Top

Current Dermatology Reports

Published in:

01-03-2018 | Psoriasis (Jaishin Wu, Section Editor)

A Review and Update of Phototherapy Treatment Options for Psoriasis

Authors: Seth T. Howell, Leah A. Cardwell, Steven R. Feldman

Published in: Current Dermatology Reports | Issue 1/2018

Abstract

Purpose of Review

Psoriasis is a chronic inflammatory skin condition affecting greater than 7 million adults in the USA. There are a multitude of treatment options available for psoriasis management. This review provides an overview of the current use of phototherapy in the treatment of psoriasis, and an update on recent phototherapy advances, either as a single modality or in conjunction with other agents.

Recent Findings

Advances in pharmacotherapy and an increased understanding of the pathogenesis of psoriasis have led to the development of new systemic treatments for psoriasis. A small number of recent studies have evaluated the use of phototherapy in comparison to or in combination with emerging and traditional treatment modalities.

Summary

Psoriasis is a chronic skin condition with a high disease burden among patients. More than half of patients are dissatisfied with their therapy, and many are not receiving adequate levels of treatment. Phototherapy remains an effective modality for the treatment of psoriasis with minimal risk. While some studies have evaluated the use of phototherapy with systemic options, more studies are needed to make definitive conclusions.

Fowler JF, Duh MS, Rovba L, Buteau S, Pinheiro L, Lobo F, et al. The impact of psoriasis on health care costs and patient work loss. J Am Acad Dermatol. 2008;59(5):772–80. https://doi.org/10.1016/j.jaad.2008.06.043.CrossRefPubMed

National Psoriasis Foundation. Learn about plaque psoriasis, guttate psoriasis, inverse psoriasis, and pustular psoriasis. https://www.psoriasis.org/about-psoriasis. Accessed November 6, 2017.

Smith J, Cline A, Feldman SR. Advances in psoriasis. South Med J. 2017;110(1):65–75. https://doi.org/10.14423/SMJ.0000000000000596.CrossRefPubMed

Ozdemir M, Engin B, Baysal I, Mevlitoglu I. A randomized comparison of acitretin-narrow-band TL-01 phototherapy and acitretin-psoralen plus ultraviolet A for psoriasis. Acta Derm Venereol. 2008;88(6):589–93. https://doi.org/10.2340/00015555-0529. PubMed

Juzeniene A, Grigalavicius M, Juraleviciute M, Grant WB. Phototherapy and vitamin D. Clin Dermatol. 2016;34(5):548–55. https://doi.org/10.1016/j.clindermatol.2016.05.004.CrossRefPubMed

van de Kerkhof PCM, Barker J, Griffiths CEM, Kragballe K, Mason J, Menter A, et al. Psoriasis: consensus on topical therapies. J Eur Acad Dermatol Venereol. 2008;22(7):859–70. https://doi.org/10.1111/j.1468-3083.2007.02534.x.CrossRefPubMed

Feldman SR, Goffe B, Rice G, et al. The challenge of managing psoriasis: unmet medical needs and stakeholder perspectives. Am Health Drug Benefits. 2016;9(9):504–13.PubMedPubMedCentral

• Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009;61(3):451–85. https://doi.org/10.1016/j.jaad.2009.03.027. Discusses general systemic treatment options in the management of psoriasis. CrossRefPubMed

Jarrett P, Scragg R. A short history of phototherapy, vitamin D and skin disease. Photochem Photobiol Sci. 2017;16(3):283–90. https://doi.org/10.1039/c6pp00406g.CrossRefPubMed

10.

Lapolla W, Yentzer BA, Bagel J, Halvorson CR, Feldman SR. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol. 2011;64(5):936–49. https://doi.org/10.1016/j.jaad.2009.12.054.CrossRefPubMed

11.

• Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol. 2010;62(1):114–35. https://doi.org/10.1016/j.jaad.2009.08.026. Provides an overview of phototherapy and photochemotherapy in the treatment of psoriasis. CrossRefPubMed

12.

•• Nakamura M, Farahnik B, Bhutani T. Recent advances in phototherapy for psoriasis. F1000Res. 2016;5:F1000. https://doi.org/10.12688/f1000research.8846.1. Highlights the recent updates pertaining to phototherapy use in psoriasis. CrossRefPubMedPubMedCentral

13.

Hemne PS, Kunghatkar RG, Dhoble SJ, Moharil SV, Singh V. Phosphor for phototherapy: review on psoriasis. Luminescence. 2017;32(3):260–70. https://doi.org/10.1002/bio.3266.CrossRefPubMed

14.

Enk CD, Sredni D, Blauvelt A, Katz SI. Induction of IL-10 gene expression in human keratinocytes by UVB exposure in vivo and in vitro. J Immunol. 1995;154(9):4851–6.PubMed

15.

Coimbra S, Oliveira H, Reis F, Belo L, Rocha S, Quintanilha A, et al. Interleukin (IL)-22, IL-17, IL-23, IL-8, vascular endothelial growth factor and tumour necrosis factor-alpha levels in patients with psoriasis before, during and after psoralen-ultraviolet A and narrowband ultraviolet B therapy. Br J Dermatol. 2010;163(6):1282–90. https://doi.org/10.1111/j.1365-2133.2010.09992.x.CrossRefPubMed

16.

Weatherhead SC, Farr PM, Jamieson D, Hallinan JS, Lloyd JJ, Wipat A, et al. Keratinocyte apoptosis in epidermal remodeling and clearance of psoriasis induced by UV radiation. J Invest Dermatol. 2011;131(9):1916–26. https://doi.org/10.1038/jid.2011.134.CrossRefPubMedPubMedCentral

17.

Zhang D, Chen Y, Chen L, Yang R, Wang L, Liu W, et al. Ultraviolet irradiation promotes FOXP3 transcription via p53 in psoriasis. Exp Dermatol. 2016;25(7):513–8. https://doi.org/10.1111/exd.12942.CrossRefPubMed

18.

DeSilva B, McKenzie RC, Hunter JAA, Norval M. Local effects of TL01 phototherapy in psoriasis. Photodermatol Photoimmunol Photomed. 2008;24(5):268–9. https://doi.org/10.1111/j.1600-0781.2008.00366.x.CrossRefPubMed

19.

Matos TR, Ling TC, Sheth V. Ultraviolet B radiation therapy for psoriasis: pursuing the optimal regime. Clin Dermatol. 2016;34(5):587–93. https://doi.org/10.1016/j.clindermatol.2016.05.008.CrossRefPubMed

20.

Wong T, Hsu L, Liao W. Phototherapy in psoriasis: a review of mechanisms of action. J Cutan Med Surg. 2013;17(1):6–12. https://doi.org/10.2310/7750.2012.11124.CrossRefPubMed

21.

Vassantachart JM, Soleymani T, Wu JJ. Comparison of phototherapy guidelines for psoriasis: a critical appraisal and comprehensive review. J Drugs Dermatol. 2016;15(8):995–1000.PubMed

22.

Pathirana D, Ormerod AD, Saiag P, Smith C, Spuls PI, Nast A, et al. European S3-guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol. 2009;23(Suppl 2):1–70. https://doi.org/10.1111/j.1468-3083.2009.03389.x.CrossRefPubMed

23.

Vangipuram R, Feldman SR. Ultraviolet phototherapy for cutaneous diseases: a concise review. Oral Dis. 2016;22(4):253–9. https://doi.org/10.1111/odi.12366.CrossRefPubMed

24.

Walker D, Jacobe H. Phototherapy in the age of biologics. Semin Cutan Med Surg. 2011;30(4):190–8. https://doi.org/10.1016/j.sder.2011.08.004.CrossRefPubMed

25.

