SERVICES

We are one of New Zealand’s leading providers of narrowband UVB (NBUVB) phototherapy services, with decades of experience. We have a full body unit, and also a half body unit – suitable for treating those with claustrophobia. NBUVB uses wavelengths of 311-312nm to treat psoriasis, vitiligo, and eczema predominantly, but it can also be used to treat polymorphous light eruption, lichen planus, pityriasis lichenoides, idiopathic urticaria, lichen amyloidosis, parapsoriasis, and a variety of other conditions.

NBUVB has not been shown to increase skin cancer risk. It is considered the treatment of choice for vitiligo, and for widespread eczema and psoriasis which fail topical therapy. It is safe to use in pregnancy, but for women who might become pregnant during treatment we would recommend folic acid supplementation.

Most patients have a test strip done first (which requires visits on consecutive days) in order to determine their starting dose. Treatments are usually done 2-3 times a week, and a course of treatment could be 2 or 3 months on average (however this is quite variable – some conditions such as vitiligo might need treatment for a year or more, some patients might require 5 or 6 months to clear their condition, and a relatively small percentage go on to maintenance treatment once a fortnight once their skin is clear in order to prevent relapse).

We have appointments 3 evenings a week, Saturday mornings, as well as ‘office hours’ in order to fit phototherapy treatments into patients’ lifestyles. The therapists who provide the treatments have been intensively trained in phototherapy and undergo ongoing professional development and mentoring to ensure that this service is maintained at the highest possible standard. We audit and improve the service regularly to ensure our protocols are consistent with international guidelines, and our success rate is as good as or better than that reported by our international colleagues.

To access this service patients can see our dermatologist, or they can be referred by their dermatologist (however our dermatologist will provide supervision of the treatment).

This includes technologies such as the excimer laser, and UV light sources delivered via fibre optic cables, such as Dualight.

At Anwyl we use Dualight, which provides targeted broadband UVB (290-330nm with peak emission in the narrowband wavelengths) or broadband UVA (330-380nm with peak emission about 365nm ie in UVA1 range). There is a fibre optic cable for light delivery with a 3.62 cm2 exit aperture. For UVA one can select doses up to 5 J/cm2, and for UVB up to 3120 mJ/cm2.

There are several advantages to targeted phototherapy:          

• uninvolved areas are spared, minimising side effects such as burns, and long term risks such as skin cancer

• higher doses can be used especially with UVB treatment of psoriasis, where 5 or 6 times the minimal erythema dose can be used, rather than starting with 50% of the minimal erythema dose) - this results in a much faster treatment response

• the manoeuverable handpiece allows for difficult areas such as the ears, or armpits, to be treated.

The disadvantage is that widespread skin disease cannot be treated in this fashion - one or two large plaques (roughly equal to an A4 page in size) or multiple small plaques (roughly equal to an A5 page in size) are about the maximal size that could be treated.

Treatment is usually carried out twice a week, following phototesting to determine the starting dose.

Blue and Red Light Phototherapy is suitable for the treatment of mild to moderate acne, affecting the face, chest, or back.  It is not suitable for treating nodular or cystic acne.

Treatments are given twice a week for 4 weeks. Ideally there should be 2 or 3 days in between treatments eg Monday and Thursday or Tuesday and Saturday schedules.  Blue ( 420nm) and Red ( 615nm ) treatments are alternated, with the first treatment being a Blue light treatment. In  other words there are 4 Blue treatments and 4 Red treatments.

Each treatment lasts 20 minutes. There is no discomfort. Some people will notice slight warmth during the Red treatment. There is no swelling or peeling or redness afterwards. There is no ultraviolet in the lamps used, and so no sunburn or photoaging occurs. In fact Red Light can be used as a treatment ( photo-rejuvenation ) for sun-accelerated aging changes.

You can use normal skin care following the treatment, however we usually advise against using acne washes and gels in conjunction with light treatment.

