UV skin therapy is nothing new
Light therapy is not a new treatment by any means. In fact it is as old as mankind – or should I say as old as animal kind. You only have to watch how your pets gravitate towards all the sunniest spots in the house on a fine day to be reminded that the sun sustains all life on the planet and that all creatures tend to experience a sense of well-being when they feel its warmth soaking into their skin, as the delightful photo above demonstrates so well!
The sensation of profound relaxation, freedom and harmony with nature that sunbathing induces is something I missed out on for most of my adult life while my vitiligo was at its worst. During that time I instinctively avoided all situations that could possibly involve being seen with my blotchy skin exposed to the curious gaze of others. I became an envious spectator each summer when everyone around me would head for the park or the beach dressed in shorts and t-shirt, sundress or bikini. An all-consuming fear of revealing my vitiligo to others (and being reminded of it myself) was the main reason I kept out of the sun. But I was also afraid of getting sunburn on my white patches because I had listened to the advice that was typically dished out to vitiligo patients regarding sun exposure - which was to avoid it due to the risk of developing cancer. This advice has since changed somewhat as doctors have realised that vitiligo sufferers actually have a lower risk of developing skin cancer than the rest of the population and that the vitamin D deficiency that is characteristic of vitiligo actually calls for more sun exposure, not less. Add to this the fact that #UVtherapy is one of the most effective treatments for vitiligo, and avoiding the sun suddenly doesn't seem to make a whole lot of sense.
#Narrowband UVB therapy is now the number one treatment of choice for many vitiligo and psoriasis patients, due to its high success rate as compared to other options. But who first discovered this treatment, and how? Well, read on because it is a fascinating story...
Treatment with sunlight, or "heliotherapy" (from the Greek sun god Helios), was used for centuries in the management of skin diseases. More than 3500 years ago, ancient Egyptian and Indian healers used an early form of PUVA involving the ingestion of certain skin-sensitising plant extracts or seeds in conjunction with sunlight for treating "leucoderma" (#vitiligo).
But it was the late 19th and early 20th century that was the seminal period in the international development of modern, medical UV therapy. At the same time as the legendary John Harvey Kellogg (of cornflakes fame) was experimenting with therapeutic sunbathing at his revolutionary holistic sanitorium in America, Dr. Auguste Rollier (known as "The Sun Doctor") was busy opening the world’s first Sun Clinics 5,000 feet above sea level in his native Swiss Alps, whilst French naturist Dr Albert Monteuuis was prescribing heliotherapy at his santatorium on the Côte d’Azur as a natural treatment for the benefit of all types of chronic illness.
As natural sunlight is not available everywhere and at all times of the year, artificial alternatives were also being developed at this time that could mimic the sun’s healing effects. This really marked the birth of modern #phototherapy, as we know it. The most famous pioneer of this technology was Niels Ryberg Finsen, originally from the Faroe Islands, who worked as a scientist in Copenhagen and whose own poor health (he suffered from Niemann–Pick disease) led him to investigate the therapeutic effects of sunbathing. He developed a new theory of phototherapy, in which certain wavelengths of light can have beneficial medical effects. He developed a so-called "chemical rays" lamp (the "Finsen lamp" below) whose UV rays could be concentrated onto the most affected parts of a patient’s body. He used this to treat tuberculosis patients and in 1903 he received a Nobel Prize for his therapeutic results with UV irradiation in lupus vulgaris.
In 1900, French electrical engineer, Gustave Trouvé miniaturised Finsen’s machine with a series of portable light radiators to heal skin diseases which marked another step towards the phototherapy technology of today.
Throughout the middle part of the 20th century the methods of these early phototherapy pioneers were adapted and built upon with particular emphasis on psoriasis treatment, which usually included the use of oral and topical steroids, and by the 1970s UVA phototherapy plus light-sensitising medication (PUVA) had become the gold standard treatment for both psoriasis and vitiligo patients. Whilst PUVA proved more effective than previous treatments it carried increased risk of sunburn, premature ageing and skin cancer and the medication used could cause other harmful side effects, including liver damage.
For all its shortcomings, PUVA was a popular treatment for many chronic skin conditions and its development led to the discovery of UVB as a more effective therapy, even when used without the addition of photosensitising medication. By the late 1970s broadband UVB was routinely being used to treat psoriasis and pruritis, followed, in 1988, by the introduction of narrowband UVB, a trend which started in Europe and then gained popularity in the USA during the 1990s.
The application of narrowband UVB to vitiligo specifically came nearly a decade later in 1997 when a pivotal study (Wiskemann 1978; Westerhof and Nieuweboer-Krobotova, 1997) demonstrated that a much higher percentage (67% vs. 46%) of patients undergoing narrowband UVB had repigmentation of vitiligo patches than those who underwent PUVA therapy. Since then, the use of fluorescent bulbs (Phillips model TL-01) that deliver narrowband UVB in the range of 310-315 nm has revolutionised clinical treatment as well as making home phototherapy devices an option. Narrowband UVB for vitiligo has become the new gold standard since it produces better and faster results than previous technologies, is well tolerated by most patients and carries very low risk.
In simple terms, the reason that narrowband UBV has the advantage over previous technologies and became the modern phototherapy treatment of choice is that it stabilises active vitiligo and stimulates new pigment better than other bandwidths and, when administered correctly, does it faster than the time it takes for the skin to burn.
This, I am sure, will not be the end of the story. New technological developments in UV therapy continue to emerge, excimer laser treatment being one example. And in another, very practical, example of ongoing research into phototherapy for vitiligo, the Centre of Evidence Based Dermatology at the University of Nottingham is currently recruiting 440 people with vitiligo, aged 5 years and over, to take part in the "HI-Light Vitiligo Trial", designed to test the effectiveness of home-based light therapy with hand-held units and topical steroids. The trial will no doubt be a valuable contribution to the sum of knowledge on vitiligo and its treatment (and hopefully benefit many of the participants at the same time). But it is also exciting to consider that, by the time some of the younger participants have reached adulthood, phototherapy - and vitiligo treatment as a whole - will have moved on even further and may even have produced that long-awaited and ultimate breakthrough: a permanent, guaranteed, safe and effective vitiligo cure.
My name is Caroline.