1
|
Kurz B, Berneburg M, Bäumler W, Karrer S. Phototherapy: Theory and practice. J Dtsch Dermatol Ges 2023; 21:882-897. [PMID: 37485907 DOI: 10.1111/ddg.15126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/12/2023] [Indexed: 07/25/2023]
Abstract
Despite the development of highly effective biologics for skin diseases such as psoriasis or atopic dermatitis, UVA and UVB therapy, alone or in combination, are still essential components of various guidelines. Phototherapy is not only a first-line treatment and highly effective for a number of skin diseases, but is also economical and has few side effects. The targeted use of UVA and UVB, if necessary, in combination with the photosensitizer psoralen in the context of PUVA therapy, enables the dermatologist to effectively treat a wide variety of skin diseases. Indications for phototherapy include epidermal diseases such as atopic dermatitis, psoriasis and vitiligo, as well as photodermatoses, mycosis fungoides, graft-versus-host disease and deep dermal diseases such as scleroderma. This article reviews the physical principles, molecular mechanisms, current treatment regimens, and individual indications for phototherapy and photochemotherapy.
Collapse
Affiliation(s)
- Bernadett Kurz
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Mark Berneburg
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Bäumler
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Sigrid Karrer
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
2
|
Kurz B, Berneburg M, Bäumler W, Karrer S. Phototherapie in Theorie und Praxis. J Dtsch Dermatol Ges 2023; 21:882-898. [PMID: 37574671 DOI: 10.1111/ddg.15126_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/12/2023] [Indexed: 08/15/2023]
Abstract
ZusammenfassungDie Therapie oder Kombinationstherapie mit UV‐A‐ oder UV‐B‐Strahlen ist trotz der Entwicklung hochwirksamer Biologika bei Hauterkrankungen wie Psoriasis oder atopischer Dermatitis nach wie vor unverzichtbarer Bestandteil verschiedener Leitlinienempfehlungen. Die Phototherapie ist nicht nur eine sehr effektive Erstlinientherapie bei verschiedenen Hauterkrankungen, sondern auch kostengünstig und nebenwirkungsarm. Der gezielte Einsatz von UV‐A und UV‐B, gegebenenfalls auch in Kombination mit dem Photosensibilisator Psoralen im Rahmen einer PUVA‐Therapie, ermöglicht dem Dermatologen eine effektive Behandlung verschiedener Hautkrankheiten. Indikationen für die Phototherapie sind epidermale Erkrankungen wie die atopische Dermatitis, die Psoriasis und die Vitiligo, ferner Photodermatosen, die Mycosis fungoides, die Graft‐versus‐Host‐Erkrankung sowie tiefe dermale Erkrankungen wie die Sklerodermie. Dieser Artikel gibt einen Überblick über die physikalischen Grundlagen, die molekularen Mechanismen, die derzeitigen Behandlungsmethoden und die einzelnen Indikationen für die Phototherapie und die Photochemotherapie.
Collapse
Affiliation(s)
- Bernadett Kurz
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Wolfgang Bäumler
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| |
Collapse
|
3
|
Oulee A, Javadi SS, Martin A, Do T, Wu JJ. Phototherapy trends in dermatology 2015-2018. J DERMATOL TREAT 2021; 33:2545-2546. [PMID: 34913808 DOI: 10.1080/09546634.2021.2019660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Trends in phototherapy utilization including its main clinical indications were last characterized by Luersen et al. for the time period of 1997-2010. In this study, we update data on the use of phototherapy in the United States from 2015 to 2018. METHODS We queried the National Ambulatory Medical Care Survey (NAMCS) data on the number of phototherapy visits as well as demographics and associated dermatoses. RESULTS There were approximately 1.31 million outpatient phototherapy visits during the study period with a decreasing trend over time. Leading indications for phototherapy were dermatitis not otherwise specified (NOS), (25.7%) followed by atopic dermatitis (AD) (11.7%), and pruritus (9.7%). CONCLUSION There is a downtrend in the use of phototherapy from 2015 to 2018. Psoriasis is no longer the main indication for phototherapy, which may be due to the advent of highly effective novel biologics.
