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Conference summaries

Phototherapy

Home Phototherapy and Tanning Salons: Risks and Benefits

Presented by: Prof. Alex Anstey
Bangor, UK

Home phototherapy is a viable option for patients who are far from their local phototherapy unit, are unable to access phototherapy due to poor transportation, and are unable to walk or have transportation to a phototherapy unit. Additional patient concerns include the inability to afford travel costs, have daytime employment which limits time availability, or parental/caregiver responsibilities that preclude their attendance.

While dermatologists had initial concerns about home phototherapy use,1 the PLUTO study demonstrated that ultraviolet B phototherapy administered at home is both safe and effective. Home therapy has also demonstrated beneficial effects clinically, improved patients’ quality-of-life, lowered the burden of treatment, and led to greater patient satisfaction.2

Home phototherapy is a viable option and is in line with the NICE eligibility criteria for biologics as it includes patients who cannot receive phototherapy prior to the initiation of biologic therapy.3 As stated in the criteria, “The optional provision of conventional therapies includes the optimal provision of phototherapies, at times and locations that are acceptable to patients… Failure to recognise and respond to this imperative will inevitably lead to higher costs in areas where pharmacological treatments for psoriasis are offered in preference to conventional therapies such as phototherapies.”1,3

Koek MB et al.4 demonstrated that home ultraviolet B phototherapy for psoriasis was not more expensive and proved to be cost effective than phototherapy in an outpatient setting. The authors concluded that home ultraviolet B phototherapy should be the primary treatment option for patients who are eligible for phototherapy as both treatments were shown to be equally effective.4 Patients also expressed a preference for home therapy.4

The 2 main types of sunbeds are bed/canopy and stand-in cabins. There are multiple manufacturers of the fluorescent tubes used in the beds and they are similar to those used in PUVA with a broad spectrum peaking at ~350 nm. The output from sunbed tubes is often much higher (50 mW/cm2) than the UVA tubes used in hospital PUVA treatment (10-20 mW/cm2).

Das S et al.5 compared the conventional sunbed lamps (Cleo Performance) (~0.7% UVB emission) with the new lamps (Cleo Natural) (~4.6% UVB emission) in the treatment of psoriasis. No difference in response was found when equal erythemal doses were given, suggesting that the spectral emission of the Cleo Natural lamp is of no greater advantage for clearance of psoriasis than conventional lamps. The Cleo Natural lamps were more erythemally powerful and resulted in a significant improvement of psoriasis when exposure times were similar to those used in conventional sunbeds.

The main concern about sunbed use is the potential risk of skin malignancy.5 Insufficient information is known about the action spectrum and dose–response relationship for melanoma to allow a meaningful estimate of risk. However, for non-melanoma skin cancer (NMSC) established numerical models are available to predict the risk from different patterns of exposure. For example, if the Cleo Natural lamps (high UVB) were used for 20 min per session for 24 sessions per year, this annual exposure would result in an erythemally effective dose of about 100 standard erythemal dose (SED) leading to:

  • ~30% increased risk for NMSC in 20-40 year olds
  • Rise to ~60% risk for skin cancer (1 in 10) in 20-60 year olds.

A population-based, case-control study including 1500 people between 25 and 74 years old observed that any use of tanning devices was associated with a 2.5 times increased risk of squamous cell carcinoma and 1.5 times risk for basal cell carcinoma.6 These findings suggest that the use of tanning devices may contribute to the incidence of NMSC.

To help identify those patients that are addicted to sunbed use, a behavioral addiction indoor tanning screener (BAITS) tool has proven effective.7

Key messages

  • Home phototherapy has the same benefit as hospital phototherapy while it is far more convenient for the patient.
  • The risks are the same for both the hospital and office phototherapy.
  • The costs for home and hospital-based phototherapy are comparable but it has the potential for significant savings if employed.
  • Tanning beds have a modest benefit in psoriasis patients but continue to have skin cancer, photo-aging, and addiction concerns.


REFERENCES

Present disclosure: The presenter had nothing to disclose.

Written by: Debbie Anderson, PhD

Reviewed by: Victor Desmond Mandel, MD



CONFERENCE SUMMARIES

Psoriasis

Treating Psoriasis in 2018

Prof. Antonio Costanzo

Alopecia areata & vitiligo

Treating Alopecia Areata and Vitiligo with JAK Inhibitors

Brett King, MD, PhD

Acne

Treatment Algorithms

Alison Layton, MD

Dermoscopy

Limits and Pitfalls of Dermoscopy

Dr. Josep Malvehy

Rosacea

Systemic Treatment of Rosacea

Dr. Eszter Baltas

Immunotherapies

Adverse Effects of Immunotherapies

Jean Bolognia, MD

UV protection

Ultraviolet Protection and Vitamin D

Prof. Thomas Vogt

Pain management in dermatology

Pain Management in Dermatology

Prof. Laurent Misery

Skin ageing

Consequences of Air Pollution on Skin Aging

Prof. Jean Krutmann

Biologics in children

The Use of Biologics in Children

Prof. Diamant Thaçi

Atopic dermatitis

Systemic Treatments of Atopic Dermatitis

Dr. Carsten Flohr

Sexually transmitted infections

STI Therapies Today and Treatment Resistance

Dr. Angelika Stary

Important viral diseases

Viral Disease Update: Coxsackie, Zika, and Varicella-Zoster

Ilona J. Frieden, MD

Lasers/lights in skin imaging

Lasers/lights in skin imaging

Prof. Giovanni Pellacani

Ethics/aesthetic

Ethics in Aesthetic Practice

Prof. Amr Rateb