Despite its status as an older treatment in a brave new world of biologics, phototherapy remains an important option for people living with psoriasis.
"It has few side effects, is safe for children and is a good option when people can’t take systemic or biologic medications — when they’re pregnant, for example, or have other medical issues,” says Erin Boh, M.D., professor and chair of the Department of Dermatology at Tulane University in New Orleans and member of the National Psoriasis Foundation Medical Board. “It can also be added safely to almost any medication for additional benefit.”
Thin plaque or guttate psoriasis lesions on the face, trunk and extremities respond well to phototherapy, which is not as useful for thick lesions or for areas such as the scalp, hands and feet, where light can’t penetrate, says Kristina Callis Duffin, M.D., assistant professor of dermatology at the University of Utah in Salt Lake City and also a member of the Medical Board.
Although phototherapy itself hasn’t changed much in the last few decades, home units are today easier to obtain.
“All it requires is a doctor’s order and your insurer’s OK,” says Duffin. “Coverage varies widely from plan to plan, but out-of-pocket costs are typically 10 to 20 percent of the unit’s cost.”
Duffin and Boh offer this advice for getting the most out of phototherapy.
Understand your out-of-pocket costs. Although Medicare and Medicaid don’t require copays for phototherapy, many other insurers now compel dermatologists to charge for each session, says Duffin.
Stick to a consistent, frequent phototherapy schedule. “Three visits a week are usual when you’re actively treating psoriasis,” says Boh. “the main reason phototherapy fails is because people don’t go often enough.”
Moisturize your skin regularly, especially right before light therapy. “Moisturizing just before phototherapy helps rays penetrate lesions,” says Duffin. “Dry, itchy skin is one of the most common side effects of phototherapy, so hydrate your skin often. use a thick, emollient moisturizer with few added ingredients to cut down on skin reactions.”
Wear goggles and cover your face during light therapy if you don’t have psoriasis there.
Use sunscreen, and wear sun-protective clothing after phototherapy. “A burn caused by narrow-band UVB can take 24 to 48 hours to come out, so protect your skin in the day or so after phototherapy to avoid adding to any damage,” says Duffin.
Get a full-body check from your dermatologist every six months while undergoing phototherapy to monitor skin for cancer. “The risk of skin cancer is low with narrow-band UVB, and regular skin checks will catch any problems early,” says Duffin.
Ask your dermatologist about cutting down on light therapy sessions once skin has cleared. “You may also be able to go with fewer treatments during warm months if you’re getting enough natural sunlight,” says Duffin.
Mix photosensitizing medications and light therapy. “Many medications, including some antibiotics, blood pressure drugs and topicals, are photosensitizing and increase your risk of a bad burn,” says Boh. Go over all medications, including any topicals, with your doctor.
Apply sunscreen or topical medications just before phototherapy.
Cover up in the light box. “Other than covering your face — unless you’re treating lesions there — as well as eyes and genitals, it’s best to wear as little as possible during phototherapy,” says Boh. “Men should wear a jock strap, but women can go naked. If you do wear clothes, make sure they’re covering the same areas each time. Otherwise you risk burning previously unexposed skin.”
Rule out phototherapy before giving it an adequate trial. You need 15 to 25 treatments before seeing visible results, said Boh.
Substitute a tanning bed for medical phototherapy. The beneficial effect of using light therapy for the treatment of psoriasis is primarily due to ultraviolet light B (UVB). tanning beds, on the other hand, deliver a wide variance of light and often include wavelengths of light that cause skin damage and cancer “tanning beds aren’t effective for psoriasis, and they raise the risk for melanoma, particularly in children and young adults,” says Duffin. NPF does not support the use of tanning beds as a substitute for phototherapy performed under doctor supervision.
Contact the Patient Navigation Center to learn more about phototherapy, other forms of treatment, insurance issues and all of the other challenges of living with psoriatic disease.
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