Bulk Billed Phototherapy

What is bulk-billed phototherapy?

• Bulk-billed phototherapy, also sometimes known as light therapy, ultraviolet therapy,  or narrow Band UVB phototherapy, is a transformative treatment that helps the majority of patients who use it, to control their eczema, vitiligo and psoriasis flare ups. 
• It can also be used effectively to control bothersome chronic itch, or pityriasis rosea.
• Phototherapy is a second line treatment, which is used frequently by dermatologists when patients fail to respond to first line treatments like creams and topical treatments.
• Our bulk-billed narrowband light therapy clinic is now open Monday to Fridays, and patients should book in advance to ensure optimal spacing between treatments. 
• Phototherapy is a safe treatment and it works effectively in the majority of patients who have it. 
• In the small number of patients who do not respond to light therapy, Dr Parisa will be able to recommend other treatments such as biologics.

How does UVB phototherapy work?

• Phototherapy is performed in a special light cabinet, where the patient wears underwear and protective goggles and stands inside for just a few seconds at first, gradually increasing exposure with time as they continue with therapy. 
• As body acclimatises, exposure is increased to 10 or 15 minutes. 
• This graduated exposure ensures your body builds up tolerance to the treatment.

How effective is UVB Phototherapy?

• UVB phototherapy is effective in 50-90% of patients, who report complete remission or noticeable improvement, according to Medical News Today, and the National Centre for Biotechnical Information.
• Why? Because light therapy or phototherapy reduces skin inflammation and slows down the production of skin cells.
• It can be very useful for small stubborn, thick plaque psoriasis, long-term palmoplantar psoriasis, nail psoriasis and scalp psoriasis.

The Journal of Clinical Immunology also reports UVB light therapy to be the gold standard of treatment for eczema and psoriasis. 

Are there any costs associated with bulk-billed phototherapy?

• Aurora Dermatology phototherapy sessions are all 100% bulk-billed under Medicare. 
• Generally three months of sessions are required, where the patient comes in three times a week for the procedure which generally only takes a few minutes. 
• The only costs associated with phototherapy include the first consultation with Dr Parisa. 
• This costs $300, or $219.15 out of pocket after a medicare rebate of $80.85. 
• There will also be a follow up review with Dr Parisa, usually after three months, and this will cost $200 or $159.35 out of pocket with a rebate of $80.85 from Medicare.

How safe is phototherapy treatment?

• Whilst sunlight (UVA) does provide some relief for skin conditions, extended periods of sun are also linked to melanoma, skin cancer, aging of the skin and wrinkles.
• UVB on the other hand has a much safer profile.
• Although the risk of skin cancer is far lower for UVB than sun or tanning beds, (due to the narrow wave band) there may be a very small increased risk of non-melanoma skin cancer with UVB <2% in one study. But after 25 years there was no greater risk than in the general population. 
• Other side effects include dry skin, so moisturising is important.
• Sometimes a sunburn-like skin reaction or skin redness will occur and in rare cases blistering.
• For people who are prone to cold sores on the lips, light therapy may make this worse so applying sunscreen to lips before treatments may help prevent cold sores.

What happens if I miss a few doses of phototherapy?

• If you miss a few doses of your phototherapy, your dose may be dropped slightly and built up again to ensure your body has built up tolerance.

How many sessions of phototherapy do I need?

• Typically narrowband UVB requires 2-3 sessions per week over a three month period. 
• Treatment with UVB phototherapy requires commitment because of the number of treatments needed each week.
• The treatment is more effective when you receive regular treatments and stick to the treatment plan that your dermatologist has recommended.

How many sessions of phototherapy do I need?

• To minimize the risk of getting burnt, the dose will be reduced by 20% compared to your previous session if one-week of treatments are missed. 
• We must restart the course if more than two weeks’ worth of treatments are missed. Holidays, weddings, school exams, work commitments and other factors need to be carefully considered when committing to phototherapy.

