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Home Phototherapy: An Overlooked Option for Psoriasis

Patients were happy with home units for psoriasis phototherapy.

Phototherapy is safe and effective for treating psoriasis. Patients usually obtain light treatment in doctors’ offices or hospital settings, but units are also available for home use. Dermatologists have considered home phototherapy devices to not work as well as office units and to have more adverse effects. These investigators compared home and hospital outpatient administration of 311-nm narrowband UVB treatments to 196 patients with mild to severe psoriasis.

Topical steroids and vitamin D derivatives were allowed during the study and were more commonly taken by outpatient-treated participants. PASI scores and other parameters of efficacy were equivalent in the two groups, as was the cumulative dose of ultraviolet light. After 46 treatments, 41.7% of hospital-based phototherapy recipients achieved a PASI 75, compared with 40.7% of home phototherapy recipients. Quality-of-life measures were also similar between groups. Adverse effect rates were comparable, although severe erythema was more frequent in the home-treatment group, and blistering was more likely in outpatient-treated participants. The burden of treatment was significantly lower, and patients were happier, with treatments delivered in the home.

Comment: Ultraviolet light is a long-enduring therapeutic modality for the treatment of psoriasis, but phototherapy is inconvenient because patients must travel to receive treatment. Insurance reimbursement issues have led to fewer and fewer ultraviolet light units in dermatologists’ offices. Most home phototherapy units were not considered by dermatologists to be very effective, but the introduction of narrowband UVB has changed that. Narrowband UVB is almost as effective as PUVA, without the need for photosensitizing medications. Home phototherapy units are convenient for patients and certainly much less expensive than other psoriasis treatment modalities, such as biologics.

— Craig A. Elmets, MD

Published in Journal Watch Dermatology June 12, 2009

Citation(s):

Koek MBG et al. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: Pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ 2009 May 7; 338:b1542. (http://dx.doi.org/10.1136/bmj.b1542)

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• Medline abstract (Free)

Anstey A. Home UVB phototherapy for psoriasis. BMJ 2009 May 7; 338:b607. (http://dx.doi.org/10.1136/bmj.b607)

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• Medline abstract (Free)

Reader Remarks:

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• phototherapy & squamous cell CA
  Kenneth B Gordon, 13 Jun 2009 8:35 PM EST
  Further studies at Mass General Hospital indicates phototherapy with UV has resulted in lower extremety squamous cell CA occurring many... [more]
• PUVA and psoriasis
  Kenneth B. Gordon, 13 Jun 2009 7:06 AM EST
  Dr. Thomas Fitzpatrick's studies at the Mass General Hospital showed a late sequella of psoralen ultraviolet treatments for psoriasis.
  
  This... [more]