Ultraviolet radiation in Physiotherapy

Therapeutic Ultraviolet radiation. for physiotherapy students

1. ULTRAVIOLET RADIATION
DR SREERAJS R

2. Sreeraj S R
http://www.noctilio.com/ultraviolent-scorpions/

3. http://www.theozonehole.com/uvrays.htm
http://www.optocleaner.com/uv-light.htm

4. Ultraviolet radiation (UVR) covers a small part of
electromagnetic spectrum lying between the visible light and
X-ray region.
Wave Length: 400 nm -100 nm
Frequency : 10
15
-10
17
http://www.ccohs.ca/oshanswers/phys_agents/ultravioletradiation.html, http://en.wikipedia.org/wiki/Ultraviolet
http://bouman.chem.georgetown.edu/S02/lect10/lect10.htm

5. Sreeraj S R
Types of UVR
UVA
400 –315 nm, near UV
Effects: Erythema without pigmentation
UVB
315 –280 nm, middle UV
Effects: Erythema without pigmentation, formation of vitamin D, skin tanning
(blister/burn)
UVC
280 –100 nm, far UV
Kills bacteria, formation of vitamin D, skin tanning

6. Sreeraj S R
Production
oTherapeuticUVusuallyproducedbythepassageofa
currentthroughanionizedvapour–oftenmercury
vapouratlowpressureorhightemperatures.
oDevices commonly used are either;
oair cooled (using air circulation with fan),
OR
owater cooled (using a water jacket surrounding the
burner with continually circulating water).

7. Sreeraj S R
Production
The therapeutic UVR are produced by mercury vapor lamps, which consists of a quartz burner
tube evacuated from air and containing traces of argon gas and mercury under reduced
pressure.
An electrode is inserted at each end of the burner tube.
The current is applied to the electrodes, the mercury vaporizes and the passage of electrons
through the vapor establishes the ultraviolet arc.
All ultraviolet lamps also produce visible light and infrared rays which heat the burner tube from
60°C to several hundred degrees.
It is necessary to incorporate a cooling device into the lamp, particularly if the lamp is to be used
close to or in contact with the patient.
Devices commonly used include air cooling (using air circulating fan), and
water cooling (using a water jacket surrounding the burner with continually circulating water).

8. Sreeraj S R
Mercury Vapor Lamp

9. Sreeraj S R
Tridymite Formation
The heat produced inside the Burner or Quartz tube causes some of
it to change to another form of silica called Tridymite.
Tridymite is Opaqueto UVR. So output of the rays tends to FALL.
A variable resistance is included in the burner circuit to increase the
potential difference across the burner & intensity of the current.

10. Sreeraj S R
Ozone Formation
Shorter UVR of < 250nm turns atmospheric oxygen into Ozone.
Levels of ozone can be detected by smell.
Ozone is a toxic gas for inhalation.
The harmful effects can be reduced by providing good ventilation.

11. Sreeraj S R
Fluorescent lamps
Thesearelow-pressuremercury
dischargetubeswithaphosphor
coatingoninside.
Thewavelengthsandtheamountof
eachemittedwilldependonthe
compositionofthephosphorused.
(mixturesofphosphates,borates,
andsilicates.)
ThisgivesaconsiderableUVAand
UVBoutputbutnoUVC.

12. Sreeraj S R
Kromayer lamp
mercury vapour lamps designed
to be used in contact with the
tissues, both on the skin surface
and in body cavities.
Water-cooled lamps, wavelength
at 366nm give both UVA and UVB,
used for treating localised lesions
as pressure areas, ulcers and
sinuses in open areas.

13. Sreeraj S R
Theraktin Tunnel

14. Sreeraj S R
Alpine Lamp
oMedium/LowPressureMercuryArcLamp/high-altitudelamps
owavelength253nm(shortwavelength)usedintreatmentof
generalizedskinconditionsasacneandpsoriasis.
oShortUVRreactwithoxygenintheairtoproduceasmall
quantityofozone(O3),
oOzoneistoxicathighconcentrationssoventilationshouldbe
adequatearoundtheselamps.

