Ultraviolet Radiation (Uvr) : Application

ULTRAVIOLET RADIATION (UVR)
APPLICATION
Ultraviolet Therapy
• Used to produce photochemical reactions in
the skin
• Wavelength: 180 to 400 nm
• 3 UV bands (A, B, and C) produce unique
effects
Ultraviolet A & B Lamp Ultraviolet C Lamp

Biophysical Effects
• Energy absorbed at a depth between 0.20 to 0.22 mm
• Damages cell proteins, DNA, & RNA to initiate local
inflammatory responses
• Effects:
– Vitamin D synthesis
– Enhances melanin production
– Thickens epidermis
– Superficial vasodilatation
– Bactericide
Contraindication of uvr
• 1. Pulmonary Tuberculosis
• 2. Severe cardiac disturbances
• 3. Systemic Lupus Erythematosis
• 4. Severe Diabetes
Contraindication of uvr
• 6. Known Photosensitivity.
• 7. Photosensitizing medication.
• 8. Deep x – Ray therapy.
• 9. Acute Febrile illness
• 10. Recent skin grafts.

dangers
• 1. Shock
• 2. Eyes - UVR may produce conjunctivitis, iritis or

cataract.
• 3. Over Dosage – UVR burn can occur. Mainly E4

reaction
• 4. Ozone – Important to ensure adequate

Ventilation in the area.
Test dose & determinig med
• It is used to assess the individual patients
(ERYTHEMAL) reaction to uvr irradiation.
• The basis for any calculation of any UVR

dosage is the MED (MINIMAL ERYTHEMAL
DOSE)
• This MED refers to the response of erythema

for the dose to be given
Test dose cont….
• The patient must understand that the purpose of the MED
test is to DETERMINE just how much EXPOSURE TIME is
necessary based on their skin sensitivity.
• Proper patient education should be given:-

• 1. Wear Goggles
• 2. Observe & monitor the skin condition
• 3. Keep skin moisture following exposure to UVR
• 4. Pigmentation changes are to be expected & are a
normal response.
• 5. Prolonged & repeated exposure leads to premature
aging.
steps to determine test dose / skin test
• 1. The area chosen for the test is of importance.
• 2. Because the patient is to inspect at regular intervals a
convenient, visible site is essential.
• 3. It should be clear of skin disease.
• 4. The FLEXOR SURFACE of the FOREARM is the most usual
site.(Other sites are – Abdomen, Medial aspect of arm /
thigh)
• 5. The selected site should be cleaned with soap & water to
remove surface grease.
• 6. Cover the patient other areas leaving only the forearm
exposed to UVR.
• 7. Three to Five holes of at least 2cm² & 1cm apart
are cut in a piece of lint/paper/cardboard is taken
for irradiation of UVR along with a slide cover – to
pull up to reveal one opening at a time.
• 8. This cutting is fixed to the forearm with adhesive plaster.

• 9. The cuttings are of different sizes & shapes in-order to
make IDENTIFICATION OF THE ERYTHEMA EASIER for the
patient.
• 10. Allow the lamp to warm up according to the
manufacturer instructions.
• 11. Place the lamp PERPENDICULAR to the area being
tested (Forearm) & a DISTANCE of 60 to 90cms from the
site.
• 12. Expose the 1st opening for 30sec, then expose the
2nd opening for another 30sec & go on till the last opening
• 13. So the 1st opening would receive the longest exposure
time & the last opening would receive the least amount of
exposure time.
• 14. Switch off the lamp
• 15. Instruct the patient to MONITOR the forearm every 2hrs

& note which opening or shape appeared pink / red first &
when it faded / disappeared.
• 16. The patient is also given a card similar to the opening to

make a note.
mInimal erythemal dose
• It is a slight reddening
(erythema) of the skin which
takes from 6 – 8hrs to
develop & which is still just
visible at 24hrs.
MED (Cont.)
• Expose 1 cut out, open the
shutters for 30- sec., expose
the 2nd cut out and leave the
1st uncover for the 30-sec.
• Repeat the steps above for the
remaining 4 cut outs, but
expose them at 15-sec
intervals
• Instruct patient to check area
every hour and record changes
UV Treatment Dosage
• SED
– No erythema
• MED
– Smallest dose that produces erythema within 1-6 hr
• E1
– Erythema lasts for 1-3 days, some scaling of skin present,
approximately 2.5x MED
• E2
– Erythema with edema, peeling, and pigmentation, approximately 5x
MED
• E3
– Severe erythema and burning, blistering, peeling, edema,
approximately, 10x MED
Description of degrees of erythema
Degree Latent Appearance color Duration of Skin Skin Desquam Relation to
of period Erythema Oedema discomfort ation of E1 Dose
Erythem In HRS skin
a
E1 6-8 Mildly pink <24hrs None None None E1
E2 4-6 Definite Pink 2 Days None Slight Powdery 2.5% of

Red. Blanches Soreness, E1
on Pressure Irritation
E3 2-4 Very red, Does 3-5 Days Some Hot & In thin 5% of
not blanch on Painful Sheets E1
pressure
E4 <2 Angry Red A Week Blister Very Thick 10% of

Painful Sheets E1
dosage
• The skin response to UVR depends on;
• 1. The quantity of UVR energy applied to unit area of the

skin.(Depends on);
a) The output of lamp – Make, Type, Aging
b) Distance between the lamp & the skin – Inverse square
law
c) Angle at which radiations fall on the skin – cosine law
d) Time for which radiations are applied
• 2. The sensitivity of the skin

