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Bridgit V Nolan1, Brad A Yentzer MD2, Steven R Feldman MD PhD2

Dermatology Online Journal 16 (2): 1 

1. SUNY Upstate Medical University, Syracuse, New York

2. Center for Dermatology Research, Department of Dermatology; Wake Forest University School of Medicine; Winston-Salem, North Carolina. sfeldman@wfubmc.edu

Abstract

Background: Phototherapy is a mainstay in the treatment of psoriasis and other photoresponsive dermatoses and home phototherapy has broadened therapeutic options. Purpose: To describe the history of home phototherapy, the technological advances in the safety and efficacy of the equipment available, and the associated issues of cost, convenience, adherence, and quality of life. Methods: We conducted a literature review of home phototherapy, broad-band UVB, narrow-band UVB, and PUVA phototherapy using PUBMED. A Google search of home phototherapy equipment and technology was also undertaken. Results: Technological advances in home phototherapy equipment have allowed for more treatment options and improvements in safety and efficacy. One randomized, controlled trial found results comparable to office-based phototherapy. Home phototherapy is convenient, cost-effective, and associated with better quality of life compared to outpatient phototherapy treatment. One trial found that adherence to home phototherapy regimens was better than to oral retinoids. Conclusions: Home phototherapy is a well-tolerated, efficacious, economical and patient friendly therapeutic option. Advantages of home phototherapy include improved quality of life, greater convenience, lower cost, and less time lost from work and social activities. Dermatologists should strongly consider home phototherapy as a first-line treatment option for appropriately selected psoriasis patients.

INTRODUCTION

Phototherapy has advanced much since the time of the ancient Egyptians when exposure to natural sunlight was used as a form of medical treatment for a variety of skin conditions. Self-treatment with UVA in the form of commercial tanning booths is widespread and many patients use this type of phototherapy without medical guidance. Fifty percent of patients with psoriasis have self-treated with sunbeds [1]. Technological innovations involving the development and improvement of ultraviolet-emitting devices designed for home phototherapy has widened the possibilities for home phototherapy of psoriasis and other photosensitive dermatoses, including mycosis fungoides, hand eczema, solar urticaria, and vitiligo [2].

Home phototherapy equipment first became commercially available in the early 1980s. Since its introduction, home phototherapy has been growing in use and is popular with many psoriasis patients [3]. An overwhelming majority (96%) of patients undergoing home phototherapy thought it was effective, as well as less costly and more convenient than the standard outpatient schedule. Not surprisingly, patient satisfaction with home phototherapy is very high [4]. Home phototherapy has evolved and improved over time. The purpose of this review is to describe the evolution of home phototherapy and to elucidate its role in the treatment of chronic inflammatory skin diseases.

METHODS

A review of the literature on home phototherapy, broad-band UVB (BB-UVB), narrow-band UVB (NB-UVB), and psoralen plus UVA (PUVA) phototherapy was conducted using PUBMED. The following search terms were used: phototherapy, home phototherapy, and psoriasis phototherapy. The efficacy, safety, and adverse effects of the various forms of phototherapy were investigated. Associated issues of convenience, cost, adherence, and quality of life were also assessed. A Google search for home phototherapy equipment and technology was undertaken. Emphasis was placed on technological evolution in the safety, efficacy, and personalization of the various units available.

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