Dermatology Weekly

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.

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

1. How the mutant selection window could reshape antibiotic use

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 hyperhidrosis

Dr. Jashin Wu examines the nondevice options for treating patients with the condition.

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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 regimen.

Hosts: Nick Andrews; George Han, MD, PhD (Icahn School of Medicine at Mount Sinai, New York, New York)

Guests: Hilary E. Baldwin, MD (State University of New York, Brooklyn); Jashin J. Wu, MD (Dermatology Research and Education Foundation, Irvine, California)

Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie

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