Feb 20, 2020
Phototherapy is a viable option for many patients with
psoriasis. Dr. George Han speaks with Dr. Jashin Wu about the
recent national guidelines from the American Academy of Dermatology
and the National Psoriasis Foundation on phototherapy, particularly
narrowband UVB. They discuss treatment advantages, potential side
effects, combination regimens, and patient reimbursement for
at-home phototherapy. “Phototherapy serves as a reasonable and
effective treatment option for [psoriasis] patients requiring more
than topical treatments but also wishing to avoid systemic
medications or if they are simply seeking an adjuvant to a failing
regimen,” advises Dr. Wu.
We also bring you the latest in dermatology news and
1. How the mutant selection window could reshape
Dr. Hilary Baldwin describes a concept in the infectious disease
literature that could help dermatologists strike a careful balance
between treatment and resistance.
2. What oral therapies work best for
Dr. Jashin Wu examines the nondevice options for treating
patients with the condition.
Things you will learn in this episode:
- Narrowband UVB is the primary type of phototherapy used in
dermatology. It acts by three major pathways: alteration of the
cytokine profile, apoptosis (programmed cell death), and UV-induced
immunosuppression of epidermal Langerhans cells.
- Phototherapy offers advantages for a wide range of patients.
“If a patient has failed topical treatment but they may not be
interested in systemic therapy -- they don’t want a biologic or
they don’t want an oral therapy --phototherapy still is a good
option for these patients. In particular, I like it for patients
with moderate disease ... between 3% and 10% body surface area,”
Dr. Wu explains.
- Phototherapy also is a good option for pregnant women who may
be concerned about potential fetal side effects associated with
most systemic agents.
- Acitretin (Soriatane)
is one of the most common agents used in combination with
phototherapy: “In theory, phototherapy could increase the risk of
skin cancer, especially if [the patient has] several hundreds of
episodes of phototherapy,” Dr. Wu notes. “Acitretin in theory may
improve the risk of skin cancer, so actually this has a protective
effect and also may reduce the number and length of phototherapy
[treatment sessions] that [are] needed.”
- It is recommended that patients undergoing phototherapy use
genital shielding to reduce the risk of skin cancers in the genital
area and wear goggles to reduce the risk of cataracts.
- Skin cancer risk in patients treated with both narrowband and
broadband UVB has been correlated with the number of treatments
received, but the risk has not shown to be significantly greater
than in the general population. “If [the patient has] had a prior
history of skin cancers, I probably wouldn’t be choosing
phototherapy as one of my first-line agents,” Dr. Wu says.
- Home phototherapy is a good option for patients who are not
able to come to the office for treatment two or three times per
week. “Sometimes the insurance carriers would actually prefer
this,” Dr. Wu explains.
- Some patients may request to stop treatment temporarily during
warmer months when they are more likely to get exposure to natural
sunlight. When resuming phototherapy, these patients will need to
repeat the induction phase before returning to a maintenance
Hosts: Nick Andrews; George Han, MD,
PhD (Icahn School of Medicine at Mount Sinai, New
York, New York)
E. Baldwin, MD (State University of New York, Brooklyn);
J. Wu, MD (Dermatology Research and Education Foundation,
Show notes by: Alicia Sonners, Melissa Sears,
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