Articles/Resources
Cline A, Collins A , Feldman S, ET AL.
Volume 25 Number 3| March 2019| 25(3): 3
Adherence to treatment for chronic diseases is a global problem
with adherence estimated at 50% by the World Health Organization
(WHO). The extent of the problem has led to a conclusion that
increasing the effectiveness of adherence interventions may have
a far greater impact on the health of the population than any
improvement in specific medical treatments.
Cline A, Collins A, Feldman S, ET AL.
Volume 24 Number 2| February 2019| 24(2):4
Phototherapy is safe, effective, relatively low-cost,
cost-effective, and compatible with other therapeutics for
psoriasis. However, use of Ultraviolet B (UVB) phototherapy in
the office setting can be challenging for patients.
Dillon JP, Ford C, Hynan LS, Pandya AG.
Photodermatol Photoimmunol Photomed. 2017;33:282–283.
Narrowband ultraviolet B (NB-UVB) phototherapy is an effective
treatment for vitiligo, resulting in up to 75% repigmentation in
9 months; however, compliance is often poor due to the economic
burden and inconvenience associated with this form of therapy.
Home phototherapy has been shown to be an effective treatment
for a variety of skin conditions, including vitiligo. Despite
this evidence, home phototherapy for vitiligo is considered
experimental and investigational by health insurance providers.
We conducted a comparative study of patients receiving in-office
or home phototherapy for vitiligo.
Cardwell L, Feldman S, Hyde K, et al.
Am J Pharm Benefits. 2018;10(1):18-21
The economic burden of psoriasis is substantial. It is important
to consider the costs to the healthcare system over a patient’s
lifetime when they start biologics or home phototherapy.
Phototherapy is an effective and economical option for the
treatment of moderate to severe plaque psoriasis.
Darne S, Leech SN, Taylor AEM.
Br J Dermatol. 2014;170(1):150-6.
Atopic dermatitis can usually be controlled with appropriate
skin care and topical steroids or topical calcineurin
inhibitors. However, more severe disease can disrupt the life of
a child and his or her family. All too often, parents receive
repeated courses of systemic steroids, which can cause HPA axis
suppression and growth retardation. Systemic immunosuppressives
also have undesirable side effects. This study shows that NB-UVB
is a useful alternative for childhood atopic dermatitis, with
few side effects. Compared with alternatives, it is cost
effective and well tolerated, and, most likely, underutilized.
Patrizi A, Raone B, Ravaiolo GM.
Clin Cosmet Investig Dermatol. 2015;8:511-520.
Atopic dermatitis (AD) is a common chronic inflammatory skin
disease that can affect all age groups. Phototherapy represents
a valid second-line intervention in those cases where
non-pharmacological and topical measures have failed. This
review illustrates the main trials comparing the efficacy and
safety of the different forms of phototherapy. Clinicians mainly
refer to the indications included in the American Academy of
Dermatology psoriasis guidelines devised by Menter et al in
2010. The efficacy of phototherapy (considering all forms) in AD
has been established in adults and children, as well as for
acute (UVA1) and chronic (NB-UVB) cases. Phototherapy is
generally considered to be safe and well tolerated, with a low
but established percentage of short-term and long-term adverse
effects, with the most common being photodamage, xerosis,
erythema, actinic keratosis, sunburn, and tenderness. A
carcinogenic risk related to UV radiation has not been excluded.
Phototherapy also has some limitations related to costs,
availability, and patient compliance. In conclusion,
phototherapy is an optimal second-line treatment for AD. It can
be used as monotherapy or in combination with systemic drugs, in
particular corticosteroids.
Sidbury R, Davis DM, Cohen DE, et al.
J Am Acad Dermatol 2014;71:327-49.
Atopic dermatitis is a chronic, pruritic inflammatory dermatosis
that affects up to 25% of children and 2% to 3% of adults. This
guideline addresses important clinical questions that arise in
atopic dermatitis management and care, providing recommendations
based on the available evidence. In this third of 4 sections,
treatment of atopic dermatitis with phototherapy and systemic
immunomodulators, antimicrobials, and antihistamines is
reviewed, including indications for use and the risk-benefit
profile of each treatment option.
Lommerts JE, Njoo MD, de Rie MA, et al.
Br J Dermatol. 2017 Jan 24.
