Last Updated on 26th August 2022 by Caroline Haye
Phototherapy for skin conditions 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 animal kind. You only have to watch how your pets gravitate towards all the sunniest spots in the house on a fine day to realise something… 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.) But, before we embark on a brief history of UV treatment, let me put the subject into the context of vitiligo.
Most people enjoy the sensation of profound relaxation, freedom and harmony with nature that sunbathing induces. But this 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 headed for the beach dressed in shorts and t-shirt, sundress or bikini I hid myself away. An all-consuming fear of revealing my vitiligo to others (and even thinking about it myself) was the main reason I kept out of the sun.
I was also afraid of getting sunburn on my white patches because I believed the doctors’ warnings regarding sun exposure… Which were to avoid it due to the risk of developing cancer. Since then, scientists have discovered that vitiligo sufferers actually have a lower risk of developing skin cancer than the rest of the population. Not only that, but the vitamin D deficiency that is characteristic of vitiligo actually calls for more sun exposure, not less. Add to this the fact that UV therapy is one of the most effective treatments for vitiligo, and avoiding the sun suddenly doesn’t seem to make a whole lot of sense.
Natural light therapy
Narrowband UVB therapy is now the number one treatment of choice for many vitiligo and psoriasis patients. A fact that is due to its high success rate as compared to other options. But who first discovered this treatment, and how? Well, read on because this brief history of UV treatment is a fascinating story which has its roots in natural light therapies…
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. This involved the ingestion of certain skin-sensitising plant extracts or seeds in conjunction with sunlight for treating “leucoderma” (vitiligo).
But it wasn’t until the late 19th and early 20th century that the international development of modern, medical UV therapy really began. 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. And 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.
Artificial light therapy
As natural sunlight is not available everywhere and at all times of the year, inventors looked for artificial alternatives to 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, he worked as a scientist in Copenhagen and his 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 also invented a “chemical rays” lamp (the “Finsen lamp” below) whose UV rays could zero in on the most affected parts of a patient’s body. This lamp was used 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… another step towards the phototherapy technology of today.
PUVA versus narrowband UVB
Throughout the middle part of the 20th century the methods of these early phototherapy pioneers evolved. Psoriasis treatment was at the forefront of these developments, 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. 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 until the discovery that UVB was a more effective therapy… With or without the addition of photosensitising medication. By the late 1970s broadband UVB was routinely being used to treat psoriasis and pruritis. And in 1988 narrowband UVB became 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. This was 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. In addition to which home phototherapy devices have become an option. Today narrowband UVB for vitiligo is the new gold standard since it produces better and faster results than previous technologies and carries very low risk.
The future of UV treatment
In simple terms, the reason that narrowband UVB has the advantage over previous technologies is that it stabilises active vitiligo and stimulates new pigment better than other bandwidths. And, when administered correctly, it does this 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 an example of recent research into phototherapy for vitiligo is the Centre of Evidence Based Dermatology at the University of Nottingham’s “HI-Light Vitiligo Trial“. This trial (ongoing at the time of writing this) is to test the effectiveness of home-based light therapy with hand-held units and topical steroids. The results will no doubt be a valuable contribution to the sum of knowledge on vitiligo and its treatment. (And, hopefully, it will benefit many of the participants at the same time). But it is also exciting to consider where we will be by the time some of the younger participants have reached adulthood. Phototherapy – and vitiligo treatment as a whole – will have moved on even further. Maybe it will even have produced that long-awaited and ultimate breakthrough: a permanent, guaranteed, safe and effective vitiligo cure.
