Home phototherapy in the U.K.'s National Health Service: time to reach out

Ungureanu, Sergiu; Arzpayma, P.; Edwards, Chris; Anstey, Alexander Vincent

doi:10.1111/bjd.14993

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…Two surveys in 2006 and 2017 documented that dermatologists worry about the risk of adverse reactions in patients on home phototherapy. 12,34 The main reasons were the potential use of the equipment as a tanning bed, excessive UV exposure, and the risk of side effects happening remotely from the hospital. 12 Although such fears may be unfounded, patients should be counseled on adverse effects: erythema, burning sensation, pruritus, nausea, blistering, ocular damage, theoretical risk of skin cancer, and death from accidental overexposure.…”

Section: Resultsmentioning

confidence: 99%

“…10,11 In a recent survey among British consultant dermatologists, only 61% were aware of home phototherapy, of whom 5% were prescribing it. 12 This situation mirrors the steady decline in utilization of phototherapy by dermatologists over the past 20 years and is unfortunate because feasibility studies document that self-administered phototherapy is safe, is effective, and saves health care cost. [13][14][15][16][17]…”

Section: Introductionmentioning

confidence: 96%

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Prescribing Home Narrowband UVB Phototherapy: A Review of Current Approaches

2018

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Conventional, full-body phototherapy equipment is costly and therefore patients are usually treated in dermatology centres. Such office-based therapy is often not feasible for those patients who live far away from a phototherapy centre due to lost time and wages, inability to travel because of extensive skin disease, or prohibitive travel costs. Home phototherapy has emerged as a modality that meets the needs of those patients. Our aim was to review available studies on UV sources, treatment protocols, efficacy, and safety of home phototherapy. A literature review was conducted on PubMed using the terms "home" AND "phototherapy" AND ("guide" OR "approach" OR "review" OR "protocol"). From the data extracted, narrowband UVB (311 nm) offers the best balance between safety and efficacy and is recommended for home phototherapy by most authors. Treatment is safe and possible adverse effects are related to overexposure (erythema, blistering). The usual treatment protocol was administering treatments on alternating days, including weekends, with dosing based on the patient's Fitzpatrick skin type. We also provide information on the available home phototherapy systems in Canada and their reimbursement. Home phototherapy is underused in Canada. Narrowband UVB phototherapy sources equipped with a 3-dimensional panel provides a practical and safe option.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Prescribing Home Narrowband UVB Phototherapy: A Review of Current Approaches

2018

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“…Consequently, surveys have shown that dermatologists are hesitant to prescribe HBPT for reasons ranging from the potential use of the equipment as a tanning bed to the risk of severe AEs occurring remotely from the hospital 62,63. Lack of familiarity with the robust safety profile of HBPT magnifies such fears and also raises legal concerns, given that the prescribing physician might be held liable 64.…”

Section: Challenges and Solutions For Home-based Phototherapy For Vitmentioning

confidence: 99%

<p>Home phototherapy for patients with vitiligo: challenges and solutions</p>

Smith¹,

Ly²,

Thibodeaux³

et al. 2019

CCID

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Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.

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“…3 Despite this, a subsequent survey of U.K. dermatologists identified recurring themes, in addition to identifying concerns about funding, potential for medicolegal liability and training difficulties. 6 Our early experience of home phototherapy in a small number of patients has been very successful with safe and effective outcomes as well as high levels of patient satisfaction. To obtain optimal patient outcomes and ensure robust safety, we recommend careful patient selection and training, remote but close monitoring by experienced phototherapy nurses supported by a hospital-based phototherapy team, as well as clear governance arrangements.…”

mentioning

confidence: 99%

Dr Dowling Munro: 1931-2019

Vivier

2020

Br J Dermatol

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Home phototherapy in the U.K.'s National Health Service: time to reach out

Cited by 6 publications

References 8 publications

Prescribing Home Narrowband UVB Phototherapy: A Review of Current Approaches

Prescribing Home Narrowband UVB Phototherapy: A Review of Current Approaches

<p>Home phototherapy for patients with vitiligo: challenges and solutions</p>

Dr Dowling Munro: 1931-2019

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