15. Sreeraj S R
Depth of Penetration

16. Sreeraj S R
Physiological effects
Immediate/acute effects
1.Erythema
2.Pigmentation
3.Increased skin growth
4.Vitamin D production
5.Esophylactic effect
6.Immunosuppressive effects
7.Effects on eye

17. Sreeraj S R
Erythema
Erythemaisreddeningoftheskin
asaresultofaninflammatory
reactionfollowingUVRexposure.
dilatationofthecapillariesand
arteriolesundertheskin.

18. Sreeraj S R
Erythemal response

19. Sreeraj S R
Pigmentation
oPigmentationortanningoftheskinfollowstheerythema,
oitsamountvarieswiththeintensityoftheerythema.
oItisduetotheincreasedactivityofmelanoblastsleadingto
depositionofthepigmentmelanintothesuperficiallayersofthe
epidermis.
oThepigmentationReducesthepenetrationofUV.

20. Sreeraj S R
Thickening of Epidermis
oUVR provokes an increased reproduction of Keratinocytes.
oThis leads to thickening of epidermis
oThis acts as a protection against the UV rays.
oSo longer doses are required to repeat an Erythemal reaction.

21. Sreeraj S R
Desquamation
oItissheddingofthecellswhich
havebeendestroyedbythe
UVR
oDesquamationorpeelingis
proportionaltotheintensityof
theerythema

22. Sreeraj S R
Vitamin D production
oUVBcanconvertsterolsinthe
skin,suchas7-dehydro-
cholesteroltovitaminD
oVitaminDisrequiredtoassist
intheabsorptionofcalcium
andphosphorousfromthe
intestinetobloodstream.
oSuberythemaldosesofUVB
areadequatetopromote
vitaminDsynthesis

23. Sreeraj S R
TheEsophylacticeffect
oGeneral UVA Irradiation leads to
oStimulation of macrophage ormononuclear phagocyte system
oIngest bacteria & produce Antibodies against Bacteria & toxins.
oSo the resistance of the body to infection is increased.

24. Sreeraj S R
Immunosuppressive Effects
oUVdestroysLangerhan’scellsandstimulatestheproliferationof
suppressorTcells.
o(Tcellsareregulatoryinthattheyinhibitantibodyproduction)
oThisimmunosuppressiveeffectsmaycontributetothe
developmentofskincancer.
oInshort,UVradiationinducesastateofrelativeimmuno
suppressionthatpreventstumorrejection.

25. Sreeraj S R
Effects on eye
oStrongdosesofUVBandCradiationtotheeyescanleadto
conjunctivitisandphotokeratitisresultsinirritationoftheeye,a
feelingofgritintheeye,wateringoftheeyeandaversiontolight
(photophobia)
oInseverecasesintensepainandspasmoftheeyelidmaybe
present.Thisisalsoknownas‘snowblindness’
oWhileUVBandCareabsorbedinthecornea,UVAcanpass
throughtobeabsorbedmainlyinthelensoftheeye.
oThestrongdosesofUVAmayleadtoformationofcataracts.

26. Sreeraj S R
Physiological effects
Long term/chronic effects
1.Solar elastosis or aging
2.Cancer

27. Sreeraj S R
Solar Elastosis & Ageing
oProlongedexposureofUVRleadto;
oprematureageingoftheskin;thisisespeciallysointhefair-
skinned.
odecreasedfunctionofsebaceousandsweatglands
olossofelastictissue
oTheskinbecomeswrinkled,dry,andleathery.

28. Sreeraj S R
Cancer
oUVraysmayhaveinfluenceonDNAandthusoncellreplication.
oLeadingtoCarcinogenesis.
oSkincancers,basalcellandsquamouscellcarcinomas.
oShorterultravioletwavesshouldbeavoided,and
ocoursesoftreatmentshouldnotexceedfourweeks.

29. Sreeraj S R
UVR dosage
Skin response to UVR depends upon:
1.Quantity of UVR energy applied to the skin
2.Biological responsiveness of skin

30. Sreeraj S R
UVR dosage
1.Quantity of UVR energy applied to the skin depends upon:
a.Output of the lamp
oLow Volt (30-110V) High-Amp (5A)
oHigh Volt (3000V) Low-Amp (15mA)
b.Distance between the lamp and the skin
c.Angle at which radiation fall on the skin
d.Time for which radiations are applied on the skin

31. Sreeraj S R
UVR dosage
2. Biological responsiveness of skin:

32. Sreeraj S R
Erythemal response

33. Sreeraj S R
Test Dose
30 sec. 60 sec. 90 sec.
Aminimaldose(MED)isthelengthof
theultravioletexposurerequiredto
produceamilderythema,which
appearswithin6to8hoursandstilljust
visibleafter24hours.

