Aug 1, 2019
Dr. John Koo talks with Dr. Vincent DeLeo about the three main
benefits of phototherapy, including its accessibility, safety
profile, and wide range of effectiveness. Some physicians may think
phototherapy is obsolete, but it continues to be a valuable tool in
the dermatologist’s armamentarium. Dr. Koo also provides various
clinical scenarios in which phototherapy may be the best treatment
option for patients.
We also bring you the latest in dermatology news and
research:
AAD, NPF update use of phototherapy for psoriasis
The latest guidelines on psoriasis care includes pros and cons;
emphasize patient choice.
Sasha D. Jaquez, PhD, says a psychology consult for children’s skin
issues can boost adherence, wellness
Clinicians should pay
attention to nonverbal cues and steer clear of scare tactics to
change a child’s behavior.
Trained interpreters essential for treating non–English-speaking
patients
Even in a private office setting, failure to engage a trained
translator is discouraged.
Things you will learn in this episode:
- Phototherapy is universally accessible to millions of patients.
Many payers prefer that patients try phototherapy before approving
treatment with biologic agents.
- Because phototherapy is purely an external treatment, systemic
safety is among its key advantages, particularly in elderly
patients, those with active or history of recent cancer, and
immunosuppressed populations in whom biologics and other systemic
agents are not advised.
- There is no convincing evidence that UVB phototherapy increases
skin cancer risk in any patient population.
- Psoralen plus UVA (PUVA) phototherapy has been shown to
increase the risk of squamous cell carcinoma in fair-skinned white
patients, but this risk has not been seen in nonwhite patients and
has been associated only with systemic PUVA, not bath
PUVA.
- Unlike biologics, which target specific molecules to treat
individual conditions, phototherapy is a nontargeted treatment with
wide effectiveness for many skin conditions. Because the
broad-spectrum efficacy is nontargeted, both UVB and PUVA are
usable for many different conditions that have nothing to do with
one another, reported Dr. Koo. Narrowband UVB was designed to treat
psoriasis but also works well for atopic dermatitis, generalized
pruritus, vitiligo, urticaria, and seborrheic dermatitis. Psoralen
plus UVA can effectively treat up to 50 different conditions,
including psoriasis, atopic dermatitis, cutaneous lymphoma, mycosis
fungoides, scleroderma, lymphomatoid papulosis, lichen planus,
graft-versus-host disease, and alopecia areata.
- The biggest disadvantage of phototherapy is that treatment may
not be convenient for patients. It can take up to 3 months to clear
the skin, with patients ideally being treated three times
weekly.
- Proper training and education of patients is critical for safe
use of home UVB. “In our practice,” Dr. Koo explains, “we insist
that nobody gets home UVB unless they spend some good amount of
time where our professional phototherapy nurses or other staff can
attest to the fact that the patient knows how to do it right.”
- Dermatology trainees aren’t always exposed to phototherapy
during residency. Dermatology residents should get involved with
phototherapy during their training, and those who have already
graduated may choose to seek additional training through the
National Psoriasis Foundation or by observing another academic or
private practitioner.
- From a financial perspective, phototherapy can be well
reimbursed.
Hosts: Elizabeth Mechcatie, Terry Rudd,
Vincent A. DeLeo, MD (University
of Southern California, Los Angeles)
Guest: John Koo, MD (University of California, San
Francisco)
Show notes by Alicia Sonners, Melissa Sears, and Elizabeth
Mechcatie.
Dr. Jaquez is a pediatric psychologist with Dell
Children’s Medical Center of Central Texas, Austin.
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