Vitiligo is a depigmenting skin disorder with an estimated
prevalence of 1%. Childhood-onset vitiligo occurs in
approximately a third of all cases. Early-onset childhood
vitiligo tends to be a more extensive and progressive type of
vitiligo. Narrowband ultraviolet-B (NB-UVB) phototherapy is an
effective treatment option in active vitiligo and leads to >75%
repigmentation in 14-75% of childhood cases. Although the
European guidelines on vitiligo state that prolonged maintenance
with NB-UVB treatment is not recommended because there is a
potential risk of photodamage, none of the patients in this
study reported melanoma or non-melanoma skin cancer. This study
suggests NB-UVB phototherapy may be a safe and effective
treatment option in childhood vitiligo and may change the
natural course of the disease. More long-term observational and
controlled studies are needed to address these important issues.
Guan STT, Theng C, Chang A.
J Am Acad Dermatol. 2015;27(4):733-735.
While phototherapy is a treatment of choice for vitiligo, it is
time consuming and generally carried out in a health
institution. This study compared home-based phototherapy with
institution-based excimer. The home based phototherapy group had
better efficacy with 72% and 50% in the group achieving good and
excellent repigmentation, respectively, in contrast to only 54%
and 36% in the excimer group. Although, the difference in
response was not statistically significant, the observed
differences in efficacy could be explained by the difference in
compliance. The patients using home-based phototherapy
demonstrated 92% adherence compared to 70% adherence in the
excimer group.
Mohammad TF, Al-Jamal M, Hamzavi IH, et al.
J Am Acad Dermatol. 2017;76(5):879-888.
Narrowband ultraviolet B light (NBUVB) is an important component
of the standard of care in vitiligo treatment. However, there
are no consistent guidelines regarding the dosing and
administration of NBUVB in vitiligo. In this study, experts in
vitiligo treatment make broad recommendations to assist
dermatologists in the treatment of vitiligo with NBUVB
phototherapy.
Farahnik B, Patel V, Beroukhim K, et al.
Psoriasis Targets and Therapy. 2016;6:105-111.
The efficacy and safety of biologic and phototherapy in treating
moderate-to-severe psoriasis is well known. However, some
patients may not respond well to biologic agents or phototherapy
on their own and may require combination therapy. Skillfully
combining a biologic agent and phototherapy may provide an
additive improvement without much increase in risks. This study
summarizes the current state of evidence for the efficacy and
safety of combining biologics with phototherapy in the treatment
of moderate-to-severe plaque psoriasis. The vast majority of
phototherapy was narrowband ultraviolet B (NBUVB) radiation.
Most cases reported enhanced improvement with combination
therapy. Serious adverse events throughout the study duration
were reported in <3% of the patients. Long-term adverse events
cannot be excluded.
Hearn RM, Kerr AC, Rahim KF, et al.
Br J Dermatol. 2008;159:931-5.
Narrow-band ultraviolet B (NB-UVB) phototherapy is a widely used
treatment. Psoralen-UVA photochemotherapy (PUVA) increases skin
cancer risk and some animal studies have raised the possibility
of an increased risk with NB-UVB. This study assessed the effect
of NB-UVB exposure treatment numbers on the risk of developing
skin cancer. No significant association between NB-UVB treatment
and BCC, SCC or melanoma. These reassuring results do not
demonstrate the early increase in skin cancers that was found
associated with PUVA treatment. However, cautious interpretation
is required as the cohort contained relatively few patients who
had a high treatment number and because the slow evolution of
skin cancers may result in a delayed incidence peak. Ongoing
risk assessment is therefore essential.
Menter A, Korman NJ, Elmets CA, et al.
J Am Acad Dermatol. 2010;62:114-35.
Psoriasis is a common, chronic, inflammatory, multisystem
disease with predominantly skin and joint manifestations
affecting approximately 2% of the population. In this fifth of 6
sections of the guidelines of care for psoriasis, we discuss the
use of ultraviolet (UV) light therapy for the treatment of
patients with psoriasis. Treatment should be tailored to meet
individual patients’ needs. We will discuss in detail the
efficacy and safety as well as offer recommendations for the use
of phototherapy, including narrowband and broadband UVB and
photochemotherapy using psoralen plus UVA, alone and in
combination with topical and systemic agents. We will also
discuss the available data for the use of the excimer laser in
the targeted treatment of psoriasis. Finally, where available,
we will summarize the available data that compare the safety and
efficacy of the different forms of UV light therapy.