34. Sreeraj S R
Test Dose
Test
applied
9.00 AM
Monday
Monday Tuesday
9 AM12 PM3 PM 6 PM 9 PM12 AM3 AM6 AM9 AM
Look at the areas at the times shown and place a tick in the box if any redness is seen.
If no redness is seen put a cross

35. Sreeraj S R
Calculation of dosage
E1 is determined from the skin test and the other erythemal dosages
can be calculated as follows:
oSub-erythemal 75% of E1.
oE2 = 2.5 x E1.
oE3 = 5 x E1.
oE4 = 10 x E1.
oDouble E4 = 20 x E1.
oE4 & Double E4 are used on open wounds.

36. Sreeraj S R
Progression of UV dosage
Doses can be progressed as follows:
oSub-erythemal –previous dose plus 12.5%.
oE1: previous dose plus 25%.
oE2: previous dose plus 50%.
oE3: previous dose plus 75%.
oE4: previous dose plus 75%.
Dosages used on open wounds are not progressed because there is no
epidermis to thicken.

37. Sreeraj S R
Alteration of the intensity with distance
Toirradiateasmallerareathesourceismovednearertothepatient,
butthetimeofexposuremustbealteredtomaintainthesame
intensityinaccordancewiththelawofinversesquares.
Newtime=Oldtimex(newdistance)
2
(Olddistance)
2

38. Sreeraj S R
Frequency of Treatment
SED :Daily
MED :Alternating Days
E2 :Twice a Week
E3 :2 Weeks Apart
E4 :Only Very Local Areas. Not Frequently Given

39. Sreeraj S R
Therapeutic uses
oPsoriasis
1.Goeckermanregimen
2.Ingram/Leeds regimen
3.Photochemotherapy
oAcne Vulgaris
oEczema
oChronic infection/wound
oVitiligo
oProtection for hypersensitive
skin
oVitamin D deficiency
oMild hypertension
oPruritis
oPsychological benefits
oNon infected wounds
oIntact skin

40. Sreeraj S R
Psoriasis
oAskincondition,whichpresents
localizedplaquesinwhichthe
rateofcellturnoverfromthe
basallayerthroughtothe
superficiallayeristoorapid.
oTheaimofultravioletirradiation
istodecreasetherateofDNA
synthesisinthecellsoftheskin
andthusslowdowntheir
proliferation
oi.e.immunosuppressiveeffectof
UVR.

41. Sreeraj S R
Psoriasis
oGoeckermanRegimen:
oThisconsistsofcoaltarapplications2to3timesadaywithgeneral(totalbody)
UVBradiationgivenonceadayasasub-erythemalorE1dose.
oIngramorLeedsRegimen:
oThepatienthasacoaltarbathbeforebeingirradiatedwithaminimalerythema
doseofUVB;
othepsoriaticlesionsarecoveredwithdithranol.
oNextdaythedithranoliscleanedoffandtheprocessisrepeated.
oLink for Video:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735239/#:~:text=The%20Goecke
rman%20regimen%20consists%20of,a%20patient's%20quality%20of%20life.

42. Sreeraj S R
Psoriasis
Photo chemotherapy :
Psoralen-type drug is given to the patient some 2 hours previously, to make
him/her sensitive to UVA radiations,
This 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.
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.

43. Sreeraj S R
Acne Vulgaris:
oThisisachronicinflammatory
conditionofthepilosebaceous
unitespeciallyaffectingthe
face,chest,andback.
oUsingUVRisaimingtoproduce
desquamationtoopenthe
blockedporesandhairfollicles.
ousuallyE2areused

44. Sreeraj S R
Eczema
oAninflammatoryresponsein
theskin,withassociated
oedema,itchingwithredness,
scaling,vesicles,andexudation
ofserumontheskin.
oItmaybecausedbycontact
dermatitis.
oItisoftenthesewhocan
benefitfrommildultraviolet
treatment.

45. Sreeraj S R
Infected Wound
oTreated with high doses of ultraviolet radiation.
oA Kromayerlamp is successful in inhibiting bacterial colony growth.
oThe doses given must be an E4.

