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Home Phototherapy

Over the years, there have been numerous studies to determine the efficacy of home phototherapy, including a simple evaluation of home phototherapy with and without the concurrent use of topical treatment, home phototherapy in addition to systemic therapy, and a pragmatic, randomized controlled trial comparing home versus outpatient phototherapy (Table 1). The efficacy of home phototherapy was demonstrated by complete remission of psoriatic lesions in 20 of 28 (71.4%) patients with long-standing, severe psoriasis after 45 exposures to high-dose BB-UVB home phototherapy as a sole therapeutic intervention [9]. Of note, the subjects underwent MED determination and were closely monitored for response to treatment with weekly visits. This arrangement constitutes more supervision than many home phototherapy regimens [3]. The need for adequate monitoring of response to treatment and incidences of adverse events is a major consideration in prescribing home phototherapy as a therapeutic intervention [27]. This consideration underscores the importance of using home phototherapy units equipped with prescription controlled timers to limit the number of treatments between office visits. Additionally, patients with extensive, recalcitrant psoriasis showed clearance of psoriatic lesions in 55 of 56 (98.2%) patients after 8 weeks of BB-UVB treatment in suberythrogenic dose with concurrent use of topical coal tar [28]. In patients with patch and early plaque stage mycosis fungoides, home phototherapy consisting of erythemogenic doses of UVB resulted in clinical and histopathological clearance and prolonged remission in 7 of 31 patients [29]. A comparison of the efficacy of high output UVB at home and at physician offices in patients with recalcitrant hand eczema demonstrated much improvement in 7 of 11 (63.6%) patients in the home group and 11 of 13 (84.6%) patients in the outpatient group [30]. Eighteen of 23 psoriasis patients demonstrated complete clearance with an additional 3 showing marked improvement with the use of NB-UVB [31]. NB-UVB was also shown to be effective in a variety of other photoresponsive dermatoses (Table 1) [31]. Home phototherapy in conjunction with oral acitretin for 12 weeks in patients with moderate-to-severe plaque psoriasis reduced PASI score by 22 percent and was clinically significant as demonstrated by an associated improvement in quality of life (as measured by DLQI) [32].

Home phototherapy had similar efficacy to outpatient phototherapy in a large, randomized, well-controlled trial (n=195). For patients undergoing home phototherapy, 82 percent and 70 percent reached Self-Administered Psoriasis Area and Severity Index (SAPASI) 50 and PASI 50, respectively, compared with 79 percent and 73 percent of the patients receiving outpatient treatment [33]. Additionally, the median SAPASI and PASI scores for patients receiving home phototherapy decreased by 82 percent and 74 percent, respectively, compared with 79 percent and 70 percent decreases in the outpatient group. The overall treatment effect, as assessed by the mean reduction in PSAI and SAPASI, and the increase in quality of life was significant and similar between the two groups [33]. As used in this study, home phototherapy was similar in efficacy to standard outpatient phototherapy.

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