The NPF reports: “Psoriasis often appears between the ages of 15 and 25, but can develop at any age.”

Psoriasis is a chronic autoimmune disease that appears on the skin.  It is not contagious.  Psoriasis occurs when the immune system sends out faulty signals that speed up the regeneration cycle of skin cells.  The most common form, plaque psoriasis, usually appears as thick, raised, red, scaly patches.  According to the National Institutes of Health, as many as 7.5 million Americans have psoriasis.

http://health.nih.gov/topic/Psoriasis
http://www.niams.nih.gov/Health_Info/Psoriasis/psoriasis_ff.asp
http://www.niams.nih.gov/Portal_en_espanol/default.asp    (en español)
 

The NPF states: “At least half of all the people who have psoriasis have it on their scalp. Scalp psoriasis can be from very mild, with slight, fine scaling to very severe with thick, crusted plaques covering the entire scalp. Psoriasis can extend beyond the hairline onto the forehead, the back of the neck and around the ears.

Other skin disorders, such as seborrheic dermatitis, may look similar to psoriasis. However, scalp psoriasis appears powdery with a silvery sheen, while seborrheic dermatitis appears yellowish and greasy.”

A report from the US Department of Health, Education and Welfare reported psoriasis was found “slightly more frequently among males (6.3 per 1,000) than females (5.3 per 1.000)…” and “…lowest among children 6-11 years and adults 18-44 year of age (less than 2 per 1,000), and highest among adults 45-74 years (11-12 per 1,000).”

NPF reports that as many as 7.5 million Americans, or approximately 2.2% of the population, have psoriasis.  Psoriasis prevalence in African Americans is 1.3 percent compared to 2.5 percent of Caucasians. (Gelfand JM, Stern RS, Nijsten T, Feldman SR, Thomas J, Kist J, Rolstad T, Margolis DJ. The prevalence of psoriasis in African Americans: results from a population-based study. J Am Acad Dermatol. 2005 Jan; 52(1):23-6.)

Phototherapy is the use of ultraviolet (UV) light to treat conditions like psoriasis. While this light occurs naturally as a component of sunlight, it can also be produced artificially with lamps that deliver controlled doses. The treatment can consist of UV light in the ultraviolet A (UVA), Broadband ultraviolet B (BB UVB), or Narrowband ultraviolet B (NB UVB) wavelengths.

Ultraviolet (UV) light is part of the overall light spectrum.  UV has shorter wavelengths than visible light and there are different spectral bands within the UV light spectrum:

• Ultraviolet A [UVA] is the light between 320 and 380 nanometers
• Ultraviolet B [UVB] is the light between 280 and 320 nanometers.
• Ultraviolet C [UVC] is the light between 190 and 280 nanometers.

UVA and UVB light are used to control skin conditions such as the abnormal regeneration rates of normal skin cells that are associated with psoriasis.
 

UVA for psoriasis is most commonly used with the drug psoralen (a photosensitizing agent) in PUVA (Psoralen + UVA) therapy. Without psoralen, UVA’s efficiency is very low compared to UVB.

UVB is very effective in the treatment of psoriasis. It has been used for decades and does not require photosensitizing medications to produce effects. UVB is about 1,000 times more effective than UVA (without psoralen) in treating psoriasis.

Phototherapy has been shown to be extremely safe and effective in controlling psoriasis. You and your physician will need to discuss how to use UVB light to keep your skin and scalp in remission with minimal side effects. People who undergo phototherapy should visit their dermatologist at regular intervals (every 6 months or as directed by your physician) for a complete skin examination.

Studies have shown that people who receive UVB phototherapy have not demonstrated an increased rate of skin cancer compared to the general population.  A 2009 paper titled, “Treatments for psoriasis and the risk of malignancy” by Rita V. Patel, DA, Lily N. Clark, MD, Mark Lebwohl, MD, and Jeffrey M Weinberg, MD stated: “Review of studies on UVB, both Narrowband and Broadband, do not indicate any increased risk of non-melanoma skin cancer or melanoma.”

However, remember that visits with your dermatologist are important both for your psoriasis and for regular skin checks. These visits should be every six months, or as recommended by your doctor.

Based on our experience, patients do not feel pain or discomfort during phototherapy treatment sessions with Levia®. A few patients may experience a warm sensation, similar to mild sunburn, at the treated site some time after treatment. No pain medication is considered necessary during treatment.  Slight discomfort is possible if high doses are used, if you feel discomfort related to treatment or are uncertain about your reaction, please consult your physician.

You will probably not see visible results after the initial 1-4 treatments -- it is imperative that you follow your prescribed treatment and do not over expose or skip an area.  Each patient is unique so results will vary.  Individuals with mild to moderate cases of psoriasis can often obtain relief after just four to ten treatment sessions. Generally, itching lessens after three to six sessions.

You should continue your treatments until all prescribed sessions are completed or until your physician recommends you stop your treatments. Contact your physician when your course of treatment is complete for maintenance treatments.

