Download Protocol - Photonet

NHS TAYSIDE
NINEWELLS HOSPITAL & MEDICAL SCHOOL
DEPARTMENT OF DERMATOLOGY - PHOTOBIOLOGY UNIT
HOME PHOTOTHERAPY EQUIPMENT (HoPE)
ULTRAVIOLET B (UVB)
TREATMENT PROTOCOL

Determine MED (minimal erythema dose) with readings at 24 hours, +/- 6 hours. If the patient’s back
is too extensively involved (active/flared) to perform the MED test, the starting dose should be
according to skin type (see Photonet skin type protocol) or Doctor’s instructions. If there is no MED
reading, use 70% of the maximum MED test dose or seek medical advice.

Initial irradiation dose: 70% of MED.

UVB treatment will be given every alternate day, with 48-hour minimum interval between treatments.
The patient will have successfully completed the training programme, which includes 1 supervised
treatment in the Photobiology Unit. For most patients, 2 days of training is adequate, but, if felt
necessary, the Phototherapy Nurse will advise a longer training programme.
Day 1 (~1½ hrs): completion of nursing documentation and MED test
Day 2 (~1 hour): demonstration of equipment and 1st supervised treatment

The Phototherapy Nurse will contact the patient every 2 weeks. The patient will also be reviewed
midway through their treatment course (after approximately 12 treatments). Further hospital
assessments may be required.

Exposure time, non-administration of UVB and adverse effects will be documented by the patient on
the Treatment Recording Sheet.

The Home Phototherapy Equipment must be warmed-up for 4 minutes prior to each treatment. Leave
the room during this period. Ensure that nobody enters the room during treatment and warm-up
periods.

The supplied protective goggles and face shield must be worn at all times unless otherwise specified.
Never expose eyes to the lamps.
Contact details:

In the event of erythema or discomfort, the patient should contact the nursing staff (see below) for
advice before administering the next treatment:
Ninewells Hospital, Dundee
Monday-Friday
Saturday
Telephone:
Photobiology Unit
7.30 am-6.30 pm
8.30 am-12.30 pm
01382 632264
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Following a painful erythema, outwith the clinic opening hours, the patient should contact:
Ward 24, Ninewells Hospital
After 6.30 pm and weekends
Telephone:
Dermatology Ward
01382 633824
Adverse effects:
No erythema – give 20% dose increments. Please note for patients with urticaria and atopic eczema
10% increments to be given from start of treatment.
Grade 1 (mild) – barely perceptible and resolves within 48 hours. Repeat previous dose then
administer 10% dose increments thereafter.
Grade 2 (moderate) – well defined erythema, possibly causing slight manageable discomfort.
Postpone one treatment then repeat previous dose if completely settled.,Administer 10% dose
increments thereafter.
Grade 3 (severe) – well defined symptomatic/painful erythema. Do not administer treatment. The
patient should be reviewed by a Doctor when possible. When erythema has completely settled, treat
with 50% of the previous dose then 10% dose increments thereafter.
Grade 4 (very severe) – painful erythema usually with bullae. No treatment and urgent/immediate
review by Doctor.

In patients with pigmented skin, erythema and oedema may not always be seen; the patient may
complain of heat and skin tightness instead.

If a patient develops facial erythema or unacceptable facial pigmentation, a protective face shield or
sunscreen (such as SPF 50) should be considered, and if started used for each treatment.

If a patient develops itch, encourage use of emollient. If itch persists, review by Doctor.

If a patient develops Polymorphic Light Eruption (PLE), encourage use of emollients and prescribed
topical steroids or seek medical advice. Postpone treatment if troublesome and reduce to 10% dose
increments.

Discharge – the patient will be reviewed and discharge planned accordingly.
If the patient is receiving UVB phototherapy for desensitisation:
o Treatment may be given three times weekly or daily
o Exposed sites only should be treated unless otherwise stated by the Doctor
o Topical steroid should be applied immediately post treatment if prescribed
o 15 treatments unless otherwise specified
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If a patient misses/cancels treatment(s), they should be advised of the following:
1-2 treatments:
repeat previous treatment time
3 treatments:
administer penultimate treatment time
4-10 treatments:
the patient must contact the Phototherapy Unit for advice
(give 50% of last treatment dose)
More than 3 weeks missed
due to, e.g. holiday or illness
repeat MED or consult starting dose
Operation of the equipment – see ‘Administration of Treatment’. Only nursing staff trained to operate
the Home Phototherapy Equipment should administer treatment.
Home_UVB_protocol/SusanYule/190813
Review Aug 2014
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