Tauscher AE, Fleischer ABJ, Phelps KC, Feldman SR. Psoriasis and pregnancy. J Cutan Med Surg. 2002;6(6):561–70. https://doi.org/10.1177/120347540200600608.CrossRefPubMed

26.

Bangsgaard N, Rørbye C, Skov L. Treating psoriasis during pregnancy: safety and efficacy of treatments. Am J Clin Dermatol. 2015;16(5):389–98. https://doi.org/10.1007/s40257-015-0137-5.CrossRefPubMed

27.

Eustace K, Dolman S, Alsharqi A, Sharpe G, Parslew R. Use of phototherapy in children. Pediatr Dermatol. 2017;34(2):150–5. https://doi.org/10.1111/pde.13072.CrossRefPubMed

28.

Schaarschmidt M-L, Schmieder A, Umar N, Terris D, Goebeler M, Goerdt S, et al. Patient preferences for psoriasis treatments: process characteristics can outweigh outcome attributes. Arch Dermatol. 2011;147(11):1285–94. https://doi.org/10.1001/archdermatol.2011.309.CrossRefPubMed

29.

Koek MBG, Buskens E, van Weelden H, Steegmans PHA, Bruijnzeel-Koomen CAFM, Sigurdsson V. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ. 2009;338(may07 2):b1542. https://doi.org/10.1136/bmj.b1542.CrossRefPubMedPubMedCentral

30.

Moseley H, Allan D, Amatiello H, Coleman A, du Peloux Menagé H, Edwards C, et al. Guidelines on the measurement of ultraviolet radiation levels in ultraviolet phototherapy: report issued by the British Association of Dermatologists and British Photodermatology Group 2015. Br J Dermatol. 2015;173(2):333–50. https://doi.org/10.1111/bjd.13937.CrossRefPubMed

31.

American Academy of Dermatology. Psoriasis: general principles for phototherapy. https://www.aad.org/practicecenter/quality/clinical-guidelines/psoriasis/phototherapy-and-photochemotherapy. Accessed November 6, 2017.

32.

American Academy of Dermatology. Psoriasis: recommendations for excimer laser therapy. https://www.aad.org/practicecenter/quality/clinical-guidelines/psoriasis/phototherapy-and-photochemotherapy/excimer-laser-therapy. Accessed November 21, 2017.

33.

American Academy of Dermatology. Psoriasis: recommendations for broadband and narrowband UVB therapy. https://www.aad.org/practicecenter/quality/clinical-guidelines/psoriasis/phototherapy-and-photochemotherapy/uvb-therapy. Accessed November 21, 2017.

34.

American Academy of Dermatology. Psoriasis: recommendations for oral PUVA photochemotherapy. https://www.aad.org/practicecenter/quality/clinical-guidelines/psoriasis/phototherapy-and-photochemotherapy/oral-puva-photochemotherapy. Accessed November 21, 2017.

35.

Coven TR, Burack LH, Gilleaudeau R, Keogh M, Ozawa M, Krueger JG. Narrowband UV-B produces superior clinical and histopathological resolution of moderate-to-severe psoriasis in patients compared with broadband UV-B. Arch Dermatol. 1997;133(12):1514–22. https://doi.org/10.1001/archderm.1997.03890480034005.CrossRefPubMed

36.

Man I, Crombie IK, Dawe RS, Ibbotson SH, Ferguson J. The photocarcinogenic risk of narrowband UVB (TL-01) phototherapy: early follow-up data. Br J Dermatol. 2005;152(4):755–7. https://doi.org/10.1111/j.1365-2133.2005.06537.x.CrossRefPubMed

37.

Maiorino A, De Simone C, Perino F, Caldarola G, Peris K. Melanoma and non-melanoma skin cancer in psoriatic patients treated with high-dose phototherapy. J Dermatol Treat. 2016;27(5):443–7. https://doi.org/10.3109/09546634.2015.1133882.CrossRef

38.

