical
with, that of UVB in that the major erythema arises later and lasts longer and
y

may not reach a peak for 2 – 4 days. As the peak of PUVA erythema occurs at
48 – 72 hours, treatment should be given twice a week until clearance. This
should be approximately 12 –18 exposures. The UVA dose, measured in 1
ph

J/cm2, is initially determined according to skin type and phototesting. Dosage

depends upon the patient’s skin-type and progressive increases are made in
terms of energy-density applied rather than in the length of time. Long-term
use leads to skin damage and there is an increased risk of squamous cell
carcinoma and cataract formation. Hence, maintenance therapy is rarely
used. The sensitizing psoralen drug means that these patients must avoid
sunlight and wear dark glasses during daylight to protect their eyes.
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 ULTRAVIOLET RADIATION Sagar Naik, PT

D Acne Vulgaris:
 This is a chronic inflammatory condition of the pilosebaceous unit especially
affecting the face, chest, and back.
 Mild acne arising at adolescence is so common as to considered a normal
feature. However, the more severe and long-lasting forms are disfiguring and

.
cause serious distress.
 The sebaceous glands become more active at puberty being stimulated by

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androgens which, coupled with infection by the acne bacillus, provokes the
formation of blackheads or comedones.
 These are clumps of keratin, sebum, and bacteria, which block the follicle.
Subsequently an inflammatory response occurs which leads to the familiar
papules and pustules.
 Ultraviolet radiation given in doses such as to cause significant peeling or
desquamation – usually E2 – are used.
4a
 The effects of the ultraviolet are to:
y Accelerate skin growth because peeling of the surface will remove the
lesions and open the blocked ducts
y Produce a non-specific inflammatory reaction to help control infection
y Sterilize the skin surface temporarily
y Cause some pigmentation, which may serve to make the papules less
obvious
 Treatment is only palliative and the condition usually returns within a few
sio
weeks of ultraviolet radiation.
 Unfortunately it may even appear to be worse a few weeks after ultraviolet
radiation, as all the lesions in the skin reach their peak at the same time,
whereas in the normal course of acne some will be resolving as others
develop.
 Irregular rates of desquamation may restrict the frequency of treatment and
possibly produce a mottled erythema.
y

D Eczema:
 Eczema is an inflammatory response in the skin, with associated oedema.
ph

The patient suffers marked itching with redness, scaling, vesicles, and
exudation of serum on the skin.
 While it may be caused by external agents (contact dermatitis), a large group
of patients have atopic eczema.
 It is often these who can benefit from mild ultraviolet treatment.
D Chronic Infection (Infected Wound):

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 ULTRAVIOLET RADIATION Sagar Naik, PT

 Infected open wounds such as pressure sores are sometimes treated with high
doses of ultraviolet radiation.
 The doses given must be such as to kill surface bacteria and therefore an E4
is used.
 The radiation from the Kromayer lamp is successful in killing bacteria in vitro

.
and the reduction in colony numbers correlated with the intensity used to the
point where E4 doses totally inhibited colony growth.

ll..
 This may be particularly valuable in circumstances where antibiotics cannot
reach the area in adequate proportions, if the infection is resistant to them or if
they are contraindicated.
 Skin oxygenation is increased for some 48 hours after the treatment.
However, subsequent return of vasoconstriction lowers the skin oxygen
tension for some 2 weeks so that treatment of the normal skin surrounding
the wound is not beneficial.
4a
D Vitiligo:
 Vitiligo is an autoimmune disease in which destruction of melanocytes in
local areas causes white patches to appear on the skin.
 For the fair-skinned this disease may be of little consequence except for the
need to protect the depigmented patches from excessive sunburn.
 In the darker-skinned it becomes a serious cosmetic problem, which can be
treated with topical psoralens and ultraviolet radiation to try to induce
sio
repigmentation.
 In climates with reliable sunshine, advice on gradual exposure may be
sufficient but in higher latitudes artificial ultraviolet radiation is used to effect
pigmentation.
 Both UVA and B stimulate melanocyte activity but there seem to be some
differences:
y UVA seems to provoke a darker and long-lasting tan although the
y

protective effects do not seem to be so marked

y UVB provokes more thickening
 It would seem sensible to apply graded doses of either or both UVA and B.
ph

 The surrounding normally pigmented area should be protected since darkening

the contrasting area must be avoided.
D Protection for Hypersensitive Skin:
 Polymorphic light eruption is the commonest of photodermatoses and
increased tolerance to sunlight can be achieved by a course of UVB, starting
with a very low dose and gradually progressing.

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D Treatment of Vitamin D Deficiency:

 Vitamin D3 is formed in skin by the action of UVB and C on 7-
dehydrocholesterol.
 Exposure to either artificial ultraviolet radiation, or if available, natural
sunlight is curative for vitamin D deficiency diseases.

