Home Phototherapy for Psoriasis
Wednesday, March 18, 2015
Psoriasis treatment has been revolutionized by the development
of biologics - for years a hot topic in dermatology. While costly,
the excitement for biologics has overshadowed long-standing,
lower-cost treatment options. Phototherapy is still an effective
treatment for psoriasis. However, office-based phototherapy is
inconvenient and, in the USA at least, an office-based approach may
also be more costly to the patient than taking a biologic
Phototherapy can also be administered at home. Indeed, when
monitored closely, home narrow-band ultraviolet B (UVB) is as
effective as office-based phototherapy treatments.1 Home
phototherapy is also a very low-cost way to manage extensive
psoriasis, although in the USA, the cost to the patient
may still exceed that of a biologic (particularly because of the
co-payment assistance programs offered by manufacturers of
biologics).2,3 One concern with home phototherapy is
that patients may be poorly adherent to the treatment. However, a
well-designed study with electronic monitoring of home phototherapy
found that adherence to home light treatments can be good,
particularly in the short term.4 In addition, for
patients with more severe extensive psoriasis, home UVB
phototherapy can be combined with oral acitretin.
Home phototherapy is currently underprescribed. Many doctors may
not know how to prescribe home phototherapy and many may not be
trained in how it should be used.5 Here is advice on how
to prescribe home phototherapy:
Choosing the right patient
Effective for patients with thin, extensive lesions.
May not be a good choice for:
- Palm/sole psoriasis (UVB does not penetrate very deep into
- Patients who drink heavy amounts of alcohol, as intoxication
could lead to injury from phototherapy or from falls
- People who travel frequently
Prescribing a device
Typically a 6-foot-tall narrow-band UVB device will be
prescribed (see Figure 1). Information about phototherapy suppliers
can be obtained at
or via an Internet search. Suppliers will provide detailed
instructions on how to prescribe their devices. Many suppliers
provide prescription pads that make it easy to check off key
information (which device, what type of bulb, what skin type). A
flat-panel unit or a flat panel with 'wings' is typically
prescribed (complete wrap-around units take up more space and are
Prescribing a device with a 'prescription-controlled timer' can
prevent the device from being used forever without monitoring.
Recommending a dosage schedule
The recommended dosing schedule depends on the patient's
sensitivity to UV and how they use the device (they should
typically stand 6 inches/15 cm from the device). The manufacturer
may recommend a schedule. Because of all the vagaries that impact
the dose, it may be simplest to recommend starting very slowly
(15-second initial treatment). A 5-15% increase in time with each
subsequent treatment is recommended, with the percent increase
dependent on patient skin type (patients with darker skin may
require greater increases in treatment time). Treatments can be
done as often as daily with broad-band UVB or every other day with
Patients can be monitored at intervals for improvement and for
safety. Annual follow up may be reasonable for patients who are
well controlled and are using the device only intermittently as
needed to maintain good control.
Our preference is to only prescribe home phototherapy devices
with a prescription-controlled timer. This permits only a fixed
number of treatments, assuring that monitoring can be done at
intervals, without unlimited use of the machine.
Obtaining coverage by health insurers may be difficult at times
(because of the uncommon use of these devices, insurers may be
unfamiliar with them). Phototherapy manufacturers may have staff
that will help contact insurers. Sometimes, letting the insurer
know how much they will be saving by not having the patient on a
biologic may encourage better coverage of the home phototherapy
device. In the USA, with its patchwork health insurance coverage,
many phototherapy suppliers will also be willing to work with the
patient to develop a payment plan, if necessary.
Figure 1. A typical home phototherapy device
(courtesy of National Biological Corporation).
When office-based and home phototherapy are not options, sun
exposure or even a tanning bed may be other low-cost options
suitable for some patients. As always, physicians need to use their
good judgment when planning treatment.
- Koek MB, Buskens E, van WH, Steegmans PH, Bruijnzeel-Koomen CA,
Sigurdsson V. Home versus outpatient ultraviolet B phototherapy for
mild to severe psoriasis: pragmatic multicentre randomised
controlled non-inferiority trial (PLUTO study). BMJ
- Staidle JP, Dabade TS, Feldman SR. A pharmacoeconomic analysis
of severe psoriasis therapy: a review of treatment choices and cost
efficiency. Expert Opin Pharmacother 2011;12:2041-54.
- Yentzer BA, Yelverton CB, Simpson GL, Simpson JF, Hwang W,
Balkrishnan R, et al. Paradoxical effects of cost reduction
measures in managed care systems for treatment of severe psoriasis.
Dermatol Online J 2009;15:1.
- Yentzer BA, Yelverton CB, Pearce DJ, Camacho FT, Makhzoumi Z,
Clark A, et al. Adherence to acitretin and home narrowband
ultraviolet B phototherapy in patients with psoriasis. J Am
Acad Dermatol 2008;59:577-81.
- Greist HM, Pearce DJ, Blauvelt M, Feldman SR. Resident
education: effect of the sixth national psoriasis foundation chief
residents' meeting. J Cutan Med Surg 2006;10:16-20.