Exposure to sunlight is helpful for certain skin disorders. One component of sunlight―ultraviolet (UV) light―is responsible for this effect. UV light has many different effects on skin cells, including altering the amounts and kinds of chemicals they make and causing the death of certain cells that can be involved in skin diseases.
Because exposure to natural sunlight varies in intensity and is not practical for a large part of the year in certain climates, phototherapy is nearly always done with artificial UV light. Treatments are given in a doctor's office or in a specialized treatment center.
UV light, which is invisible to the human eye, is classified as A, B, or C, depending on its wavelength. Ultraviolet A (UVA) penetrates deeper into the skin than ultraviolet B (UVB). UVA or UVB is chosen based on the type and severity of the person's disorder. Ultraviolet C is not used in phototherapy. Some lights produce only certain specific wavelengths of UVA or UVB (narrowband therapy), which are used to treat specific disorders. Narrowband therapy helps limit the sunburn–like effect caused by phototherapy.
Phototherapy is sometimes combined with the use of a psoralen. The combination of a psoralen plus UVA is known as PUVA therapy. Psoralens are drugs that may be taken by mouth before treatment with UV light. Psoralens sensitize the skin to the effects of UV light, allowing shorter, less intense exposure.
Side effects of phototherapy include pain and reddening similar to sunburn with prolonged exposure to UV light. UV light exposure also increases the long-term risk of skin cancer, but the risk is small for brief courses of treatment. Psoralens often cause nausea and extreme sensitivity to sunlight. In addition, because psoralens enter the lens of the eye, UV-resistant sunglasses must be worn for at least 12 hours after undergoing PUVA therapy.