Ernest Lee,MD , John Koo, MD, and Tim Berger, MD
Abstract
Background
UVB phototherapy is a common treatment modality for psoriasis and other skin diseases. Although UVB has been in use for many decades, many clinicians are hesitant to use this type of phototherapy because of concern over increasing the skin cancer risk. Over the past 20 years, numerous studies have been published examining this issue, but a consensus or analysis of the skin cancer risk is required for the dermatologist to make an educated risk–benefit analysis.
Objective
To assess the risk of skin cancer associated with UVB phototherapy.
Methods
All prospective or retrospective studies were identified in MEDLINE from 1966 to June 2002. Bibliographies were searched to identify any additional studies examining this issue. All studies that attempted to quantify or qualify any additional skin cancer risk from UVB phototherapy were included. Study selection was performed by two independent reviewers. Results Eleven studies (10 of which concerned psoriasis patients), involving approximately 3400 participants, were included. Of note, three of the studies involved the same cohort: members of the 16-center US Psoralen plus UVA (PUVA) Follow-up Study. Other than the most recent Finnish study, all studies eventually showed no increased skin cancer risk with UVB phototherapy.One of the PUVA cohort studies examined genital skin cancers, and found an increased rate of genital tumors associated with UVB phototherapy, although this study has not been duplicated.
Conclusion
The evidence suggests that UVB phototherapy remains a very safe treatment modality
Buy UVB Home Phototherapy online without a prescription or doctors letter
Showing posts with label Dermalight. Show all posts
Showing posts with label Dermalight. Show all posts
Monday, August 31, 2009
Is Home phototherapy comparable to in-clinic treatment?
Is Home phototherapy comparable to in-clinic treatment?
SOURCE: Kristina Fiore, Staff Writer, MedPage Today
Published: May 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
TITLE: Home phototherapy is comparable to hospital-based ultraviolet B treatment for psoriasis patients, researchers have found.
In a randomized controlled trial, home phototherapy was as safe and effective as hospital-based treatment, Mayke Koek, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues reported online in BMJ.
“We regard home ultraviolet B phototherapy to be a worthy alternative to standard outpatient ultraviolet B phototherapy for patients with psoriasis,” the researchers concluded.
They explained that many patients who could benefit from phototherapy don’t get it because of time constraints: treatment typically involves going to the hospital three times a week for eight to 10 weeks.
Also, some dermatologists believe that home phototherapy is inferior to hospital treatment and carries more risks, such as inaccurate dosimetry, phototoxicity, and unsupervised continuation of irradiation. The researchers said there is little evidence for this.
So the present study looked at 196 psoriasis patients from 14 hospital dermatology departments in the Netherlands who received either home- or hospital-based phototherapy.
Home therapy patients used a TL-01 home phototherapy unit, while those who came to the hospital for treatment received standard, narrowband ultraviolet B phototherapy.
The researchers found that home phototherapy was as safe and effective as outpatient phototherapy, both clinically and in terms of quality of life.
A total of 82% of patients treated at home reached a treatment effect as measured by the self-administered psoriasis area and severity index (SAPASI), compared with 79% of those treated in an outpatient setting.
Likewise, 70% reached treatment effect as measured by the clinically assessed psoriasis area and severity index (PASI), compared with 73% of outpatients.
The treatment effects were significant across all groups (P<0.001).
As for safety concerns, the researchers found that patients treated themselves at home more frequently than they would have been treated at the hospital. But the cumulative dose they received by the end of treatment was only slightly higher than hospital-treated patients.
They found that regardless of treatment, 87% of patients had at least one occurrence of mild erythema, while 58% reported burning sensations, 39% had severe erythema, and 6% had blistering. No differences were observed between groups.
“Our results refute the widespread fear of more acute safety risks with ultraviolet B phototherapy used at home,” the researchers said.
They also found that the burden of undergoing phototherapy was significantly lower for patients treated at home (P<0.001).
Quality of life increased equally, regardless of treatment, but those treated at home were more likely to rate their experience with the therapy as “excellent” (42% versus 23%, P=0.001).
The researchers concluded that phototherapy administered at home is “equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting.”
In an accompanying editorial, Alex Anstey, M.D., of Royal Gwent Hospital, called the study “pragmatic” and said an economic assessment of different phototherapy service models is now needed.
“This should include the costs of the equipment, costs of teaching patients how to use the equipment, and costs for a clinical governance system within which home phototherapy can operate,” Dr. Anstey said.
He added that dermatologists “should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit. The case for home provision of UVB phototherapy for psoriasis is most persuasive in sparsely populated areas.”
Review the latest UVB phototherapy devices like Dermalight80 and DermarayUV
SOURCE: Kristina Fiore, Staff Writer, MedPage Today
Published: May 08, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
TITLE: Home phototherapy is comparable to hospital-based ultraviolet B treatment for psoriasis patients, researchers have found.
