Dermatology Weekly

Dr. John Koo talks with Dr. Vincent DeLeo about the three main benefits of phototherapy, including its accessibility, safety profile, and wide range of effectiveness. Some physicians may think phototherapy is obsolete, but it continues to be a valuable tool in the dermatologist’s armamentarium. Dr. Koo also provides various clinical scenarios in which phototherapy may be the best treatment option for patients.

We also bring you the latest in dermatology news and research:

AAD, NPF update use of phototherapy for psoriasis

The latest guidelines on psoriasis care includes pros and cons; emphasize patient choice.

Sasha D. Jaquez, PhD, says a psychology consult for children’s skin issues can boost adherence, wellness

Clinicians should pay attention to nonverbal cues and steer clear of scare tactics to change a child’s behavior.

Trained interpreters essential for treating non–English-speaking patients

Even in a private office setting, failure to engage a trained translator is discouraged.

Things you will learn in this episode: 

• Phototherapy is universally accessible to millions of patients. Many payers prefer that patients try phototherapy before approving treatment with biologic agents.
• Because phototherapy is purely an external treatment, systemic safety is among its key advantages, particularly in elderly patients, those with active or history of recent cancer, and immunosuppressed populations in whom biologics and other systemic agents are not advised.
• There is no convincing evidence that UVB phototherapy increases skin cancer risk in any patient population.
• Psoralen plus UVA (PUVA) phototherapy has been shown to increase the risk of squamous cell carcinoma in fair-skinned white patients, but this risk has not been seen in nonwhite patients and has been associated only with systemic PUVA, not bath PUVA.
• Unlike biologics, which target specific molecules to treat individual conditions, phototherapy is a nontargeted treatment with wide effectiveness for many skin conditions. Because the broad-spectrum efficacy is nontargeted, both UVB and PUVA are usable for many different conditions that have nothing to do with one another, reported Dr. Koo. Narrowband UVB was designed to treat psoriasis but also works well for atopic dermatitis, generalized pruritus, vitiligo, urticaria, and seborrheic dermatitis. Psoralen plus UVA can effectively treat up to 50 different conditions, including psoriasis, atopic dermatitis, cutaneous lymphoma, mycosis fungoides, scleroderma, lymphomatoid papulosis, lichen planus, graft-versus-host disease, and alopecia areata.
• The biggest disadvantage of phototherapy is that treatment may not be convenient for patients. It can take up to 3 months to clear the skin, with patients ideally being treated three times weekly.
• Proper training and education of patients is critical for safe use of home UVB. “In our practice,” Dr. Koo explains, “we insist that nobody gets home UVB unless they spend some good amount of time where our professional phototherapy nurses or other staff can attest to the fact that the patient knows how to do it right.”
• Dermatology trainees aren’t always exposed to phototherapy during residency. Dermatology residents should get involved with phototherapy during their training, and those who have already graduated may choose to seek additional training through the National Psoriasis Foundation or by observing another academic or private practitioner.
• From a financial perspective, phototherapy can be well reimbursed.

Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (University of Southern California, Los Angeles)

Guest: John Koo, MD (University of California, San Francisco)

Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie.

Dr.  Jaquez is a pediatric psychologist with Dell Children’s Medical Center of Central Texas, Austin.

You can find more of our podcasts at http://www.mdedge.com/podcasts     

Email the show: podcasts@mdedge.com

Interact with us on Twitter: @MDedgeDerm