Prescribing Home Narrowband UVB Phototherapy: A Review of Current Approaches

Abstract

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.

Advances in phototherapy for psoriasis and atopic dermatitis

“…Because of its excellent safety profile, NB-UVB is generally recommended for home phototherapy. Great number of studies showed that home UVB phototherapy is safe and comparable efficacious as office-based treatment [68,69]. Although formal prescriptions are not required, before starting a home-phototherapy regime, dermatologists should determine the dosing schedule, duration of treatment and how to address the potential side effects.…”

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

“…Most importantly, PT requires frequent visits (up to three times per week) to institution-based PT centers for several months to years. This can be logistically difficult and/or financially prohibitive for certain patients, especially those who do not live near PT centers, are unable to afford transportation, or cannot secure insurance coverage for PT 49. One alternative to institution-based PT is home-based PT (HBPT).…”

“…In a 2010 study among 89 vitiligo patients receiving home- or institution-based PT, HBPT was found to be as safe as institution-based PT, illustrated by a similar occurrence of side effects between the two groups 43. Despite such advantages of HBPT, there are many challenges that have suppressed its widespread adoption 49. The following section will focus on challenges and solutions related to HBPT for patients with vitiligo.…”

“…Unfortunately, there has been no multicenter RCTs to compare institution-based versus HBPT in vitiligo 43. Smaller studies in vitiligo have yielded results consistent with PLUTO,49,56,57 but the majority of HBPT guidelines for vitiligo are based on specialist consensus36 and data from other skin diseases 11. Therefore, there remains a tremendous need for further studies.…”

“…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. All of this contributes to an overall decline in prescribing HBPT that effectively limits vitiligo treatment options, disadvantaging providers and patients alike 49,56,57…”