In a randomized controlled trial, home phototherapy was as safe and effective as hospital-based treatment, Mayke Koek, M.D., of the University Medical Center Utrecht in the Netherlands, and colleagues reported online in BMJ.
“We regard home ultraviolet B phototherapy to be a worthy alternative to standard outpatient ultraviolet B phototherapy for patients with psoriasis,” the researchers concluded.
They explained that many patients who could benefit from phototherapy don’t get it because of time constraints: treatment typically involves going to the hospital three times a week for eight to 10 weeks.
Also, some dermatologists believe that home phototherapy is inferior to hospital treatment and carries more risks, such as inaccurate dosimetry, phototoxicity, and unsupervised continuation of irradiation. The researchers said there is little evidence for this.
So the present study looked at 196 psoriasis patients from 14 hospital dermatology departments in the Netherlands who received either home- or hospital-based phototherapy.
Home therapy patients used a TL-01 home phototherapy unit, while those who came to the hospital for treatment received standard, narrowband ultraviolet B phototherapy.
The researchers found that home phototherapy was as safe and effective as outpatient phototherapy, both clinically and in terms of quality of life.
A total of 82% of patients treated at home reached a treatment effect as measured by the self-administered psoriasis area and severity index (SAPASI), compared with 79% of those treated in an outpatient setting.
Likewise, 70% reached treatment effect as measured by the clinically assessed psoriasis area and severity index (PASI), compared with 73% of outpatients.
The treatment effects were significant across all groups (P<0.001).
As for safety concerns, the researchers found that patients treated themselves at home more frequently than they would have been treated at the hospital. But the cumulative dose they received by the end of treatment was only slightly higher than hospital-treated patients.
They found that regardless of treatment, 87% of patients had at least one occurrence of mild erythema, while 58% reported burning sensations, 39% had severe erythema, and 6% had blistering. No differences were observed between groups.
“Our results refute the widespread fear of more acute safety risks with ultraviolet B phototherapy used at home,” the researchers said.
They also found that the burden of undergoing phototherapy was significantly lower for patients treated at home (P<0.001).
Quality of life increased equally, regardless of treatment, but those treated at home were more likely to rate their experience with the therapy as “excellent” (42% versus 23%, P=0.001).
The researchers concluded that phototherapy administered at home is “equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting.”
In an accompanying editorial, Alex Anstey, M.D., of Royal Gwent Hospital, called the study “pragmatic” and said an economic assessment of different phototherapy service models is now needed.
“This should include the costs of the equipment, costs of teaching patients how to use the equipment, and costs for a clinical governance system within which home phototherapy can operate,” Dr. Anstey said.
He added that dermatologists “should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit. The case for home provision of UVB phototherapy for psoriasis is most persuasive in sparsely populated areas.”
Review the latest UVB phototherapy devices like Dermalight80 and DermarayUV
UV phototherapy with Dermalight 80 on the eyelids.
Present status of eyelid phototherapy.
Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.
Prystowsky JH, Keen MS, Rabinowitz AD, Stevens AW, DeLeo VA.
Department of Dermatology, Columbia-Presbyterian Medical Center, New York, NY.
BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis.
OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment.
METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids.
RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients’ records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue.
CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.
Clinical efficacy and transmittance of ultraviolet and visible radiation through human eyelids.
Prystowsky JH, Keen MS, Rabinowitz AD, Stevens AW, DeLeo VA.
Department of Dermatology, Columbia-Presbyterian Medical Center, New York, NY.
BACKGROUND: Phototherapy for the eyelid has not previously been recognized as a safe and effective treatment of photoresponsive dermatoses of the eyelid, such as atopic dermatitis, vitiligo, psoriasis, lymphomatoid papulosis, and parapsoriasis.
OBJECTIVE: The purpose of this study was to demonstrate the efficacy and safety of this treatment.
METHODS: Two cases are presented to demonstrate clinical efficacy. In addition, a retrospective eye evaluation of seven patients receiving a combined total of greater than 1300 eyelid phototherapy treatments was performed. To determine whether potentially harmful UV radiation is significantly transmitted through eyelid skin, an in vitro study was conducted to measure the percentage transmittance of ultraviolet-visible radiation through five excised eyelids.
RESULTS: In the two cases presented, remarkable improvement occurred without adverse side effects, suggesting that it is possible to deliver incremental UV dosages to eyelid skin to achieve clearing of skin disease. Retrospective analysis of patients’ records revealed no ocular disease from the phototherapy. In vitro eyelid examination produced data that indicated negligible quantities of UV radiation were transmitted through eyelid skin compared with the visible spectrum, in which up to 77% of the radiation was transmitted through the tissue.
CONCLUSION: The combined clinical experience and transmittance data suggest that eyelid phototherapy is a safe and effective treatment in selected patients.
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