UVB therapy for eczema and TSW

I was lucky enough to get UVB phototherapy on the NHS to help heal my eczema and perhaps help speed the healing of topical steroid withdrawal (TSW). They didn’t really know whether it would help but there was one other patient going through TSW who was also having treatment.

This blog is about my experience, what UVB therapy is, how it can work to help treat eczema and topical steroid withdrawal, the pros and cons and how it affected my skin.

How does it work?

The most common type of phototherapy used to treat eczema is narrowband ultraviolet B (UVB) light.  This uses a special machine to emit UVB light, which is the best part of natural sunlight for treating eczema. Phototherapy helps to:

• Reduce itch
• Calm inflammation
• Increase vitamin D production
• Ramp up bacteria-fighting systems in the skin

Source: The National Eczema Association

What does UVB feel like?

Here’s my quick rundown of what the therapy is like.

• You go into a private room where the UVB machine is, undess and apply moisturiser all over.
• Once you’re naked and moisturised you ring the little doorbell to tell them you’re ready and step into the tardis like machine, making sure you put down the paper foot protector on the floor.
• You have to stand the exact same position each session to ensure an even coverage from the UBV rays
• You must also remember to wear eye protection (and for guys, a sock over your willy, there is a hilarious poster reminding guys to do this that makes me chuckle every week)
• The nurse runs through your personal details, checks they have the correct information, agrees the next dose, checks you have eye safety, sets it going and leaves the room so you can get dressed again afterwards. The feeling is divine, like a warm yellow glow that filters through my closed eyelids, taking me to another land, with desert sands, cactus and aloe and a huge orange disc of sun beating down. I love that feeling of sun warmed skin.
• That’s it! The treatments begin at about 10 seconds which increase in increments of 1 or 2 seconds and sometimes staying the same for a maintenance dose.
• You could go up to 30 sessions if it is doing your skin some good. I got just over half way through treatment before lockdown and my last session then was 33 seconds long.
• Treatment may stop earlier if it’s not working or making your skin worse.
• For me it can make my skin feel a little itchy after a treatment but I’ve not noticed any adverse skin reactions.
• TSW gives you so many cycles of flare, burn, flake and peel you do feel sunburnt on a regular basis anyway, but I don’t think the UVB is burning my skin.

Important information

• You must avoid being in the sun while you do UVB as it could be dangerous for your skin.
• Always stand in the same position each week.
• Don’t have a drastic hair cut or expose skin that was previously covered half way through your treatment course as this skin could burn.
• Remember to moisturise before each session using an emollient or cream that is not plant based as plant oils can react with the treatment and cause burns. I use Balneum before each treatment.
• Be aware that they are used to patients also using topical steroids and encouraged me to do so and up the dose. Explain to them what TSW is, why you are doing it and stick to your guns. My nurses now understand and have accepted my right to choose how I have this treatment. If you would like to download a handout that I’ve created to explain TSW visit www.whatallergy.com/freeresources
• Take notes, and make a record of each treatment length. Ask questions. I found that whilst they did explain what would happen I’m still not sure why or how it works and I asked a lot of questions.
• Take your own emollient or moisturiser as they will try to make you use theirs otherwise and it may not be suitable for your skin. Annoyingly they seem to requite the use of paraffin based creams but try to find a good one you can trust such as Double Base, Diprobase or Balneum.

Is it working?

This is so hard to tell whilst going through TSW as the skin flare, burn, crust and flake is a regular cycle.

My first session was on 19th February and it all stopped in the middle of March when Covid-19 put a stop to it being safe to continue. I managed to do 18 sessions before they stopped.

The nurses at the hospital thought it was working from their regular observations of the redness of my skin. I feel I am slowly improving, but them deteriorating, or not quite that but still experiencing days of intense itching and the flare, crust, flake cycle. These have got easier though and I do feel I am healing. Is it UVB that helped? It’s impossible to prove this for sure.

Would I have continued healing anyway? Who knows.

I think my face is slowly healing from my hairline and ears forwards. I’m still getting really itchy, still getting flares, but recovering fast and seeing some really lovely smooth skin coming through.

In the photograph above I think you can see a difference on my forehead and around my eyes. Less creases, wrinkles and smoother looking.

I’ve now started the treatment again since lockdown has eased. Annoyingly it has to start back at the beginning so I started last week on 10 seconds again. They hope to take me up to 30 seconds.

Is anyone else doing UVB therapy for eczema? Has it helped? Anyone tried it during TSW? If you’d like to try it please feel free to ask any questions and I’ll do my best to answer them