## Does UVBNB work alone in treating Vitiligo?

I came across a Medscape article this morning and found it very interesting. One of the sections was entitled “NBUVB as Monotherapy in Vitiligo” and I thought I’d share it with you here.

The article leads one to determine that regular treatment every two days or three times per week is more effective than less frequent treatment plans.

The results of monotherapy with NBUVB have been better in Asian skin. Approximately three-quarters of patients in the series by Kanwar et al. achieved greater than 75% to complete repigmentation after NBUVB treatment for a maximum period of 1 year.[23] The mean duration of disease was significantly shorter in those who had marked to complete pigmentation compared with those who had poorer response. As with any treatment modality for vitiligo, the best results were observed in lesions on the face and neck, followed by the proximal limbs and trunk. Perifollicular pigmentation was the most common type of initial repigmentation that was observed in approximately three-quarters of patients. Continue reading

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Posted in Focus, Medical Articles, Research | | 3 Comments

## Narrow-band UVB phototherapy in 150 patients with vitiligo

This is a study from 2009, it does make a good read.

This study proves that NBUVB therapy is an effective and safe tool in the management of vitiligo, with good stability of repigmentation and cosmetic appearance.

TITLE: Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo

AUTHORS: Y Hari Kishan Kumar1, G Raghu Rama Rao1, K.V.T Gopal, G Shanti, K Veerabhadra Rao

Background: Very few studies have been performed to evaluate the efficacy and safety of narrow-band ultraviolet B (NBUVB) therapy in Indian patients with vitiligo and are of small sample size.

Aims: The purpose of this study is to know the efficacy and safety of NBUVB in 150 vitiligo patients of various age groups. Continue reading

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## Insurance – Is it really a blessing?

A continuing challenge for sellers of ultraviolet phototherapy products are the insurance companies we have to deal with on a daily basis. One thing for sure is that the insurance companies are there to make money and not help their customers. It is really sad that our customers have to go through hell and back to get anything from virtually any insurance company. Organizations like MEDICARE, AETNA and CIGNA simply do not cover ultraviolet phototherapy for Vitiligo period for home phototherapy.

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## Comparing Home to Outpatient UVB Phototherapy

The article below relates to Psoriasis.  I believe that similar results would be found if this or a similar study were done with patients with Vitiligo. My suspicion would be that the results if the the study were done for Vitiligo would show that there would be a higher acceptance. Vitiligo does require a longer treatment regimen over many months and seldom do Vitiligo patients see any results in fewer than 40 to 60 treatments. (three to five months) and visiting a clinic every 2 days with no results showing and spending time in the car, money from your bank account tends to discourage folks. Vitiligo patients really do save significant money and time with home phototherapy. Continue reading

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## CIGNA is in the Dark Ages for people with Vitiligo

As unbelievable as it may sound, CIGNA insurance took a major step backwards last month following AETNA’s lead (in 2004) to stop paying claims for patients with Vitiligo. Aetna stopped in 2004 for home phototherapy systems and last month CIGNA hit with both barrels and stopped covering Vitiligo for UVB Narrow Band Home Users and also for in-clinic UVB NB Therapy. I find it absolutely incredulous that a company can take such a giant step backwards.

CIGNA actually have the balls to say that Vitiligo is a cosmetic problem and not worthy of insurance coverage! This is a real challenge for peope with Vitiligo. AETNA, some branches of Blue Cross / Blue Shield, Medical Mutual of Ohio all think that Vitiligo is a cosmetic problem and not a disease!

The new CIGNA policy can be found at http://uvbnarrowband.com//wp-content/uploads/pdfs/Cigna_Insurance_Coverage_2010.pdf. This is a true shame.

AETNA’ say “Aetna considers home phototherapy experimental and investigational for the treatment of vitiligo because there is a lack of evidence regarding the safety and effectiveness of home phototherapy for this condition.” Their policy can be found at www.aetna.com/cpb/medical/data/400_499/0422.html

## IN CLINIC PHOTOTHERAPY

Page 2 of 13

CIGNA does not cover phototherapy, photochemotherapy or excimer laser therapy for the treatment of localized or generalized vitiligo in any setting because such treatment is considered cosmetic and not medically necessary. Services that are cosmetic are not covered under most benefit plans.

## HOME PHOTOTHERAPY

Page 8 of 13 says Not Medically Necessary/Cosmetic/Not Covered for E0691 through E0694 which are the HCPCS codes used by insurance firms for UV Phototherapy Products used in the home.

They seem to be quite emphatic.

