Ultraviolet A‑1 treatment

Your doctor has referred you for a course of UVA-1 phototherapy for your skin condition. This leaflet explains this treatment in detail, including its risks and benefits. If you have any questions or concerns, please speak to the doctor or nurse caring for you.

What is UVA-1 phototherapy?

UVA-1 phototherapy is a treatment where the skin is exposed to a type of ultraviolet light. It is part of the types of ultraviolet rays given off by the sun. The purpose of the treatment is healing of the skin condition by this light. It achieves this in a number of ways, including reducing the activity of immune cells in the skin, which are overactive in many skin conditions. It also has an effect on fibroblast cells, which are responsible for the production of collagen in the skin. UVA-1 is principally used to treat morphoea, scleroderma and granuloma annulare.

What does the treatment involve?

UVA-1 therapy must be carried out in hospital under medical supervision. It will be necessary for you to attend three times per week during the course of treatment. The length of the treatment course will vary from one patient to another; an average course is usually between 8 – 10 weeks.

The time of exposure for your first treatment is decided from the reaction of your skin, in response to test doses carried out on a small area on your back or arm. After that, increasing doses will be given at each visit, depending on the reaction of your skin.

Light exposure will take place in a specially designed unit. We usually ask that you remove all your clothing. Each machine is screened off to make sure your treatment is given in private; however, men must wear genital protection. The practical aspects of this will be discussed with you by the nursing staff.

To make sure all your affected skin receives the UVA-1 treatment, we will give you specific instructions on how to position yourself on the unit to ensure that all of your skin is exposed evenly, each time. If you choose to wear underwear, please make sure it covers the same areas of skin on each visit. If an area of skin that has previously been covered is exposed to the UVA-1 treatment, it may burn.

Please let us know if you have started any new medications or creams while having treatment, as some can make your skin more sensitive to light.

For the phototherapy to be effective, you must also use the skin treatment prescribed by the supervising doctor; however, please do not apply any creams or ointments to your skin before you go in the machine, apart from an appropriate moisturiser. If you are not sure which moisturising creams you can use, please ask a member of the phototherapy unit staff.

What are the possible side-effects?

• There is a small risk that your skin may burn, with redness and soreness (particularly in patients with a very fair complexion). The risk of these effects are minimised by careful selection by the staff of the UVA-1 dose you will be given at each treatment. The risk of this can also be reduced by making sure that the same areas of your skin are exposed to the light at each treatment.
• Some tanning of your skin is likely.
• Very occasionally, patients develop polymorphic light eruption, which is an itchy rash due to sunlight.
• Skin dryness. This can be helped with liberal use of moisturising creams. It is important that you use the topical treatment recommended by the department, during the course of treatment.
• If you do not wear the protective goggles / visor during treatment, you risk developing a sunburn type reaction to your eyes and this may also increase your risk of developing cataracts in the future.
• If you have a history of cold sores which are triggered by sun, these can also occur during UVA1 treatment.
• Long-term use of UVA-1 (UVA-1 therapy over many years) causes premature ageing of the skin (dryness, freckling and wrinkling) and increases the risk of developing skin cancer. Therefore, it is our policy to limit the total amount of UVA- 1 treatments you can receive.

Practical points

• It is important that no clothing is worn whilst undergoing treatment in the light cubicle (except for male patients who need to wear genital protection).
• On no account should the eye protection used during light exposures in the cubicle be removed.
• Throughout the course of your treatment, you should not sunbathe or use a sun bed at any time. During bright sunny days, sun block may be required on exposed sites, e.g. face, neck and hands etc. Care should be taken when working in the garden, taking long walks or working outdoors, especially on a day of treatment. Protective clothing such as a hat, gloves and long sleeved garments are advised.

Valuables

All your valuables are your own responsibility.

Storage of results

We record the information about your treatment in an anonymised form on a secure database for audit proposes in accordance with good medical practice. The anonymised data may also be used for research.

To help the smooth running of the unit and our aim to give a high standard of care, we would appreciate your co- operation with the above points.