ULTRAVIOLET RADIATIONS

K.S.Kumar Assistant Professor SVIMS

Introduction
Ultraviolet radiation (UVR) in Electromagnetic spectrum lying between the violet end of the visible light at 290-400nm and X-ray region. The radiations introduced to the tissues through subcutaneous tissue, hair follicles, and sebaceous glands. 3 UV bands (A, B, and C) produce unique effects UV light produce photochemical reactions in skin Penetration-Long(UVA)>short (UVC) wavelength
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Physics
The wavelength from 400-100 nm. The biological effects of the radiation vary enormously with wave length (three regions) 1- UVA: 400-320 nm 2- UVB: 320-290 nm 3- UVC: 290-180 nm

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SKY

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Photo catalytic Reaction

Photo catalytic is a decomposition reaction formed when Titanium Dioxide (TiO2), as a catalyst, absorbs Ultraviolet (UV) radiation from sunlight or illuminated light source (ultraviolet lamps). TiO2 can be used semipermanently because, as a catalyst, it is not consumed in the process and therefore does not change.

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Benefits of Photo catalytic Reaction

The surface of TiO2 meet and react, the photo catalytic oxidation will effectively disinfect, deodorize, clean and purify air and different surface areas.

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Types of UV
UV-A (400-320 nm)
AKA: near UV Effects: Erythema without pigmentation

UV-B (320-290 nm)

AKA: middle UV Effects: Erythema without pigmentation, formation of vit D, skin tanning (blister/burn)

UV-C(290-180nm)
AKA: far UV Kills bacteria, formation of vit D, skin tanning
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Types of UV Lamps
Hot UV Lamps Produced by argon gas & Mercury vapor housed in a quarts tube Low Volt (30-110V) High-Amp (5A) Electrical current passes through tube, argon gas heats, vaporizing and polarizing mercury to produce UV light in ALL 3 bands and visible violet light. A Kromayer lamp- Dr. K.S.K & UVB. UVA 8

Types of UV Lamps
Cold UV Lamps High Volt (3000V) Low-Amp (15mA) Energy is cooler than Hot and produce UV-C only Applied closer to the body (1 in from the tissues)

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Production of UVR
The natural source -sun. Protect our eyes from bad effects of Ultraviolet radiations.

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Production of UVR
It produced by mercury vapour lamp 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 burner tube. The current is applied to the electrodes, the mercury vapour and the passage of electrons through the vapour establishes the UVR.
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Production of UVR

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Production of UVR
It produce visible light and infrared rays(60C to several hundred degrees) Necessary to incorporate a cooling device into the lamp (close to, or in contact with the patient). Air cooling (using air circulation with fan), and water cooling (using a water jacket surrounding the burner with continually circulating water).

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Ultra-Violet Apparatus
The UV apparatus is grouped as follows: 1- Air-cooled lamps: Hanovia Alpine Sun Lamp, wavelength 253nm (short
wavelength) used in treatment of generalised skin conditions as acne and psoriasis.

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Ultra-Violet Apparatus
2- Water-cooled lamps: Kromayer lamp, wavelength at 366nm give both UVA and UVB, used for treating localised lesions as pressure areas, ulcers, sheves and sinuses in open areas.

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Types of UV Lamps
Fluorescent tubes: Theraktin lamp consists of a number of fluorescent tubes incorporated into a semicircular tunnel. The wavelength between 290 and 350nm (UVA long) used in treating psoriasis affecting large areas.

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UV Bands and Effects

Band Wavelength Effects UVA 320-400nm Erythema without pigmentation UVB 240-360nm Erythema without pigmentation 290- 290-300nm Erythema with pigmentation 320 Skin Tanning (darken) nm 299nm 270-300nm Formation of Vitamin D UVC 270-300nm Formation of Vitamin D
(Filter by
Ozone)

260-270nm Kills Bacteria 254nm Skin Tanning

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Biophysical Effects
Energy absorbed at a depth between 0.20 to 0.22 mm Damages cell proteins, DNA, & RNA to initiate local inflammatory responses. Longer UV affecting the tissue more than the shorter bands.

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PHYSIOLOGICAL EFFECTS
Local Erythema Pigmentation Desquamation Growth of epithelial cells Antibiotic effects General Formation of vitamin D The Esophylactic effect Variations in responses to UVR Natural protection against UVR

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Erythema
Erythema is reddening of the skin as a result of an inflammatory reaction stimulated by ultraviolet rays release of histaminelike substance dilatation of the capillaries and arterioles and exudation of fluid into Dr. K.S.K skin.

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Pigmentation or tanning
Pigmentation or tanning of the skin follows the erythema, its amount varies with the intensity of the erythema. Pigmentation is due to the increased deposition of the pigment melanin ( pigmentation of the hair, skin, and eye produced by melanocytes) formed in the basal cell layer of the skin by the melanoblasts, and migrates to the superficial layers of the epidermis.
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Pigmentation or tanning

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Desquamation
It is the casting off of the cells which have been destroyed by the UVR, desquamation is proportional to the intensity of the erythema.

