Targeted Phototherapy

Introduction :
Targeted phototherapy, also called concentrated phototherapy or focused phototherapy or
microphototherapy, involves delivery of Ultraviolet radiation directly focused on the target skin lesion
through special delivery mechanisms such as fiber-optic cables.
Mechanism of action
Most targeted phototherapy devices (laser or nonlaser type) emit radiation in the UVB range, with peak
emission in the narrowband wavelength (around 308-311 nm), while some non-laser machines emit
UVA radiation also.
1. Apoptosis of pathogenically relevant cells including T-cell apoptosis in the treatment of
psoriasis, mycosis fungoides and atopic dermatitis, and mast-cell apoptosis in pruritic skin
disorders.
2. Stimulation of melanocyte-stimulating hormone, increased melanocyte proliferation, and
melanogenesis as in vitiligo.
3. Decreased release of histamine from both basophils and mast cells in histaminic disorders such
as urticaria pigmentosa.
4. Other effects, such as alteration in cytokine production (Upregulation of IL-10 and suppression
of IL-12,17, and local immunosuppression, increase in collagenases etc.
Devices for targeted phototherapy
1. Excimer laser
a. Operates in UV range (308 nm xenon-chloride laser)
b. These machines are available from companies such as Photomedex and wave light
technologies
c. Have a spot size of < 2cm2
d. The machines however are costly, bulky and difficult to maintain
2. Intense pulse light therapy (Monochromatic excimer light)
a. Operate in wavelength of 304nm (excilite) and 308nm (Pxlite)
b. These machines are less bulky, cheaper and larger spot size as compared to excimer
laser
3. Light based targeted phototherapy
a. Both UVA and UVB (including NBUVB) spectra are available
b. They are less bulky, cheaper and easier to maintain than laser systems
c. Examples of commercially available units include
i. Dualight/Theralight UVA and UVB
ii. B clear targeted photoclearing system UVB only
iii. Bioskin UVB only
Advantages of targeted phototherapy
1. Exposure of involved areas only and sparing of uninvolved areas, thus minimizing acute side
effects such as erythema and long-term risk of skin cancer over unaffected skin
2. Quick delivery of energy and thereby shortened duration of treatment

3. Delivery of higher doses of energy. Since uninvolved areas are not exposed, higher doses of
energy can be delivered selectively to the lesions, thereby enhancing efficacy, achieving faster
response, reducing cumulative dose.
4. The maneuverable hand piece allows treatment of difficult areas such as scalp, nose, genitals,
oral mucosa, ear etc.
5. Easy administration for children as delivery is hand-held
6. These machines are less bulky as compared to conventional phototherapy units
Disadvantages
1. Expensive devices
2. Inadequate to treat extensive areas. (not recommended if the treatment area exceeds 10% of
BSA)

Indications
1.
2.
3.
4.
5.
6.
7.
8.
9.

Psoriasis
Seborrhoeic dermatitis
Vitiligo
Cutaneous T-Cell lymphoma
Atopic Dermatitis
Pityriasis lichenoides
Uritcaria pigmentosa
Morphea , Scleroderma
Hand dermatitis

Contraindications
Absolute
1.
2.
3.
4.

Photosentisitivity disorders
Xeroderma pigmentosum
History of malignant melanoma
Basal cell nevus

Relative
1. Risk factors for melanoma
2. History of non-melanoma skin cancer
3. History of exposure to arsenic, ionizing radiation, cyclosporine, immunosuppressive
medications