.
 Some bed-bound elderly patients may benefit from artificial UVB to maintain
vitamin D and calcium levels to counteract senile osteoporosis.

ll..
D Treatment for Mild Hypertension:
 The general (whole body) suberythemal doses of UVB can significantly
lower blood pressure.
 Since this effect occurred with UVB and not with UVA, it was considered to
be mediated by calcium regulating hormones associated with increased
vitamin D production.
D Treatment of Pruritus:
4a
 Pruritus occurs due to biliary cirrhosis or uraemia.
 The intractable and serious itching that can occur due to raised bile acid
level can successfully treated by suberythemal whole-body UVB either alone
or in combination with the drug cholestyramine.
D Psychological Benefit:
 Considerable psychological benefit has been claimed as an effect of ultraviolet
sio
radiation on the grounds that patients expect to feel better and the consequent
tanning makes them look better.
D Non-Infected Wounds:
 Once infection has cleared, or if it was never present, the aim of ultraviolet
radiation is to stimulate the growth of granulation tissue and thus speed up
repair.
 Short UVB rays damage granulation tissue whereas longer UVA stimulate its
y

growth.
 Consequently, some form of filter is used which will allow UVA to be emitted
but not UVB. E.g., Blue Uviol glass or cellophane.
ph

D Intact Skin:
 Intact skin may be treated with ultraviolet radiation if it is in a pressure area
that is likely to break down.
 An E1 dose is given in order to increase the circulation through the area and
improve skin conditions.
 This may also be done for more resistant conditions such as chilblains.

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 ULTRAVIOLET RADIATION Sagar Naik, PT

[Papule: A small, circumscribed, solid, elevated lesion of the skin is known

as papule.
Pustule: A small-circumscribed elevation of the skin containing purulent
fluid is called pustule.
Comedones: A plug of sebaceous material and epithelial debris in the

.
pilosebaceous orifice is known as comedones.
Contact Dermatitis: Allergic reaction of the skin mediated by delayed

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hypersensitivity to a substance, which comes in contact with the surface of
the skin, is known as contact dermatitis.
Atopic Eczema: A generalized and prolonged hypersensitivity to common
environmental antigens is called atopic eczema.
Pressure Sore: A bed sore; a decubital ulcer appearing on dependent sites
usually on lumbosacral region, most commonly in bed-ridden elderly persons
is known as pressure sore.
4a
Senile Osteoporosis: Diffuse osteoporosis of unknown cause affecting
elderly, especially women. There is reduction of total bone mass and
compression fracture of vertebrae may be noted.
Pruritus: Severe itching is known as pruritus.
Biliary Cirrhosis: Progressive and widespread necrosis of liver cells
associated with inflammation and fibrosis leading to loss of normal liver
architecture due to biliary obstruction which may be primary resulting from
destruction of intrahepatic bile ducts or secondary to large duct biliary
sio
obstruction is called biliary cirrhosis.
Uraemia: A toxic condition caused by retention in the blood of waste
substances especially products of protein metabolism normally excreted in
urine is known as uraemia.
Chilblain: A cutaneous injury from exposure to cold or damp climates
producing localized itching, swelling and painful erythema commonly
affecting fingers, toes, and ears is called chilblain.]
y
ph

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Ö Types of Skin:

Type Description
Always burn
Type I
Never tan

.
Always burn
Type II
Tan slightly

ll..
Sometimes burn
Type III
Always tan
Never burn
Type IV
Always tan
Pigmented skin
Type V
Mongoloid
Heavily pigmented skin
4a Type VI

Ö Dangers of Ultraviolet Radiation:

D Eyes:
Negroid

 If ultraviolet rays are allowed to fall on the eye, conjunctivitis may occur.
 To prevent this physiotherapist always wears protective goggles when the
lamp is on.
sio
 The patient is also provided with goggles or his eyes are screened using cotton
wool.
D Overdose:
 Overdose should not occur if an accurate technique is used.
 However, a number of factors may result in the patient receiving a stronger
dose than that given at a previous treatment.
y Using a different lamp with a stronger output
y

y Moving the lamp closer to the patient (or vice versa), thus giving a more
intense dose
ph

y A change in the patient’s drug regimen

y Poor timing technique
y Previously protected skin being irradiated at subsequent treatments
 Unfortunately the effects of overdose do not appear for sometime and there is
little that can be done once the erythema appears.
 If, however, an accidental overdose is immediately suspected, infrared
radiation may be given to the area in an attempt to increase local circulation
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 ULTRAVIOLET RADIATION Sagar Naik, PT

and thereby disperse the histamine-like substance that produces the

erythema.
D Ozone:
 Because ozone is formed it is important to ensure adequate ventilation in the
area.

.
Ö Contraindications to Ultraviolet Radiation:

ll..
 Acute skin conditions – acute eczema, dermatitis, and an existing ultraviolet
erythema.
 Skin damage due to ionizing radiations – deep X-ray therapy.
 Systemic lupus erythematosus can be triggered or exacerbated.
 Photoallergy – allergic reaction to ultraviolet radiation.
 Acute febrile illness – whole-body treatment should be avoided.
 Recent skin grafts.
4a
sio
y
ph

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 ULTRAVIOLET RADIATION Sagar Naik, PT

.
ll..
4a
sio
y
ph

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