Bonis B, Kemeny L, Dobozy A, Bor Z, Szabo G, Ignacz F. 308 nm UVB excimer laser for psoriasis. Lancet (London, England). 1997;350(9090):1522. https://doi.org/10.1016/S0140-6736(05)63945-1.CrossRef

39.

Gerber W, Arheilger B, Ha TA, Hermann J, Ockenfels HM. Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach. Br J Dermatol. 2003;149(6):1250–8. https://doi.org/10.1111/j.1365-2133.2003.05709.x.CrossRefPubMed

40.

Mudigonda T, Dabade TS, Feldman SR. A review of targeted ultraviolet B phototherapy for psoriasis. J Am Acad Dermatol. 2012;66(4):664–72. https://doi.org/10.1016/j.jaad.2011.07.011.CrossRefPubMed

41.

Mysore V. Targeted phototherapy. Indian J Dermatol Venereol Leprol. 2009;75(2):119–25. https://doi.org/10.4103/0378-6323.48655.CrossRefPubMed

42.

Zhang P, Wu MX. A clinical review of phototherapy for psoriasis. Lasers Med Sci. October 2017;33(1):173–80. https://doi.org/10.1007/s10103-017-2360-1.CrossRefPubMedPubMedCentral

43.

Bulat V, Situm M, Dediol I, Ljubicic I, Bradic L. The mechanisms of action of phototherapy in the treatment of the most common dermatoses. Coll Antropol. 2011;35(Suppl 2):147–51.PubMed

44.

Shenoi SD, Prabhu S. Photochemotherapy (PUVA) in psoriasis and vitiligo. Indian J Dermatol Venereol Leprol. 2014;80(6):497–504. https://doi.org/10.4103/0378-6323.144143.CrossRefPubMed

45.

Zanolli M. Phototherapy treatment of psoriasis today. J Am Acad Dermatol. 2003;49(2 Suppl):S78–86.CrossRefPubMed

46.

Hunter HJA, Griffiths CEM, Kleyn CE. Does psychosocial stress play a role in the exacerbation of psoriasis? Br J Dermatol. 2013;169(5):965–74. https://doi.org/10.1111/bjd.12478.CrossRefPubMed

47.

Fortune DG, Richards HL, Kirby B, McElhone K, Markham T, Rogers S, et al. Psychological distress impairs clearance of psoriasis in patients treated with photochemotherapy. Arch Dermatol. 2003;139(6):752–6. https://doi.org/10.1001/archderm.139.6.752. CrossRefPubMed

48.

Piaserico S, Marinello E, Dessi A, Linder MD, Coccarielli D, Peserico A. Efficacy of biofeedback and cognitive-behavioural therapy in psoriatic patients: a single-blind, randomized and controlled study with added narrow-band ultraviolet B therapy. Acta Derm Venereol. 2016;96(217):91–5. https://doi.org/10.2340/00015555-2428. PubMed

49.

Kragballe K. Vitamin D and UVB radiation therapy. Cutis. 2002;70(5 Suppl):9–12.PubMed

50.

Aggarwal P, Aggarwal K, Jain VK. Tacalcitol: a useful adjunct to narrow band ultraviolet B phototherapy in psoriasis. J Dermatolog Treat. 2016;27(6):546–51. https://doi.org/10.3109/09546634.2016.1163318.CrossRefPubMed

51.

Dua I, Aggarwal K, Jain VK. Comparative evaluation of efficacy and safety of calcipotriol versus tacalcitol ointment, both in combination with NBUVB phototherapy in the treatment of stable plaque psoriasis. Photodermatol Photoimmunol Photomed. 2017;33(5):275–81. https://doi.org/10.1111/phpp.12324.CrossRefPubMed

52.