Acne is primarily a disorder of keratinisation of the pilosebaceous ( hair follicle/sebaceous gland ) units. Bacteria called Propionibacterium acnes get trapped in the blocked pilosebaceous units and promote inflammation. P acnes produce porphyrins, which can be activated by light, which results in the bacteria being killed by their own products. Blue light works best to do this, but Red light penetrates deeper into the skin. It is likely that other mechanisms are at work also, since Red light can be beneficial in acne without altering bacterial populations.

At the completion of 4 weeks of treatment 50% of patients have a marked improvement; 8 weeks later ( without further treatment ) about 75% of patients have a marked improvement. In other words, the greatest benefit is seen 2 months after the treatment is completed. This improvement is usually maintained for a further 2 or 3 months.

There are various kinds of allergy and therefore various kinds of allergy test. The ‘patch test’ is the allergy test best suited for determining the cause of Type IV hypersensitivity reactions. Typically this sort of hypersensitivity results in delayed reactions, often of an eczematous nature, occurring one to several days after exposure to the allergen.

Patch testing involves application of test substances ( usually to the back ) on Day one, removing them and checking for reactions on Day 3, and checking for reactions again on Day 5. At Anwyl we recommend doing a further check on Day 7 or 8 as roughly 10% of reactions are missed by failing to do this late reading. A routine screen of common allergens are tested ( this varies from country to country but here we use the European Standard Series for adults, and our own Paediatric Standard Series for children ). In adults additional allergens are almost always tested, depending on their history of exposure.

Photopatch testing is carried out when the allergen in question might be a photoproduct. A photoproduct occurs when chemical A is changed into chemical B by the action of ultraviolet light. If chemical B is the allergen then one needs to apply chemical A in the patch test, and then expose the patch test site to ultraviolet light. At Anwyl Photopatch testing involves applying test substances on Day 1, phototesting ( to ensure the patient is not abnormally photosensitive ) on Day 2, reading the phototest and exposing the test substances to a measured dose of UVA light on Day 3, and reading the test sites on Day 5.

Patch testing is indicated for:

• hand eczema

• localised or generalised eczema which responds poorly to treatment

• patients with a history of metal allergy who require metal joint replacements, stents, or dental prostheses

• some cases of chronic urticaria

Contact allergic dermatitis is as common in children as it is in adults, but irritant reactions are more common in children, so the tests are more difficult to interpret.

Our dermatologist can assess your skin for skin cancer and give advice on self-checks and sun protection. We recommend most New Zealanders to check their skin a couple of times a year, and to seek a professional opinion on any spot that is changing, and any spot that looks different to all your others (an odd one out). Most suspicious lesions can be treated on site, but where treatment would be better done by a plastic surgeon or specialist dermatologic surgeon then the appropriate referral will be made.

We have facilities for photographic surveillance of moles (often referred to as ‘mole-mapping’), This involves taking photographs or your skin, region by region, and comparing photographs over time to detect changes. Photographs are stored on a secure platform with access limited to Dr Judd and our therapists who take the photos.

At Anwyl photographic surveillance is never performed as a stand- alone procedure but always accompanied by a full skin check (clinical and dermatoscopic) by a dermatologist. Photographic surveillance will not be carried out on those 18 years of age or younger.

For most patients a clinical and dermatoscopic skin check is all that is required, and photographic surveillance is best suited to those with very large numbers of moles (hundreds) or where all the moles look quite different to each other.

Dr Judd deals with all skin diseases other than rashes which occur in the paediatric age group as part of an infection such as measles or chickenpox (since these are more appropriately dealt with by a General Practitioner or Paediatrician). There are literally thousands of different skin complaints and hardly a day goes by without seeing something rare and unusual.

Dr Judd’s particular interests are in eczema, psoriasis, acne, contact allergy, vitiligo, occupational dermatoses, scabies, fungal infections, frontal fibrosing alopecia, and perioral dermatitis.

Botox (Botulinum toxin) injections for axillary hyperhidrosis (excessive sweating in the armpits) has a high success rate, and the benefits last 6-12 months. We do not use Botulinum toxin injections for sweating of the face, palms or soles, and we do not use it for the treatment of wrinkles and frown lines.

Mr Rod Studd practises general adult urology with a special interest in the management of prostate cancer and bladder cancer.