The 2022 British guidelines for narrowband ultraviolet B phototherapy: an absolute necessity for anyone administering or prescribing phototherapy

Abstract

The British Association of Dermatologists (BAD) and British Photodermatology Group (BPG) guidelines 1 have been developed by a group of 10 highly experienced dermatologists in the phototherapeutic field, supported by a medical physicist, a phototherapy nurse, three patient representatives and a professional technical team. The guidelines have been established using the BAD's recommended methodology. 2 Both the BAD and BPG have an excellent track record of publishing phototherapy guidelines 3 and this is certainly the case with these guidelines, which can be considered an absolute necessity for anyone administering or prescribing phototherapy. The guidelines provide detailed insights and highlight recommendations for practical use of narrowband ultraviolet B (NB-UVB) phototherapy both in the clinic and at home. These recommendations were developed on the basis of evidence from systematic reviews of the literature pertaining to the clinical questions identified, after internal discussion. Recommendations and outcome measures of importance to patients were set and ranked according to the GRADE methodology (i.e. grading of recommendations assessment, development and evaluation). 2 In total 38 phototherapeutic recommendations derived from literature review and consensus are provided for many diseases, including psoriasis, eczema, vitiligo, palmoplantar dermatoses, lichen planus, morphoea (localized scleroderma), mycosis fungoides, pityriasis lichenoides, progressive macular hypomelanosis, subacute and nodular prurigo, idiopathic or secondary pruritus, and chronic urticaria, as well as photodermatoses, such as polymorphic light eruption, solar urticaria, actinic prurigo, photoaggravated eczema and hydroa vacciniforme.These guidelines offer many specific references, and an impressive appendix of 580 pages with an additional 464 references. They present information on light sources and dosimetry, protocols for treatment delivery, an evidence-based analysis of the efficacy of combining therapies with various topical or systemic agents, contraindications, and safety and adverse effects. One special feature is recommendations regarding the circumstances under which treatments can be administered in pregnant or breastfeeding patients and children. In addition, the authors provide a list of key future research recommendations, such as patient characteristics that predict their response to NB-UVB, a re-evaluation of NB-UVB vs. psoralen plus ultraviolet A for the treatment of certain diseases, and long-term treatment follow-up and safety

Tolerability of Narrow-band Ultraviolet-B Phototherapy for Different Dermatological Diseases in Relation to Co-medications

“…For a variety of drugs, a photosensitising potential has been described and the simultaneous intake of such medication during phototherapy can potentially lead to drug-induced photosensitivity reactions. Guidelines propose individual MED testing if potentially photosensitising medication is taken concomitantly ( 26 ). However, it remains quite undefined as to which medications are photosensitising.…”