Al-Hamamy HR, Al-Mashhadani SA, Mustafa IN. Comparative study of the effect of narrowband ultraviolet B phototherapy plus methotrexate vs. narrowband ultraviolet B alone and methotrexate alone in the treatment of plaque-type psoriasis. Int J Dermatol. 2014;53(12):1531–5. https://doi.org/10.1111/ijd.12444.CrossRefPubMed

53.

Calzavara-Pinton PG, Sala R, Arisi M, Rossi MT, Venturini M, Ortel B. Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis. Br J Dermatol. 2013;169(1):130–6. https://doi.org/10.1111/bjd.12277.CrossRefPubMed

54.

Lynde CW, Gupta AK, Guenther L, Poulin Y, Levesque A, Bissonnette R. A randomized study comparing the combination of nbUVB and etanercept to etanercept monotherapy in patients with psoriasis who do not exhibit an excellent response after 12 weeks of etanercept. J Dermatol Treat. 2012;23(4):261–7. https://doi.org/10.3109/09546634.2011.607795.CrossRef

55.

Park KK, Wu JJ, Koo J. A randomized, “head-to-head” pilot study comparing the effects of etanercept monotherapy vs. etanercept and narrowband ultraviolet B (NB-UVB) phototherapy in obese psoriasis patients. J Eur Acad Dermatol Venereol. 2013;27(7):899–906. https://doi.org/10.1111/j.1468-3083.2012.04611.x.CrossRefPubMed

56.

Kagen M, Cao LY, Oyetakin-White P, Tacastacas JD, Yan C, McCormick TS, et al. Single administration of lesion-limited high-dose (TURBO) ultraviolet B using the excimer laser: clinical clearing in association with apoptosis of epidermal and dermal T cell subsets in psoriasis. Photodermatol Photoimmunol Photomed. 2012;28(6):293–8. https://doi.org/10.1111/j.1600-0781.2012.00692.x.CrossRefPubMed

57.

Al-Mutairi N, Al-Haddad A. Targeted phototherapy using 308 nm Xecl monochromatic excimer laser for psoriasis at difficult to treat sites. Lasers Med Sci. 2013;28(4):1119–24. https://doi.org/10.1007/s10103-012-1210-4.CrossRefPubMed

58.

Levin E, Debbaneh M, Malakouti M, Brown G, Wang E, Gupta R, et al. Supraerythemogenic excimer laser in combination with clobetasol spray and calcitriol ointment for the treatment of generalized plaque psoriasis: interim results of an open label pilot study. J Dermatol Treat. 2015;26(1):16–8. https://doi.org/10.3109/09546634.2013.860210.CrossRef

59.

Berneburg M, Herzinger T, Rampf J, Hoetzenecker W, Guenova E, Meisner C, et al. Efficacy of bath psoralen plus ultraviolet A (PUVA) vs. system PUVA in psoriasis: a prospective, open, randomized, multicentre study. Br J Dermatol. 2013;169(3):704–8. https://doi.org/10.1111/bjd.12466.CrossRefPubMed

60.

El-Mofty M, Mostafa WZ, Yousef R, Abdel Halim MRE, el Hawary M, Abdel Kader H, et al. Broadband ultraviolet A in the treatment of psoriasis vulgaris: a randomized controlled trial. Int J Dermatol. 2014;53(9):1157–64. https://doi.org/10.1111/ijd.12317.CrossRefPubMed

61.

Su L-N, Xu X, Tang L, Yu N, Ding Y-F. UVA1 phototherapy in the treatment of palmoplantar pustulosis: a pilot prospective study. Lasers Med Sci. 2016;31(8):1641–3. https://doi.org/10.1007/s10103-016-2031-7.CrossRefPubMed

62.

Aggarwal K, Khandpur S, Khanna N, Sharma VK, Pandav CS. Comparison of clinical and cost-effectiveness of psoralen + ultraviolet A versus psoralen + sunlight in the treatment of chronic plaque psoriasis in a developing economy. Int J Dermatol. 2013;52(4):478–85. https://doi.org/10.1111/j.1365-4632.2012.05692.x.CrossRefPubMed

63.

