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Wood's lamp - UV light for dermatologic assessment

Introduction

  • the Wood's lamp emits long wave UV light (typically in the 320–400 nm range, with a peak wavelength around 365 nm and traditionally use Wood’s glass - barium silicate with nickel oxide that blocks most visible light while transmitting UVA, but new devices usually just use 365nm LEDs) which is used to detect flourescence of skin or hair to help diagnose various conditions
  • 365 nm wavelength is energetic enough to excite many endogenous and exogenous fluorophores in skin, hair, nails, and some materials, causing them to fluoresce in visible light, yet it remains in the safer UVA range
  • it has various use cases:
    • differentiating epidermal vs dermal hyperpigmentation:
      • melanin acts as an absolute light absorber.
      • if a dark patch (like melasma) becomes significantly more prominent with sharp borders under the lamp, the pigment is superficial (epidermal).
      • if the patch remains unchanged, the pigment is settled deeper in the skin (dermal)
    • differentiating true vitiligo vs fading rash:
      • hypopigmented skin caused by scarring or poor blood flow stays dull.
      • true autoimmune vitiligo, which completely lacks pigment, glows with a stark, blinding chalk-white or blue-white outline
      • also useful for detecting ash-leaf vitiligo of tuberous sclerosis
    • differentiating acne vs Pityrosporum folliculitis:
      • red bumps on the chest or back can look identical to regular acne.
      • normal acne blocks follicles and shows minor red/orange speckles, whereas a fungal yeast overgrowth (Malassezia) will glow in broad yellow-green sheets
    • detecting tinea fungal infections
      • BUT cannot rule out a tinea infection on its own
      • common body ringworm and athlete's foot (typically caused by Trichophyton rubrum) generally show no fluorescence
      • Trichophyton tonsurans lives inside the hair shaft (endothrix) and does not fluoresce at all
    • assessing Rx success of tinea and detect potential areas for relapse
      • antifungal treatments destroy the fungi, the brightness of the fluorescence steadily diminishes
    • detecting Pseudomonas in wounds
    • detecting porphyrins in urine
    • detecting presence of dried cat urine
      • cat urine is generally highly concentrated and contains high concentrations of phosphorus and blood plasma proteins (such as albumin)
      • bright yellow or neon yellow-green fluorescence but over a long period, as the components break down, the glow slowly fades into a duller, pale white or faint yellow
      • BUT false positives due to:
        • carpet cleaners, wallpaper glue, laundry detergents (usually blinding, bright ice-blue or stark white rather than yellow), and spilled tonic water can also glow
      • thus need to check shape and smell to confirm
    • detecting scorpions at night (they are nocturnal):
      • scorpions fluoresce a vibrant, bright neon green, cyan, or blue-green colour
      • although you may need a higher wattage UV lamp for this
  • a Wood's lamp should NOT be used for corneal flouroscein staining eye examinations as:
    • 365nm is the wrong spectrum for fluorescein - you need cobalt-blue light (~450–490 nm) viewed through a yellow filter
    • 365nm thus gives much lower sensitivity for detecting corneal pathology (only ~50%)1)
    • 365nm gives unnecessary UV-A radiation to the sensitive eye - indeed in normal use of a Wood's lamp, the patient should close their eyes if near the face

Examples

Appearance normal skin variations
blue white normal skin
bright flourescent hydrated skin
purple flourescent thin dehydrated skin
light violet dehydrated skin
white spots horny layer of skin or skin dead cells
white flourescent thick corneum layer of skin
brown pigmentation / dark spots
bright yellow flourescent oily skin / comedone / milia
Appearance skin pathology
coral red flourescence erythrasma (Corynebacterium) bacterial porphyrins esp. in skin folds, arm pit, groin
yellow-green / coppery orange flourescence tinea versicolor (Malassezia) due to pityrialactone
green flourescence Monocytogenes
light blue-green flourescence tinea capitis due to Microsporum audouinii, M. canis, etc - due to the metabolite pteridine
dull blue flourescence tinea capitis due to Trichophyton schoenleinii
bright green flourescence tinea - Microsporum ferrugoid, M. woolly, M. gypseum; Pseudomonas (due to pyocyanin pigment);
dark green flourescence tinea versicolor; Pseudomonas;
bright or strong red flourescence pigmentation, melasma, coffee spots, erthropoietic protoporphyria
bright blue white flourescence vitiligo, albinism due to total melanin loss and dermal collage auto-flouresceses
Appearance urine pathology
bright pink-orange flourescence porphyria tarda
red flourescence congenital porphyria
woodslamp.txt · Last modified: 2026/07/31 06:02 by gary1

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