Name of the Procedure:

Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B

Summary

Photochemotherapy, also known as Goeckerman treatment, involves applying tar or petrolatum to the skin, followed by exposure to ultraviolet B (UVB) light. This combined therapy is primarily used to treat severe skin conditions by reducing inflammation and slowing down the rapid growth of skin cells.

Purpose

The medical condition this procedure addresses is primarily psoriasis, which is characterized by red, scaly patches on the skin. The goal of the treatment is to reduce symptoms, achieve clearer skin, and improve the quality of life for patients suffering from chronic skin conditions.

Indications

• Severe psoriasis unresponsive to other treatments
• Chronic dermatitis
• Pityriasis rubra pilaris
• Lichen planus

Patient criteria include individuals with extensive skin involvement or those who have not responded adequately to topical treatments and oral medications.

Preparation

• Avoid using topical treatments like corticosteroids for at least 24 hours before the procedure.
• Patients may need to shower and cleanse the skin before each session.
• Any pre-existing skin infections should be treated beforehand.
• Patients should discuss any current medications with their doctor to avoid photosensitivity reactions.

Procedure Description

1. The patient's skin is thoroughly cleaned.
2. Coal tar or petrolatum is applied evenly to the affected areas.
3. The patient is exposed to UVB light in a phototherapy unit for a specific amount of time, tailored to their skin type and condition severity.
4. The treatment is typically repeated daily over several weeks.

No anesthesia or sedation is required. The primary tools used include topical agents (tar or petrolatum) and a UVB phototherapy unit.

Duration

Each session lasts between 30 minutes to one hour. The complete course of treatment usually spans several weeks, with daily sessions.

Setting

The procedure is performed in an outpatient dermatology clinic equipped with phototherapy units.

Personnel

• Dermatologist
• Nurse or phototherapy technician

Risks and Complications

Common risks:

• Skin irritation or burning
• Folliculitis (inflammation of hair follicles)

Rare risks:

• Skin cancer risk with prolonged or excessive UV exposure

Management includes adjusting the treatment regimen or stopping the therapy if severe side effects occur.

Benefits

Patients typically see a significant reduction in symptoms and clearer skin. Improvements can be noticed within a few weeks of starting treatment.

Recovery

Patients can resume normal activities immediately after each session. They should:

• Moisturize the treated skin regularly.
• Use sunscreen on exposed areas.
• Attend follow-up appointments to monitor progress and adjust treatment as needed.

Alternatives

Other treatment options include:

• Topical corticosteroids
• Systemic medications (methotrexate, biologics)
• Light therapy alone

Pros and cons:

• Topical steroids can be effective but might cause skin thinning with long-term use.
• Systemic medications can have significant side effects.
• Light therapy alone is less effective without tar or petrolatum.

Patient Experience

During the procedure, patients might experience mild warmth or tingling where the UVB light is applied. After treatment, the skin may feel dry or slightly irritated, which can be managed with moisturizers. Pain management usually isn't necessary, but any discomfort can be alleviated with over-the-counter pain relievers if needed.