Gahalaut P, Soodan PS, Mishra N, Rastogi MK, Soodan HS, Chauhan S. Clinical efficacy of psoralen + sunlight vs. combination of isotretinoin and psoralen + sunlight for the treatment of chronic plaque-type psoriasis vulgaris: a randomized hospital-based study. Photodermatol Photoimmunol Photomed. 2014;30(6):294–301. https://doi.org/10.1111/phpp.12125.CrossRefPubMed

64.

Yilmaz A, Ozkiraz S, Akcan AB, Canpolat M. Low-cost home-use light-emitting-diode phototherapy as an alternative to conventional methods. J Trop Pediatr. 2015;61(2):113–8. https://doi.org/10.1093/tropej/fmu076.CrossRefPubMed

65.

Pfaff S, Liebmann J, Born M, Merk HF, von Felbert V. Prospective randomized long-term study on the efficacy and safety of UV-free blue light for treating mild psoriasis vulgaris. Dermatology. 2015;231(1):24–34. https://doi.org/10.1159/000430495.CrossRefPubMed

66.

Weinstabl A, Hoff-Lesch S, Merk HF, von Felbert V. Prospective randomized study on the efficacy of blue light in the treatment of psoriasis vulgaris. Dermatology. 2011;223(3):251–9. https://doi.org/10.1159/000333364.CrossRefPubMed

67.

Kleinpenning MM, Otero ME, van Erp PEJ, Gerritsen MJP, van de Kerkhof PCM. Efficacy of blue light vs. red light in the treatment of psoriasis: a double-blind, randomized comparative study. J Eur Acad Dermatol Venereol. 2012;26(2):219–25. https://doi.org/10.1111/j.1468-3083.2011.04039.x.CrossRefPubMed

68.

Kemeny L, Csoma Z, Bagdi E, Banham AH, Krenacs L, Koreck A. Targeted phototherapy of plaque-type psoriasis using ultraviolet B-light-emitting diodes. Br J Dermatol. 2010;163(1):167–73. https://doi.org/10.1111/j.1365-2133.2010.09763.x. PubMed

69.

•• Anderson KL, Feldman SR. A guide to prescribing home phototherapy for patients with psoriasis: the appropriate patient, the type of unit, the treatment regimen, and the potential obstacles. J Am Acad Dermatol. 2015;72(5):868–78. https://doi.org/10.1016/j.jaad.2015.02.003. Provides explanation pertaining to home phototherapy prescription for patients with psoriasis. CrossRefPubMed

70.

•• Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol. 2013;149(10):1180–5. https://doi.org/10.1001/jamadermatol.2013.5264. Highlights important psoriasis treatment topics such as patient dissatisfaction, undertreatment and treatment trends. CrossRefPubMed

Title: A Review and Update of Phototherapy Treatment Options for Psoriasis
Authors: Seth T. Howell
Leah A. Cardwell
Steven R. Feldman
Publication date: 01-03-2018
Publisher: Springer US
Published in: Current Dermatology Reports / Issue 1/2018
Electronic ISSN: 2162-4933
DOI: https://doi.org/10.1007/s13671-018-0211-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

A Review and Update of Phototherapy Treatment Options for Psoriasis

Abstract

Purpose of Review

Recent Findings

Summary

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 1/2018

Update on Oral Therapy for Psoriasis

Enteropathy in Psoriasis: A Systematic Review of Gastrointestinal Disease Epidemiology and Subclinical Inflammatory and Functional Gut Alterations

Evaluation of the Itchy Patient

Effects of Biologic Therapy on Cardiovascular Disease in Psoriasis

Update on Noninvasive Diagnostic Imaging and Management of Nonmelanoma Skin Cancer

Review Update on Topical Therapy for Psoriasis