Each patient is unique so results will vary. Relief can last for an extended period and regular maintenance treatments will prolong it.  Consult with your physician for a maintenance program typically requiring once a week phototherapy treatments to prolong clearing.

Levia® is a FDA cleared device specifically designed to provide phototherapy in the home under the direction of a physician.  It provides two unique ultraviolet light beam delivery attachments, LiteBrush™ and LiteSpot™, which enable the patient to target the precise location of their psoriatic spots.  By enabling this treatment at home, Levia delivers results and saves time, eliminating the numerous trips required to be treated at a medical office. A major recent study¹ reported, “Ultraviolet B phototherapy administered at home is equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting. Furthermore, ultraviolet B phototherapy at home resulted in a lower burden of treatment and led to greater patients’ satisfaction.”

1 Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomized controlled non-inferiority trial (PLUTO study); Mayke B G Koek, Erik Buskens, Huib van Weelden, Paul H A Steegmans, Carla A F M Bruijnzeel-Koomen and Vigfús Sigurdsson; BMC Medical Research Methodology 2006, 6:39; BMJ 2009;338:b1542

Personal Targeted Phototherapy™, or PTP, is the name of the therapy delivered by Levia®.  Levia enables your physician to customize the energy of the UVB light delivered, the adjustment of energy between sessions, the amount of time between sessions, and the total number of sessions required to create a personalized treatment regimen for you.  By providing two unique ultraviolet light beam delivery attachments, LiteBrush™ and LiteSpot™, you can target the UVB light to the precise location of the psoriatic spots and minimize the exposure of uninvolved skin.  The patented design of the LiteBrush delivers phototherapy directly to the scalp or other hair bearing areas, previously very difficult to treat effectively with other scalp psoriasis therapies. Levia provides Personal Targeted Phototherapy in the privacy and comfort of your home.

UVB - Select™, the rated output of Levia’s proprietary light engine, is in the 300-320nm spectral band.  Studies^{2, 3} have shown that this is the most therapeutically useful light in the treatment of psoriasis and is similar in effectiveness to Narrowband UVB (311-315nm).

The elimination of the 290-300nm component of Broadband (290-320) UVB reduces the rays which primarily cause Erythema (redness of the skin). UVB-Select, therefore, allows delivery of stronger doses (multiple MEDs) to psoriatic plaques while minimizing the effect on surrounding uninvolved skin.

2. Parrish J, Jaenicke k (1981) Action spectrum for phototherapy of psoriasis. J Invest Dermatol 76:359-62
3. Kirke S, Lowder S, Lloyd J, Diffey B, Matthews J, and Farr P (2007) A Randomized Comparison of Selective Brandband UVB and Narrowband UVB in the Treatment of Psoriasis, J Invest Dermatol 127:1641-1646
 

Yes, absolutely. As with all phototherapy devices, exposure to UV light, whether it is from the sun or from devices like Levia®, requires eye protection.  Protective eyewear is included with each new Levia purchased.  In addition, we offer medical grade protective eyewear for sale on our website if you need a replacement, or if you have someone helping you with your treatment.

Use of UV resistant, opaque Nitrile gloves to reduce UVB exposure to the hands during treatment is also recommended. 

Patients are strongly advised to follow the treatment guidelines and treatment sessions prescribed by their physician and to study the Levia® Instruction Manual carefully.  Since UVB treatment affects skin cells at the dermal layer and maturity of keratinocytes may take 3-6 weeks, it can take several sessions before initial results are observed.  It is also important to complete the entire number of treatment sessions prescribed by your physician for best results.  Always wear eyewear with UV protection and gloves during treatment.  Please call our Customer Service department with any questions. (800) 8-LERNER (800-853-7637)

Are there specific steps I can take to maximize my Personal Targeted Phototherapy™ (PTP) results with Levia®?
As previously stated, patients are strongly advised to follow the treatment guidelines and complete the treatment sessions prescribed by their physician.  In addition, the following steps are recommended:

• For patients that have scaling associated with their psoriasis, a Salicylic Acid Shampoo (UVBcare 1 Shampoo) should be used on the affected area the day before Levia.  This should be done at least 12 hours prior to treatment.
• Immediately prior to treatment, Levia® Index-Matched Mineral Oil (UVBcare 2 Treatment Oil) should be applied to the affected areas. A thin film over the skin and scale provides better coupling of light and deeper penetration.
• After treating your scalp, wash the area with a tar based shampoo (UVBcare 3 Scalp). Do not use tar based shampoo within 24 hours before your next treatment session.
• After treating your skin, wash the area and apply a soothing moisturizing lotion (UVBcare 3 Skin).
   

Ultraviolet (UVB) phototherapy is generally very effective when used alone.  However, in certain cases, the use of phototherapy and another modality in combination may improve clearing and remission times or may extend the “holiday” between courses of another modality.  This subject should be discussed with your physician.

