Embrace Your Dermatologist
by Michael Caswell, Ph.D.
American dermatologists expound on the dangers of exposure to ultraviolet radiation; however, they continue to use it therapeutically. Dermatologists use ultraviolet radiation therapy for an assortment of medical conditions such as atopic dermatitis, psoriasis and localized scleroderma. Much of the research discovering these therapeutic uses of ultraviolet radiation was conducted in Europe where UV exposure is more acceptable. The therapeutic effects of modest exposure to ultraviolet radiation should be a source of pride for our industry and can become a new source of increased sales for your tanning salon.
The term atopic dermatitis is used to define a group of common skin diseases with an unknown origin that affects about 10 percent of the Western population. Atopic dermatitis, or eczema, is frequently treated with corticosteriods, which can induce undesirable side effects. Because atopic dermatitis is so difficult to treat, some new approaches have been found, including phototherapy. The ability of UV radiation to reduce the severity of atopic dermatitis gives your tanning salon the opportunity to help the dermatologist's patient.
Atopic dermatitis flares and subsides for unknown reasons; however, patients have noticed that flare-ups were less severe in summer. Recent scientific studies show atopic dermatitis to be reduced in the presence of immunosuppressants, drugs that suppress the immune function of the skin. UVB, which is highest in the summer sun, also is known to reduce the skin's immunological response. Because these two pieces of information suggest that UV might reduce the severity of atopic dermatitis by an immunsuppression mechanism, scientists in Germany and elsewhere have examined the therapeutic value of various types of ultraviolet radiation on atopic dermatitis.
UVAII (320nm to 340nm), UVAI (340nm to 400nm), UVB (290nm to 320nm) and combinations of UVA and UVB and PUVA each have been used therapeutically for atopic dermatitis. The results have been variable depending on the patient. New scientific studies from Europe have reevaluated the efficacy of phototherapy in treating atopic dermatitis.
Examining the studies published to date leads one to the conclusion that UVAI is best at reducing the severity of atopic dermatitis. The combination of UVA and UVB was reported to be more efficient at reducing the severity of atopic dermatitis than UVB alone. The clinical results with UVAI therapy are reported to be superior to results with the combination of UVA and UVB. These results suggest that suppressing the immune system can reduce the severity of the disease, but that other factors also may play an important role.
Psoriasis is an inherited inflammatory disease of the skin characterized by chronic red plaques particularly on the elbows and knees. About 1 percent to 2 percent of the population in industrialized countries will suffer from this disease, but the percentage varies according to race and ethnic group.
A variety of immunological mechanisms are known to play a major role in the outbreak of psoriasis. Because psoriasis is immunologically based, one would expect agents that suppress the immune system to control the disease. This is generally true. Although ultraviolet radiation occasionally provokes psoriasis, UVB radiation is normally beneficial. After phototherapy treatment to control the disease, continued maintenance phototherapy usually is successful in managing the disease. There probably are individuals who control their psoriasis by visiting their favorite tanning bed on a regular basis.
Very large doses of UVA have proven to be of little value in controlling psoriasis unless psoralens are included in the therapy (PUVA therapy). PUVA therapy has been extremely successful in controlling psoriasis, but increases the risk of squamous cell cancer, basal cell cancer and melanoma, as reviewed in the July 1997 issue of LOOKING FIT.
Localized scleroderma is a condition of the skin in which fibrotic lesions lead to muscle atrophy and disfigurement. This condition can lead to significant discomfort and loss of mobility. Recent evidence presented in the Journal of the American Academy of Dermatology indicates that high doses of UVAI therapy reduced the size of sclerotic plaques, decreased skin thickness and increased elasticity. In four of 10 patients, complete clearance was obtained. None of the patients experienced further improvement after phototherapy ceased. In the three months after phototherapy, only one patient experienced a partial relapse.
The ability of ultraviolet radiation to reduce the severity of psoriasis, atopic dermatitis and localized scleroderma represents an opportunity for tanning salons to join with dermatologists in a common goal. Other therapeutic opportunities exist for those willing to initiate a dialogue with dermatologists. Visit your local dermatologist to explain your salon's capabilities and invite your dermatologist to visit your salon.
Explain that your salon is a clean establishment where patients could receive whole body UV irradiation on a regular basis. Further explain that you follow all federal and state regulations and be prepared to discuss your pricing schedules and your hours of operation. Make your dermatologist comfortable with your business so he or she can, if they choose, refer patients confidently.
Remember that you're not a physician and you must not recommend UV radiation to patients suffering with a skin condition. Only a physician can do that. Rather, you would like the physician to refer phototherapy patients to your salon once he or she has deemed it appropriate. Your dermatologist will determine if and when their patient will receive a recommendation for your salon. Working with your local dermatologist can enhance your business and improve the relationship between the tanning industry and your local dermatologist.