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Growth of epithelial cells

Is increased as a part of the repair process which follows the erythema.

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Antibiotic effects
Destructive effects of ultraviolet radiation include the destruction of viruses, bacteria, and other small organisms on the skin surface (effect of UVB).

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Formation of vitamin D
Is accelerated by UVR, vitamin D is required to assist in the absorption of calcium and phosphorous from the intestine to blood stream.

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The Esophylactic effect

The resistance of the body to infection is increased as a result of stimulation of reticulo-endothelial system antibodies against bacteria and toxins.

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Variations in responses to UVR

Depend on skin type, degree of pigmentation and age of subject

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Natural protection against UVR

Due to repeated exposure to UVR, the sensitivity of the skin is decreased.

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THERAPEUTIC EFFECTS
1- The erythema: in cases need increased circulation of the skin as acne, or infected wound, pressure areas or around ulcer. 2- Desquamation is useful in conditions where the pores and hair follicles blocked as in acne.

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THERAPEUTIC EFFECTS
3- Growth of epithelial cells is a major effect used in the treatment of open areas as pressure areas, ulcers and slow healing surgical incisions. 4- Antibiotic effects are the second major effect used in infected conditions as acne, pressure areas and ulcers.

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DOSAGE
Determined by Minimal Erythema Dose
 Least amount of UV exposure time to produce redness within 1-6 hrs and disappear within 24 hours

Hot Lamps
 Determined by each patient and each lamp  Standard distance = 30 in., not closer than 15 in.

Cold Lamps
 Standard MED value K.S.K  12-15 seconds atDr.a distance = 1 in.
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Minimal Erythemal Dose (MED) First degree Erythemal dose (E1) Second degree Erythemal dose (E2) Third degree Erythemal dose (E3) Fourth degree Erythemal dose (E4)

DOSAGE

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Determining MED
Cardboard Test Strips
1. 6 different shapes cut out 2. Use to cover shapes

UV Lamp 30 in. away Exposes 1 cut out, open the shutters for 30sec., 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 Dr. K.S.K 35 record changes

Dosage
A first degree erythema dose (E1): produce a mild erythema, appears within 6 to 8 hours, and disappeared in 24 hours. A second degree erythema dose (E2): produce an erythema, appears within 4 to 6 hours, and disappear within 48 hours(1-3days). A mild sunburn, little discomfort may be left. Definite pigmentation and powdery desquamation- 1-2 weeks.

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Dosage
A third degree erythema dose (E3): Produce a marked erythema, appears within 2 or 4 hours and lasts for 72 to 96 hours. It resembles severe sunburn, associated with oedema and tenderness. Subsequent pigmentation and desquamation are marked with skin peeling. A fourth degree erythema dose (E4): Produce an intense erythema which appears within 2 or 4 hours and may last for a week or more causing oedema and exudation of fluid into the tissue.
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CALCULATION OF DOSAGE
E1 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. The two significant units of measurement are:
The length of time (seconds). The distance from the source of UVR to Dr. K.S.K the patient (millimetres).

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CALCULATION OF DOSAGE
E1 is determined from the skin test, the E2, E3 and E4 are calculated using the formulas: E2 = 2 x E1 E3 = 5 x E1 E4 = 10 x E1
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PROGRESSION OF DOSAGE
It causes reactions which thicken the superficial layers, each dose must be progressed in specific way to reach the same effective level of ultraviolet at each treatment. Doses are progressed as follows: (PE) E1 is progressed by 25% of the preceding dose E2 is progressed by 50% of the preceding dose E3 is progressed by 75% of the preceding dose
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PROGRESSION OF DOSAGE
E4 -unusual to areas of normal skin. Used for ulcers where slough is present. Whilst normal skin develops a resistance to successive doses of UV, non-skin areas do not, and it is possible to treat an area not covered by skin with the same dose on successive days to achieve the same result.
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Examples of progression of dosage

Examples of progression of dosage
If E1 is 30s at 450mm, find the second progression (P2E1)?

