INFOGRAPHICPSORIASIS

Phototherapy for Psoriasis

May 05, 2023
WHAT IS PHOTOTHERAPY? Phototherapy is also known as light therapy. It uses a specialized artificial light to treat psoriasis—typically, under medical supervision at the dermatologist’s office. Benefits of Phototherapy for Psoriasis ● It slows down the overproduction of skin cells. ● It suppresses an overly active immune system. ● It reduces inflammation and itch. TYPES OF PHOTOTHERAPY UVB (Ultraviolet light B) Narrowband UVB lamps and bulbs release a narrow range of UV light between 311 and 313 nanometers (nm). [Inset:] For plaque or guttate psoriasis Broadband UVB emits broader wavelengths of light between 270 and 390 nm. [Inset:] For plaque psoriasis Narrowband UVB is the most common form of phototherapy. It generally works to clear psoriasis faster, produce longer periods of remission, and require fewer weekly treatments than broadband UVB. Targeted UVB Targeted UVB light therapy may be delivered using a device, called an excimer laser. The system emits UVB light at 308 nm. [Inset:] For small areas of the body, like the scalp, feet, and hands Targeted UVB can clear the skin fast and exposes the body to fewer UV rays than a full-body unit does, meaning there’s lower risk of side effects. PUVA (Psoralen plus UVA) PUVA is a two-step treatment. 1. Psoralen, a natural compound that makes the skin more sensitive to light is applied to the skin or taken orally. 2. The skin is then exposed to UVA light, which penetrates the skin deeply. It could be a whole body UVA or localized UVA using a smaller hand or foot unit, depending on the area of skin involved. [Inset:] For people with severe psoriasis who haven’t responded to other treatments Over 70% of people who were treated with oral PUVA achieved a 75% or higher improvement in their psoriasis severity, in one study. Combination light therapy Phototherapy may be more effective when combined with topical treatments, like coal tar or dithranol cream, or oral medications like apremilast or methotrexate. CAN I DIY PHOTOTHERAPY? Don’t Use a Tanning Bed Artificial tanning beds are different from phototherapy units. They emit mostly UVA light, not UVB, and they’re considered too risky. Using tanning beds and sunlamps increases the risk of skin cancer by 59%. Just one indoor tanning session can increase a person’s risk of melanoma by 20%, squamous cell carcinoma by 67%, and basal cell carcinoma by 29%. These are all forms of skin cancer. UVA radiation can also damage both the skin and eyes and cause premature aging. Get Natural Sun Carefully The sun emits infrared light (heat), visible light, and UV light (including UVA, UVB, and UVC), and it can help psoriasis the same way phototherapy treatments do. But be careful. • Limit your time in the sun to 30 minutes or less of midday sun per day. That’s between the hours of 11 a.m. and 2 p.m. In the summer months, keep your time in the sun shorter than you do in the winter months. • Talk to your doctor. Sun exposure isn’t recommended for everyone, and some psoriasis treatments, like tazarotene and coal tar, can increase the risk of sunburn. Consider At-Home Phototherapy In-home UVB phototherapy units are available by prescription. Administering the treatment to yourself at home can be cheaper and more convenient. One trial compared in-office and at-home phototherapy, and found that they’re equally effective and have similar side effects. HOW MUCH DOES PHOTOTHERAPY COST? $1,400 to $4,000 per year: The estimated cost of phototherapy when you factor in monitoring and office visit costs. $5,000 for 3 years: The estimated cost of at-home phototherapy, according to a small study. Many private health insurance, Medicaid, and Medicare policies cover in-office treatments, but at-home treatments are less likely to be covered. IS PHOTOTHERAPY RIGHT FOR ME? Phototherapy is a time-consuming treatment, usually involving visits to the doctor’s office 1 to 3 times a week for several weeks to months. So it might not be ideal for those who have lots of everyday commitments, such as work and family. At least 20 phototherapy sessions are required for the best results, according to a study. IS PHOTOTHERAPY SAFE? Phototherapy is considered safe for children, pregnant and breastfeeding women, and people who have a weakened immune system, cancer, or an ongoing infection. There are also no drug interactions. Possible Side Effects of Phototherapy… ● Dry skin ● Itching ● Blistering burns (but this is rare) ● Increased risk of cold sores, if you’re prone to them ● Psoralens can cause headaches, nausea, and vomiting. … and how to avoid them ● Moisturize your skin with a lipid-replenishing moisturizer right after treatment. ● Apply sunscreen to your lips before treatment. ● Avoid natural sunlight or wear sun-protective clothing when outdoors on the day of treatment. ● Avoid exposure to sunlight after PUVA therapy. During phototherapy, you’ll wear special glasses to protect your eyes. Sensitive parts of the body that aren't affected by psoriasis, such as the face or genitals, should be covered or protected with SPF 50+ sunscreen. SOURCES American Academy of Dermatology, “Psoriasis Treatment: Phototherapy.” Beyer, V., et al. (2010) Recent Trends in Systemic Psoriasis Treatment Costs. JAMA Dermatology. Boniol M, Autier P, Boyle P, Gandini S. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012 Jul 24;345:e4757. Chen, X., et al. (2013) Narrow-band ultraviolet B phototherapy versus broad-band ultraviolet B or psoralen-ultraviolet A photochemotherapy for psoriasis. Cochrane Database Systematic Review. Hyde, K., et al. (2018) Psoriasis Treatment Cost Comparison: Biologics Versus Home Phototherapy. The American Journal of Pharmacy Benefits. InformedHealth.org (2017) Does light therapy (phototherapy) help reduce psoriasis symptoms? Inzinger, M., et al. (2011) Efficacy of psoralen plus ultraviolet A therapy vs. biologics in moderate to severe chronic plaque psoriasis: retrospective data analysis of a patient registry. The British Journal of Dermatology. Koek, Mayke B. G., et al. (2009) Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). British Medical Journal. National Psoriasis Foundation, “Phototherapy.” Singh, Rasnik K., et al. (2016) The Patient’s Guide to Psoriasis Treatment. Part 1: UVB Phototherapy. Dermatology and Therapy. Wehner MR, Shive ML, Chren MM, Han J, Qureshi AA, Linos E. (2012) Indoor tanning and non-melanoma skin cancer: systematic review and meta-analysis. BMJ. World Health Organization, “More can be done to restrict sunbeds to prevent increasing rates of skin cancer.” 2017.