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.