46. Sreeraj S R
Non-Infected Wounds
oThe aim of ultraviolet radiation is to stimulate the growth of
granulation tissue and thus speed up repair.
oCan be used in surgical incisions, pressure areas, venous and
arterial ulcers.
oUVA, E3 dose is sufficient.

47. Sreeraj S R
Incipient pressure areas
oUVRmaybeusedtoprevent
pressureareasfrombreaking
downand
ostimulatethegrowthof
epithelialcellsandtodestroy
thesurfacebacteria.
oE1doseprogresseddailyusing
theKromayerlamp.
oInareassuchastheheelsor
theelbowswheretheskinis
thicker,anE2maybeused.

48. Sreeraj S R
Vitiligo
oAnautoimmunediseaseinwhich
destructionofmelanocytesin
localareascauseswhitepatches
toappearontheskin.
oBothUVAandBstimulate
melanocyteactivity
oUVAseemstoprovokeadarker
andlong-lastingtanalthoughthe
protectiveeffectsdonotseemto
besomarked
oUVBprovokesmorethickening

49. Sreeraj S R
Protection for Hypersensitive Skin
oPolymorphiclighteruptionisthecommonestofphotodermatoses
oincreasedtolerancetosunlightcanbeachievedbyacourseof
UVB
ostartwithaverylowdoseandgraduallyprogressing.

50. Sreeraj S R
Vitamin D Deficiency
oVitamin D3 is formed in skin by the action of UVBand Con 7-
dehydrocholesterol.
onatural sunlight can also be curative for vitamin D deficiency
diseases

51. Sreeraj S R
Mild Hypertension
oThegeneral(wholebody)suberythemaldosesofUVBcan
significantlylowerbloodpressure
oitisbelievedtobeduetocalciumregulatinghormonesassociated
withincreasedvitaminDproduction.

52. Sreeraj S R
Pruritus
oTheintractableandseriousitchingthatcanoccurduetoraisedbile
acidlevelinbiliarycirrhosisoruraemia.
ocansuccessfullytreatedbysuberythemalwhole-bodyUVBeither
aloneorincombinationwiththedrugcholestyramine.

53. Sreeraj S R
Psychological Benefit
oPatients expect to feel better and the consequent tanning makes
them look better.

54. Sreeraj S R
Contraindications to UVR
oAcuteskinconditions–acuteeczema,dermatitis,lupus
erthematosis(auto-immunedisease)andherpessimplex
oanexistingultravioletErythema.
oSkindamageduetoionizingradiations–deepX-raytherapy.
oPhotoallergy–allergicreactiontoultravioletradiation.
oAcutefebrileillness–whole-bodytreatmentshouldbeavoided.
oRecentskingrafts.

55. Sreeraj S R
Dangers
oShock:themachineshouldbeearthedandthemainpowercordinsulation
intact.
oEyes:itisimportanttoprotecttheeyesofbothpatientandtherapistfrom
scatteredandreflectedradiations.Thepatientshouldweargoggleseven
whennotfacingthesourceofradiations.Thephysiotherapistshouldbeaware
ofthecumulativeeffectofUVRthroughtheday.
oOverdosage:toavoidlongexposuretoUVR,useanaccuratetimingdevice
especiallyforperiodsoverabout1minute.Overlapofdosesmayleadto
burn.
oIncaseofanaccidentaloverdoseinfraredradiationmaybegiventothearea
toincreaselocalcirculationandtherebydispersethehistamine-likesubstance
thatproducestheerythema.
oSensitization:severaldrugsandsomefoodsinfewpatientscanalterthe
effectofUVRandcausesensitivity.

56. Sreeraj S R
References
1.Electrotherapy Explained by Low and Reed
2.Textbook of Electrotherapyby Singh Jagmohan
3.http://faculty.ksu.edu.sa/68417/RHS%20321/ULTRAVIOLET%20%20RADIATIONS%20(2).pdf
4.http://www.aarogya.com/conditions-and-diseases/specialties/physiotherapy/4823-
electrotherapy.html?start=2
5.Ultraviolet Radiation by Sagar Naik. physio4all
6.Ultraviolet germicidal irradiation: current best practices by Stephen B. Martin, Jr. et al.
ASHRAE Journal, August, 2008