E1= 30s at 450mm P1E1 = E1 + 25% of E1 = 30 +30/4 = 30 + 7.5 =37.5s P2E1 = P1E1 + 25% of P1E1 = 37.5 +37.5/4 = 46.9s P2E1 = 47s at 450mm.
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Alteration of the intensity with distance

The low of inverse square state that: as distance between the source and the patient increases the intensity decreases in proportion to the square of the distance and this is represented in the equation: New time = old time X (new distance)2 (old distance)2 that is nt = ot X (nd)2 (od)2
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Alteration of the intensity with distance

Using the Kromayer lamp, is U- shaped burner lies 25mm from the window of the treatment head. Thus the patient will always be at least 25mm from the surface of UVR. Because this distance is a constant, it is not included in the description of the dose. For example: the expression I/C indicates contact of the outer window with the patient and a distance therefore of 25mm between the patient and the source of UV, but it must be included in all calculations.
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Alteration of the intensity with distance

Example Using the Kromayer, if the E1 of the patient is 1s I/C, find the E1 at 100mm? Nt = Ot X (nd)2 (od)2 Nt = X Ot = 1s Nd = 100 + 25 (constant distance) = 125 mm Od = 25 mm X = (1)2 X (125)2 (25)2 = 25s That if E1 I/C is 1s, the E1 at 100mm is 25s.
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Alteration of the intensity with distance

Example Using air-cooled lamp, the distance is measured from the burner of the lamp to the patient. Using the air cooled lamp, if the E1 at 900mm is 60s, find the E1 at 450mm? Nt = ot X nd2/ od2 Nt = ? Ot = 60s Nd = 450mm Od = 900mm Nt = 60 X (450)2 / (900)2 = 15s
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Alteration of the intensity with distance

Example If the E1 at 900mm is 60s, the E1 at 450mm is 15s. Using the Kromayer, if the E1 I/C is 1s, find the E3 at 100mm. Step 1: E1 = 1s I/C E3 = 5 X E1 = 5s I/C Step 2: nt = ot X nd2/od2 Nt = ? Ot = 5s Nd = 25 + 100 = 125mm Od =25mm Nt = 5 X (125)2/ (25)2 = 125s E3 at 100mm = 125s

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Selection of dosage
The dosage level is selected according to the effects required for the treatment of the presenting condition. The following guide lines should be followed: 1- E1 or MED -total body area. 2- E2 - up to 20% of the total body area. 3- E3 - up to 250cm2 of normal skin. 4- E4 - up to 25cm2 of normal skin, but it is usually only given to non-skin areas where the size of the area is not important.
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Frequency of Treatment
It depends on the level of erythema produced. Successive doses of ultraviolet must never be given to normal skin while the erythema produced by preceding dose is still visible. The following guide lines should be followed when treating normal skin: E1 or MED / daily. E2 / every second day. E3 / every third or forth day (twice weekly). E4 / once a week. N.B. when treating non-skin areas such as pressure areas or ulcers, all doses may be given daily as there is no erythema reaction produced.
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Indications
Acne:UV produce
desquamation to open the blocked pores and hair follicles. Erythema produced will improve the condition of the skin, stimulate the growth of healthy epithelium, and stimulate the antibiotic effect to destroy the infecting organisms. Dose-the shoulders and back-E3. E2-the face, chest and neck.
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Indications
Psoriasis: UV decrease the DNA synthesis in the cells of the skin and to improve the skin condition. E1- large area/progressed daily. E2-small areas every second day and progressed each treatment.

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Indications
Incipient pressure areas: breaking down and producing an open and infected wound to stimulate the growth of epithelial cells and to destroy the surface bacteria. E1 dose progressed daily-Kromayer lamp. E2-the heels or the elbows (skin is thicker)

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Pressure Areas

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Indications
Infected open wounds: infected surgical incisions, pressure areas, venous and arterial ulcers. Distort and remove the slough (infected materials), stimulate the growth of healthy granulation tissues and promote healing by stimulate growth of epithelium. E3-daily.
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Indications
Non- infected open wounds: promote healing in surgical incisions, pressure areas, venous and arterial ulcers. Counter-irritation: its counterirritant effect in the relief of pain. E4 - cause discomfort and producing mask of pain caused by deep structures.
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Indications
Vitamin D production Rickets- not exposed to sunlight for an extended time degreased production of Vit-D degreased the intestines ability to absorb and subsequently process calcium. Bedridden patients.

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contraindications
Dermatological conditions: acute eczema, lupus erthematosis (autoimmune disease), and herpes simplex- exacerbated. Hypersensitivity to sunlight: patients who react adversely to even minimal exposure to sunlight. Febrile disorders: patient with high temperature.
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contraindications
Deep X-ray therapy: before three months pass after X-ray therapy to avoid hypersensitivity. Infrared therapy: if the erythema due to IR therapy is still present this will increase the effect and absorption of UVR. Photo-allergy: if the patient is known to develop a rash after exposure to sunlight, treatment with UVR should be avoided. Tuberculosis or tumours: may be exacerbated by the effect of UVR.
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Dangerous
Shock: Damage of the eye: may produce conjunctivitis, iritis or cataract. The eyes of both therapist and patient must be protected by wear Goggles made of glass absorb all UVR and offer maximum protection.

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Dangerous
Over dosage: there is a risk of producing an ultraviolet burn if care is not taken to prevent the overlap of doses. Sensitising drugs: number of drugs and some food in a few patients are known too sensitive patient to the effect of UVR.

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