UVB phototherapy may produce a reaction similar to natural sunlight.  The area treated may tan due to the absorbed UVB wavelengths just as your skin would tan with sunlight.  However, Personal Targeted Phototherapy™ reduces the exposure of the uninvolved skin surrounding the treatment area to minimize change in skin color.

To produce results, UVB phototherapy requires the delivery of a specific amount of light energy (dose).  Most types of phototherapy systems deliver unfocused light.  Because they expose a larger portion of the skin to UV light, they must deliver it with lower overall intensity to avoid over-treating uninvolved skin.  Therefore, this requires a longer treatment time to receive a therapeutic dose on involved skin.

The Levia LiteBrushTM and LiteSpotTM attachments, allow you to target the UVB light directly and precisely to the affected areas of the skin.  This means that Levia® can deliver a higher intensity of light.  By targeting the beam and increasing its intensity, Levia can safely deliver the therapeutic treatment dose in less time. 

The UVB light from most home phototherapy devices is within the same spectral band as the light emitted from Levia® (see UVB - Select FAQ).  A major difference, however, is the method of light delivery.  Panels and booths cannot precisely target the light where the psoriasis spot is located. A way to overcome this problem is to mask the adjacent uninvolved skin in order to protect it from unnecessary exposure to UVB light.

Whole body phototherapy is paced by the level of light that is tolerated by uninvolved skin. Targeted phototherapy directs the light exactly where it is needed and the levels are adjusted based on the tolerance or the affected area. Generally, affected areas and thick plaque can tolerate more light. By adjusting the level of energy delivered Levia optimizes the dose based on the increasing tolerance of the affected area, and is not slowed down by the lower tolerance of uninvolved skin. Levia targets the UVB light directly to affected areas of skin and scalp.  For areas with hair, the beam is delivered through the quartz fiber-optic “bristles” of the LiteBrushTM, right on to the scalp (bypassing obstructing hair).  For areas without hair, the LiteSpot™ concentrates a 3cm² beam of light on to the affected areas minimizing exposure to healthy, uninvolved skin.
 

No photochemical agents are required with Levia® and UVB phototherapy in general.

We recommend pre-treatment reduction of psoriatic scale by washing or wiping with compresses saturated with salicylic acid.  Shampoos that contain salicylic acid (UVBcare 1 Shampoo) are useful for pre - treatment of scalp psoriasis as they may help to reduce and soften scales. Removal of loose, excess scale through gentle washing permits increased penetration of UVB light during your treatment session.

To improve UVB light transmission, fragrance-free mineral oil (UVBcare 2 Treatment Oil) should be applied to the affected area prior to treatment. One should avoid oil with fragrance because the fragrance will absorb UVB light.  Mineral oil should be used on both the scalp and affected skin areas prior to treatment.

Lerner Medical offers Index Matched Mineral Oil (UVBcare 2 Treatment Oil), Salicylic Acid Shampoo (UVBcare 1 Shampoo), Tar Shampoo (UVBcare 3 Scalp), and soothing skin moisturizers (UVBcare 3 Skin), for sale on this website. 

Yes, Levia® is covered by a 12-month limited warranty. For warranty details, please refer to the Levia Instruction Manual or contact our Customer Service Department. (800) 8-LERNER (800-853-7637)

Levia® has been specifically designed for personal home use under the direction of a physician and requires a prescription for use. You will also need to learn how to use Levia.  We have designed it to be easy to use but we strongly advise that you read the Levia Instruction Manual and consult with your physician.

We are committed to providing all required support through our Customer Service and Nurse Educator Departments [(800) 8-LERNER (800-853-7637)] to ensure that users of Levia have the best possible treatment experience.  We look forward to establishing a close relationship with Levia users. 

Many insurance carriers reimburse treatment for home based phototherapy devices as durable medical equipment (DME).  If your insurance plan includes DME coverage, it should approve payment for Levia®.  Consult your insurance provider for additional information or call our Customer Service department for assistance.  (800) 8-LERNER (800-853-7637)

Yes, absolutely.  We have trained personnel who will be very pleased to assist you with your insurance claim. We will need some basic information about you, your insurance company, and your physician.  Consult the insurance reimbursement section of this website for additional information or call our Customer Service Department for assistance.  (800) 8-LERNER (800-853-7637)

Yes, we have customer service representatives who are very willing to help with your questions about insurance reimbursement and to work with your insurance company to determine coverage.  In most cases, insurance companies consider home based phototherapy treatment devices as durable medical equipment (DME).  Check with your insurance company to see if your plan offers reimbursement for DME.

Reimbursement processing is usually initiated by a Letter of Medical Necessity (LOMN) from your physician.  We offer a suggested format for a LOMN which your physician may wish to reference (See LOMN).

In addition the NPF offers sample letters for healthcare professionals to help with insurance carriers: www.psoriasis.org