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Relevance of Phototherapy in Dermatology Practice
The relevance of phototherapy in current dermatology practice was discussed at the 2018 Dermcoll, the 51st Annual Scientific Meeting of the Australasian College of Dermatologists, which was held in May on the Gold Coast, Queensland.
Dr Monisha Gupta summarised and reviewed recent literature on current indications, mechanism of action, safety and recommended protocols regarding phototherapy for dermatological conditions.
Her presentation explained that, although PUVA therapy has been little used for psoriasis since the introduction of biological agents, the efficacy of PUVA is similar to the biological agents with PASI90 for PUVA of around 60 per cent, which is better than ustekinumab and about the same as infliximab.
UVB is also effective in psoriasis and shows the same response with a subsequent course, which is not the same for biological agents. There are now LED (light-emitting diode) UVB light sources and
digital systems where UVB can be confined to individual plaques. This saves uninvolved skin being exposed to UVB, but for patients with widespread disease, it may take significantly longer than whole-body UVB.
UVB works well if combined with biological agents and has been shown to be synergistic when used with
etanercept and potentially with other biological agents. Studies have not shown an increase in skin cancer with narrow-band UVB, but if multiple or prolonged courses are given, it remains a theoretical risk.
Dr Gupta also explained that there are social benefits of office UVB with staff interactions and psychological support. There are home-based phototherapy machines that are safe and effective, but there are concerns with lack of supervision and potential for the patient to overuse them.
Gupta, M. Phototherapy – relevance in current dermatology practice. Dermatology Research Review. Issue 48 – 2018. Page 1.
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