CALCULATION OF DOSAGE
• E1/MED is the basic of UV calculation which is
determined for each individual patient by
performing a skin test.
• From this point all other doses of UVR can be

calculated.
• E2 = 2½ x E1
• E3 = 5 x E1
• E4 = 10 x E1
CALCULATION OF DOSAGE
• EXAMPLE:
• If the E1 dose of the patient is 25sec, calculate the

E3 dose?
• E1 dose = 25sec
• E3 dose = 5 x E1
• E3 dose = 5 x 25 = 125sec
Calculation of new dose
• The dose at different distances from the lamp to
skin can be calculated by formula;
• NEWDOSE = OLD DOSE X NEW DISTANCE²

OLD DISTANCE ²
Progression of dosage
• An exposure to UVR should not be repeated until the
erythema caused by a previous dose has faded.
• Thickening of the epidermis
• Necessary to increase the exposure in order to repeat the

erythemal reaction at each successive dose
• Doses are progressed as follows:

• To repeat an E1 25% of the preceding dose is added
Progression of dosage
• Examples of progression of dosage
– If E1 is 30sec, find the second progression (P2E1)?
• E1= 30sec
• P1(Day one progression)E1 = E1 + 25% of E1 = 30 +30/4 =

30 + 7.5 =37.5sec
• P2(Day two progression) E1 = P1E1 + 25% of P1E1 = 37.5

+37.5/4 = 46.9sec
• P2E1 = 47sec
Selection of dosage level
• 1. An E1/MED – Given to the total body area (Whole

body)
• 2. An E2 - May not be given to up to 20% of total

body area
• 3. An E3 – May not be given to up to 250cm² of

normal skin
• 4. An E4 – May only be given to an area up to 25cm²

of normal skin.
Frequency of UVR treatment
• 1. An E1 / MED may be given DAILY
• 2. An E2 – Should be given every second day
• 3. An E3 – Should be given every 3 or 4th day (Twice Weekly)
• 4. An E4 – may only be given once a week or even once a

fortnight.
• . when treating non-skin areas such as pressure areas or
ulcers, all doses may be given daily as there is no erythema
reaction produced.
Sensitization / sensitizing drugs
• A number of drugs & some foods in a few patients are
known to sensitize patients to the effects of UVR.
• Commonly seen sensitizing groups are;

• 1. psoralens - Sensitizer
• 2. Sulphonamides - Antibiotic
• 3. Phenothiazine – Tranquilizer
• 4. Barbiturates
• 5. Gold therapy
• 6. Aspirin & Derivatives
Cases Commonly Tx. With UVR
• 1. Pressure sores
– Incipient – E1 progress
– Grade 1 – E2 progress
– Grade 2 – E2 ( non-infected ) E3 ( infected )
– Grade 3 – E3 ( non-infected ) E4 ( infected )
– Grade 4 – E4
2. Ricketts – E2 progress
• 3. Acne – E2 progress
• 4. Psoriasis – E2 progress , Leeds regime – E1
• 5. non-infected wound – E2 progress
• 6. slough ( brown E3, Black E4 )
• 7 Boils – E3 progress
Special Consideration
• 1. Coefficient of applicator
– Length of rod/25 mm
2. Palms – 15x normal
3. Soles – 25x normal
4. Mucous membrane – 2x normal
5. Dorsum of the hand – 5x normal
6. For wound around heel and ankle – E1 progress
7. For children below 2years – ½ adult dose
8. For children 2 – 6 y/o – 2/3 adult dose

Ultraviolet Radiation (Uvr) : Application

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ultraviolet Radiation (Uvr) : Application

Uploaded by

Copyright:

Available Formats

ULTRAVIOLET RADIATION (UVR)

Ultraviolet A & B Lamp Ultraviolet C Lamp

• 2. Severe cardiac disturbances

• 3. Systemic Lupus Erythematosis

• 8. Deep x – Ray therapy.

• 9. Acute Febrile illness

• 10. Recent skin grafts.

• 2. Eyes - UVR may produce conjunctivitis, iritis or

• 3. Over Dosage – UVR burn can occur. Mainly E4

• 4. Ozone – Important to ensure adequate

• The basis for any calculation of any UVR

• This MED refers to the response of erythema

• Proper patient education should be given:-

• 8. This cutting is fixed to the forearm with adhesive plaster.

• 14. Switch off the lamp

• 15. Instruct the patient to MONITOR the forearm every 2hrs

• 16. The patient is also given a card similar to the opening to

E1 6-8 Mildly pink <24hrs None None None E1

E2 4-6 Definite Pink 2 Days None Slight Powdery 2.5% of

E4 <2 Angry Red A Week Blister Very Thick 10% of

• 1. The quantity of UVR energy applied to unit area of the

• 2. The sensitivity of the skin

• From this point all other doses of UVR can be

• If the E1 dose of the patient is 25sec, calculate the

• NEWDOSE = OLD DOSE X NEW DISTANCE²

• Thickening of the epidermis

• Necessary to increase the exposure in order to repeat the

• Doses are progressed as follows:

• P1(Day one progression)E1 = E1 + 25% of E1 = 30 +30/4 =

• P2(Day two progression) E1 = P1E1 + 25% of P1E1 = 37.5

• 1. An E1/MED – Given to the total body area (Whole

• 2. An E2 - May not be given to up to 20% of total

• 3. An E3 – May not be given to up to 250cm² of

• 4. An E4 – May only be given to an area up to 25cm²

• 1. An E1 / MED may be given DAILY

• 2. An E2 – Should be given every second day

• 3. An E3 – Should be given every 3 or 4th day (Twice Weekly)

• 4. An E4 – may only be given once a week or even once a

• Commonly seen sensitizing groups are;

You might also like