7/29/2019 Ultraviolet Light Treatment

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Ultraviolet Light Treatment. If ultraviolet-induced peeling of the skin is of value in

acne vulgaris, it is when comedones are profuse and when there are superficial

acutely inflamed papules and nodules.

In ultraviolet therapy pronounced local effects are desirable. Each exposure

should produce marked erythema, which will be followed by a fine dry exfoliationof the epidermis. Before any treatment is given, the patient should be informed

of the inevitable erythema and carefully acquainted with its duration and the

subsequent peeling. The dose given is governed somewhat by the patient's

acquiescence to the concomitant discomforts.

At the time of treatment the eyes are shielded with goggles or, better yet, water-

moistened pledgets of cotton. Ultraviolet is usually given at a fixed distance such

as 30 inches, and the treatment time is gradually increased in successive

treatments. Each exposure should be long enough to produce erythema of the

skin.

X-ray Therapy. Because of the efficacy of oral antibiotics, retinoids, and

intralesional triamcinolone acetonide, x-ray treatment of acne is only rarely

used. Because of the general disrepute into which x-ray therapy has fallen, x-ray

therapy is now given only in extremely severe cases of cystic acne in men and

women in their twenties or older in whom all other methods, including oral

prednisone or triamcinolone acetonide intramuscularly, and Accutane orally,

have failed. The patient should be completely aware of the alleged hazards of x-

ray therapy that are being publicized today. For the technique of x-ray therapy

for acne, reference should be made to the seventh edition of this book (p. 259).

Scar Removal. After acne vulgaris has cleared, particularly the indurated and

cystic types, profuse pitted scarring may be an unfortunate disfigurement.

Although there is no method by which all scars may be removed, several means

are used to relieve scarring.

Derrnabrasion. Also known as skin planing, this is a useful and effective method

for removing or improving postacne scars. It is done with rotating motor-driven

steel wire brushes or diamond fraises. The eyes are protected with gauze pads

during the spraying of the refrigerant. An area of about 13 sq cm is frozen with

an aerosol spray of fluorethyl or dichlorotetrafluoroethane such as Frigiderm.

Immediately after the freezing, the eye pads and other gauze pads are removed

from around the treatment site to avoid entanglement with the high-speed

rotating brush. The frozen skin is then removed with long even strokes of the

brush. As soon as thawing occurs, the area is refrozen if more dermabrasion is

intended at the site. Moderate bleeding is mopped with sponges, and the next

area is treated similarly. When the treatment is completed, the bleeding is

stopped by pads in about 15 minutes. Nonadherent dressing pads (TeIfa pads)

are placed on the wound and then bandaged.