How long does phototherapy take to work?

• Improvement is gradual and variable, dependent on how your skin and condition respond to treatment. 
• It normally takes at least 20 treatments /6 weeks to see any effects, so you don’t see immediate improvement. 
• You will be required to be reviewed by your dermatologist every 6 to 12 weeks (normally every 12 weeks) to determine how your skin is responding to the treatment and if further treatment is required.

What happens in a phototherapy session?

• Treatments are usually performed by one of our nurses, and we set the energy according to your skin colour to prevent you from burning.
• Each Treatment lasts seconds to minutes as we gradually increase the dose. 
• You will be standing in the centre of a cabinet with a bank of specially designed light tubes. inside a light box for each treatment.
• If you need to come out of the cabinet for whatever reason during treatment, you can do so at any time as the door is not locked so you don’t have to feel like you are trapped inside. 
• Your eyes are shielded with maximum protection UV wrap-around sun goggles.
• Wear underwear for each treatment to protect the genital area. 
• If you have active psoriasis or eczema on your buttocks, wearing a G-string for women and a sock for men is advised. 
• Please ensure you wear the same type of underwear each time you have treatment to ensure the same surface area is treated and to minimise tan lines in different locations.
• Do not wear perfume or aftershave before being treated.
• Do not apply treatment creams or ointments at home before coming for treatment. 
• After each treatment, you need to apply moisturiser and sunscreen to protect yourself from the sun, and you can resume using your creams/ointments after 6 hours.
• Other medications prescribed for your skin can be used whilst receiving NBUVB; however, do not apply Daivobet ointment before treatment. 
• These can be applied after treatment.

What are the short term side effects of phototherapy?

• Short term side effects include burning, redness, itch, tanning or blisters, just like you might have after sunburn. You will be instructed what to do if this occurs. 
• It is important to contact us if the burn is severe, so that the appropriate treatment can be given. 
• Exposure to natural sunlight on your treatment days should be avoided. The combination of phototherapy and natural sunlight can increase your risk for sunburn.
• Do not use tanning or sun beds during your treatment. 
• A rash brought on by the exposure to UVB can occur, but this is rare. 
• Precipitation of a cold sore is possible (if you are susceptible). Protect the area with SPF 50+ sunscreen, where cold sores usually occur. 
• Your skin may feel drier whilst having phototherapy. To overcome any feeling of dryness, it is recommended that you use fragrance-free soap, wash & moisturisers. 
• During treatment, moisturise regularly and reduce the use of soap while bathing to prevent further skin dryness. 
• A flare of your condition may occur, this may be due to the light itself or heat produced.
• If goggles are not worn correctly, eye damage may occur.
• When the psoriasis or eczema gets better there is often a darkening of the skin over the site of the psoriasis. 
• This darkening can take up to 3 months to disappear.

What are the long-term effects of phototherapy?

• Minimal increased risk of premature aging including age spots, fine lines and wrinkles, freckles, dark spots or discolouration loss of elasticity, changes in the texture and tone of the skin, however this is significantly less risk than natural sunlight. 
• Phototherapy may slightly increase the risk of skin cancer but is very signifcantly less than the the risk of exposure to natural sunlight.
• It is nevertheless important to have your skin checked by your dermatologist, on a regular basis.

What are the long-term effects of phototherapy?

• Minimal increased risk of premature aging including age spots, fine lines and wrinkles, freckles, dark spots or discolouration loss of elasticity, changes in the texture and tone of the skin, however this is significantly less risk than natural sunlight. 
• Phototherapy may slightly increase the risk of skin cancer but is very signifcantly less than the the risk of exposure to natural sunlight.
• It is nevertheless important to have your skin checked by your dermatologist, on a regular basis.

Resources

• What patients need to know about UVB therapy at Aurora Dermatology – the above information can be printed out here.
• Consent Form for Phototherapy is here.
• Watch our phototherapy patient video for eczema here