Psoriasis

Australian guidelines released for narrow-band UVB phototherapy


The first Australian consensus-based recommendations have been developed for the use of narrowband UVB phototherapy in conditions such as psoriasis, eczema and vitiligo.

Led by Dr Har Simrat Kaur of Department of Dermatology, Liverpool Hospital, Sydney, a group of nine Australian dermatologists with expertise in NBUVB phototherapy were brought together to discuss current practices and to develop consensus guidelines for the use of phototherapy in various skin dermatoses.

They reached consensus on more than 32 questions relating to the use of phototherapy, which they say should provide a framework of recommendation to encourage consistency and efficacy in an Australian setting for phototherapy.

Published in the Australasian Journal of Dermatology, the statement includes recommendations on the starting dose for NBUVB phototherapy in psoriasis, eczema and vitiligo and how the starting dose should be determined.

Recommendations are also provided for therapeutic doses, dose increments and maximum doses for NBUVB phototherapy. However the panel also advise different maximum doses for different body regions such as hands, feet, face and body.

Phototherapy should be delivered based on disease-based protocols with eczema protocols tending to have more gentle escalation and lower maximal dose, they advised. Ideally, NBUVB phototherapy should be carried out thrice a week during the treatment phase, but less frequently for maintenance.

The consensus-based recommendation on benchmarks for expected outcomes of NBUVB phototherapy, such as 60%–75% of patients with psoriasis achieving achieve PASI 75 after 12 weeks of treatment. In vitiligo they suggest that about 36% patients can expect a greater than 75% degree of repigmentation at 12 months.

Guidance is also provided on the maximum duration of phototherapy for a patient, with recommendations that phototherapy should be ceased if it is not working after 36 sessions for psoriasis and eczema and after 75 sessions for vitiligo.

The panel also reached consensus on monitoring requirement during the use of NBUVB phototherapy, such as full skin checks after 150 sessions or annually. They said phototherapy could be offered to patients at risk of developing skin cancer with informed consent, noting that NBUVB was not proven to increase risk of skin cancer.

Other recommendations cover infection control measures and COVID-19 safety protocols, UV-protection for patients, and the use of phototherapy in subgroups such as children, the elderly and women during pregnancy.

According to the authors, phototherapy may be combined with some topical therapies such as corticosteroids, retinoids and calcineurin inhibitors and also with some systemic therapies such as biologics but not cyclosporine A, azathioprine or mycophenolate mofetil.

The guidance was not intended to be prescriptive but “addresses a gap in dermatological practice across Australia, and the recommendations contribute a reference framework for the phototherapeutic care specifically tailored for Australian residents,” they concluded.

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