All I can say is that this is a huge step backwards for folks with Vitiligo. Their earlier policy’s did cover Vitiligo!

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Posted in Insurance, The UV Guy's Ramblings | Tagged , , , | 1 Comment

## Do I need Dosimetry for Home use of UVB Narrow Band for Psoriasis, Eczeme and Vitiligo?

One of the questions that arises from time to time is “Do I need a dosimeter in my home system?” My answer is No, so let’s talk about it.

In the past I have sold a few systems with dosimeters for home use at about \$500.00 each as an add-on sale and I usually felt a pang of guilt because in my opinion the dosimeter is not needed for the home user. It may offer a slight benefit but not worth the add-on cost. I have not sold a system with a dosimeter to a home user for about ten years now. Clinical systems are a different story.

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## UVB Narrow Band in the Home. Is it really effective?

There is no doubt that home treatment is effective and well tolerated.

It’s great to have an independent source ratify what we’ve known for years. UV Phototherapy at home is safe, well tolerated and here in the USA, very cost effective for the patient and the insurance company that sometimes is paying the bill.

Since the publishing of the article in the British Medical Journal on the effectiveness of UVB Treatment in the home, Continue reading

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## UVB Narrow Band Treatment Times at Home

Controlled Prescription Timer

The subject of treatment times and how to self treat comes up quite often from doctors and patients looking to use UVB Narrow Band for the treatment of Vitiligo. Generally the best option is to learn how to use your own skin as a meter. This works for the vast majority of people.  I have posted the typical treatment protocol in the “Useful Pages” section of my blog. The specific posting/page can be found at PLEASE CLICK HERE

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## Joules, Watts, Milli-Joules, Milli-Watts. Energy and Power!

James Prescott Joule

Confused by terms?

It’s really easy!

The joule (symbol J) is the derived unit of energy in the International System of Units. It is defined as:

$, 1, mathrm{J}=1, mathrm{kg} cdot mathrm{m}^{2} cdot mathrm{s}^{-2}$

How should I pronounce Joule?

In common speech, we screw up a lot and use the term energy when we mean power and vice versa, energy is the ability to do work, while power is the rate at which work is done.

OK so now you’re more confused.

You’re not the only one!

POWER vs ENERGY

We should not use these words interchangeably, they are very different terms.

Power is meaured in Horsepower, Watts and a few other terms. For the purpose of this discussion, we’ll stay with Watts or milliwatts (thousandths of watts) which is typically the power level of phototherapy panels and booths used in the home and clinic.

Energy for the purpses of our discussion is measured in Joules or millijoules. A  joule is a watt-second or one watt of power delivered over a one second period.

So let’s talk about UV Phototherapy. The doctor wants to record in the chart the dosage that any given patient has received during a treatment, this is typically stated in terms of “mJ” (millijoules) in the case of UVB and UVB Narrowband and in “J” (Joules) in the case of UVA/PUVA treatment.

To detemine how many J or mJ a patient receives the clinic one needs to know the power coming from the lamps and then set a time to deliver the correct dose.

In a typical (not all) home UVB Narrowband units the typical output power is 2.5 mw/sq. cm. at roughly 6” from the unit when the unit leaves the factory.

The formula used to calculate is

Time(Minutes) = (Joules/cm2 x 16.67) / (Power in milliwatts/cm2)

Therefore to calculate the time for 350 mJ  (350 mJ = 0.35J) with a unit generating 2.5 mw/sq. cm.

Desired dose = 350 mJ (0.35 J)
Phototherapy Power = 2.5 mw/ sq cm.

(0 .35J) then (.35 * 16.67)/2.5 would be 2.3 minutes.

We know that a system in a doctors’ office / clinic must be calibrated using this formula of perhaps a DOSIMITERY system. The typical home user dod not need to worry about this, this is why we recommend the simpler home treatment protocol at <CLICK HERE>, it’s so much easier as the typical home user does not have a UV power meter to help with clibration and system setup.

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## What is a load of crap? Beware of the CURE!

If one listens to experts on Vitiligo, one learns that no cure has been found. The ongoing research looks promising but many years of good research need to be completed before a “cure” can be found. Today, there are treatments for Vitiligo that can help with the re-pigmenting of some areas of the body, particularly those areas where we have a reasonable number of hair follicles. We learn that it is at the base of each hair, in the follicle that any remaining melanocytes or pigment cells  hang out waiting to excited by creams such as Protopic or Elidel as well as Laser and UVB Narrowband. (UVB311). Continue reading

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