Collapse
Affiliation(s)
- Aislyn Oulee
- Dermatology Research and Education Foundation, Irvine, CA, USA.,Riverside School of Medicine, University of California, Riverside, CA, USA
| | - Sogol S Javadi
- Dermatology Research and Education Foundation, Irvine, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Amylee Martin
- Dermatology Research and Education Foundation, Irvine, CA, USA.,Riverside School of Medicine, University of California, Riverside, CA, USA
| | - Tran Do
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jashin J Wu
- Dermatology Research and Education Foundation, Irvine, CA, USA
| |
Collapse
|
4
|
Torres AE, Lyons AB, Hamzavi IH, Lim HW. Role of phototherapy in the era of biologics. J Am Acad Dermatol 2020; 84:479-485. [PMID: 32339702 PMCID: PMC7194984 DOI: 10.1016/j.jaad.2020.04.095] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 12/20/2022]
Abstract
Phototherapy is a safe and effective treatment for many dermatologic conditions. With the advent of novel biologics and small molecule inhibitors, it is important to critically evaluate the role of phototherapy in dermatology. Surveys have shown that many dermatology residency programs do not dedicate time to teaching residents how to prescribe or administer phototherapy. Limitations of phototherapy include access to a center, time required for treatments, and insurance approval. Home phototherapy, a viable option, is also underused. However, it should be emphasized that modern phototherapy has been in use for over 40 years, has an excellent safety profile, and does not require laboratory monitoring. It can be safely combined with many other treatment modalities, including biologics and small molecule inhibitors. In addition, phototherapy costs significantly less than these novel agents. Dermatologists are the only group of physicians who have the expertise and proper training to deliver this treatment modality to our patients. Therefore, to continue to deliver high-quality, cost-effective care, it is imperative that phototherapy be maintained as an integral part of the dermatology treatment armamentarium.
Collapse
Affiliation(s)
- Angeli Eloise Torres
- Manila, Philippines; Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Alexis B Lyons
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Iltefat H Hamzavi
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Henry W Lim
- Photomedicine and Photobiology Unit, Department of Dermatology, Henry Ford Health System, Detroit, Michigan.
| |
Collapse
|
5
|
Halepas S, Lee KC, Higham ZL, Ferneini EM. A 20-Year Analysis of Adverse Events and Litigation With Light-Based Skin Resurfacing Procedures. J Oral Maxillofac Surg 2020; 78:619-628. [DOI: 10.1016/j.joms.2019.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/12/2019] [Accepted: 12/06/2019] [Indexed: 01/10/2023]
|
6
|
Smith MP, Ly K, Thibodeaux Q, Bhutani T, Nakamura M. Home phototherapy for patients with vitiligo: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:451-459. [PMID: 31388308 PMCID: PMC6607222 DOI: 10.2147/ccid.s185798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/07/2019] [Indexed: 12/31/2022]
Abstract
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.
Collapse
Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Tan SY, Buzney E, Mostaghimi A. Trends in phototherapy utilization among Medicare beneficiaries in the United States, 2000 to 2015. J Am Acad Dermatol 2018; 79:672-679. [PMID: 29574089 DOI: 10.1016/j.jaad.2018.03.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 03/05/2018] [Accepted: 03/11/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Phototherapy is a cost-effective treatment for many dermatoses, yet the emergence of alternative therapies such as biologics led many to think that phototherapy utilization was declining. OBJECTIVE To characterize national, historical phototherapy utilization and costs among Medicare beneficiaries. METHODS Longitudinal analysis of the Medicare Part B National Summary Data File from 2000 to 2015 for phototherapy billing codes. Geographic distribution of clinics and provider type obtained from the Medicare Provider Utilization and Payment Data for 2012 to 2015. RESULTS The overall volume of phototherapy services billed to Medicare from 2000 to 2015 increased by 5% annually, from 334,670 to 692,093. Ultraviolet B therapy comprised 77% of phototherapy volume, utilization of psoralen plus ultraviolet A therapy declined by 9% annually, and excimer laser services grew by 29% annually. The number of phototherapy clinics is increasing but remains concentrated in only 11% of US counties. Between 2012 and 2015, dermatologists accounted for 92% of phototherapy volume. LIMITATIONS Commercial payers and institutional claims (hospital-based physicians) are excluded. Clinical indications for phototherapy use are not reported in this database. CONCLUSION Phototherapy utilization has grown, though the service mix has shifted toward ultraviolet B and laser excimer therapy and away from psoralen plus ultraviolet A therapy. Dermatologists manage most phototherapy. Uneven geographic distribution of phototherapy clinics limits access in nonurban areas, and further evaluation is needed to determine its impact on rural communities.
Collapse
Affiliation(s)
- Sally Y Tan
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Buzney
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts.
| |
Collapse
|
8
|
Hum M, Kalia S, Gniadecki R. Prescribing Home Narrowband UVB Phototherapy: A Review of Current Approaches. J Cutan Med Surg 2018; 23:91-96. [PMID: 30221998 DOI: 10.1177/1203475418800947] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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.
Collapse
Affiliation(s)
- Matthew Hum
- 1 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sunil Kalia
- 2 Photomedicine Institute, Vancouver Coastal Health and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Robert Gniadecki
- 3 Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|