UVB Light Therapy:
What the science says about safety and efficacy

Clinically proven for the treatment of chronic skin conditions.

Psoriasis

Treatment options for psoriasis have expanded in recent years, UV light therapy remains an essential therapeutic option for patients with psoriasis. Phototherapy is efficacious, is cost-effective and generally lacks the systemic immunosuppressive properties of both traditional and biologic systemic therapies.

A randomized controlled trial of 100 patients demonstrated that NB (Narrow Band)-UVB therapy in the treatment of psoriasis has improved efficacy when compared with BB (Broad Band)-UVB therapy.

Menter, Korman et al. Guidelines of care for the management of psoriasis and psoriatic arthritis J Am Acad Dermatol 2010;62:114-35

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.

Menter A, Korman NJ, Elmets CA, et al.
J Am Acad Dermatol. 2010;62:114-35.

Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fifth of 6 sections of the guidelines of care for psoriasis, we discuss the use of ultraviolet (UV) light therapy for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients’ needs. We will discuss in detail the efficacy and safety as well as offer recommendations for the use of phototherapy, including narrowband and broadband UVB and photochemotherapy using psoralen plus UVA, alone and in combination with topical and systemic agents. We will also discuss the available data for the use of the excimer laser in the targeted treatment of psoriasis. Finally, where available, we will summarize the available data that compare the safety and efficacy of the different forms of UV light therapy.

Combining biologic and phototherapy treatments for psoriasis: safety, efficacy, and patient acceptability.

Farahnik B, Patel V, Beroukhim K, et al.
Psoriasis Targets and Therapy. 2016;6:105-111.

The efficacy and safety of biologic and phototherapy in treating moderate-to-severe psoriasis is well known. However, some patients may not respond well to biologic agents or phototherapy on their own and may require combination therapy. Skillfully combining a biologic agent and phototherapy may provide an additive improvement without much increase in risks. This study summarizes the current state of evidence for the efficacy and safety of combining biologics with phototherapy in the treatment of moderate-to-severe plaque psoriasis. The vast majority of phototherapy was narrowband ultraviolet B (NBUVB) radiation. Most cases reported enhanced improvement with combination therapy. Serious adverse events throughout the study duration were reported in <3% of the patients. Long-term adverse events cannot be excluded.

Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy.

Hearn RM, Kerr AC, Rahim KF, et al.
Br J Dermatol. 2008;159:931-5.

Narrow-band ultraviolet B (NB-UVB) phototherapy is a widely used treatment. Psoralen-UVA photochemotherapy (PUVA) increases skin cancer risk and some animal studies have raised the possibility of an increased risk with NB-UVB. This study assessed the effect of NB-UVB exposure treatment numbers on the risk of developing skin cancer. No significant association between NB-UVB treatment and BCC, SCC or melanoma. These reassuring results do not demonstrate the early increase in skin cancers that was found associated with PUVA treatment. However, cautious interpretation is required as the cohort contained relatively few patients who had a high treatment number and because the slow evolution of skin cancers may result in a delayed incidence peak. Ongoing risk assessment is therefore essential.

Vitiligo

AIMS: The purpose of this study is to know the efficacy and safety of NB (Narrow Band) UVB phototherapy in 150 patients with vitiligo.” “CONCLUSION: Our study proves that NB-UVB therapy is a safe and effective tool in the management of vitiligo, with good stability of repigmentation of repigmented sites during follow-up.

Kishan K, Rao GR, Gopal KV, et al. Evaluation of narrow-band UVB phototherapy in 150 patients with vitiligo. Indian J Dermatol Venereol Leprol. 2009;75(2):162-6.

The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo.

Mohammad TF, Al-Jamal M, Hamzavi IH, et al.
J Am Acad Dermatol. 2017;76(5):879-888.

Narrowband ultraviolet B light (NBUVB) is an important component of the standard of care in vitiligo treatment. However, there are no consistent guidelines regarding the dosing and administration of NBUVB in vitiligo. In this study, experts in vitiligo treatment make broad recommendations to assist dermatologists in the treatment of vitiligo with NBUVB phototherapy.

Randomized, parallel group trial comparing home-based phototherapy with institution-based 308 excimer lamp for the treatment of focal vitiligo vulgaris.

Guan STT, Theng C, Chang A.
J Am Acad Dermatol. 2015;27(4):733-735.

While phototherapy is a treatment of choice for vitiligo, it is time consuming and generally carried out in a health institution. This study compared home-based phototherapy with institution-based excimer. The home based phototherapy group had better efficacy with 72% and 50% in the group achieving good and excellent repigmentation, respectively, in contrast to only 54% and 36% in the excimer group. Although, the difference in response was not statistically significant, the observed differences in efficacy could be explained by the difference in compliance. The patients using home-based phototherapy demonstrated 92% adherence compared to 70% adherence in the excimer group.

Twenty-year follow-up using a postal survey of childhood vitiligo treated with narrowband ultraviolet-B phototherapy.

Lommerts JE, Njoo MD, de Rie MA, et al.
Br J Dermatol. 2017 Jan 24.

Vitiligo is a depigmenting skin disorder with an estimated prevalence of 1%. Childhood-onset vitiligo occurs in approximately a third of all cases. Early-onset childhood vitiligo tends to be a more extensive and progressive type of vitiligo. Narrowband ultraviolet-B (NB-UVB) phototherapy is an effective treatment option in active vitiligo and leads to >75% repigmentation in 14-75% of childhood cases. Although the European guidelines on vitiligo state that prolonged maintenance with NB-UVB treatment is not recommended because there is a potential risk of photodamage, none of the patients in this study reported melanoma or non-melanoma skin cancer. This study suggests NB-UVB phototherapy may be a safe and effective treatment option in childhood vitiligo and may change the natural course of the disease. More long-term observational and controlled studies are needed to address these important issues.

Eczema

UVB, in particular NB (Narrow Band) UVB, is now commonly chosen as the best therapeutic option due to its efficacy, availability and low risk.

Patrizi A, Raone B, Ravaiolo GM. Management of atopic dermatitis: safety and efficacy of phototherapy. Clin Cosmet Investig Dermatol. 2015;8:511-520.

Guidelines of care for the management of atopic dermatitis. Section 3. Management and treatment with phototherapy and systemic agents

Sidbury R, Davis DM, Cohen DE, et al.
J Am Acad Dermatol 2014;71:327-49.

Atopic dermatitis is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2% to 3% of adults. This guideline addresses important clinical questions that arise in atopic dermatitis management and care, providing recommendations based on the available evidence. In this third of 4 sections, treatment of atopic dermatitis with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option.

Management of atopic dermatitis: safety and efficacy of phototherapy

Patrizi A, Raone B, Ravaiolo GM.
Clin Cosmet Investig Dermatol. 2015;8:511-520.

Atopic dermatitis (AD) is a common chronic inflammatory skin disease that can affect all age groups. Phototherapy represents a valid second-line intervention in those cases where non-pharmacological and topical measures have failed. This review illustrates the main trials comparing the efficacy and safety of the different forms of phototherapy. Clinicians mainly refer to the indications included in the American Academy of Dermatology psoriasis guidelines devised by Menter et al in 2010. The efficacy of phototherapy (considering all forms) in AD has been established in adults and children, as well as for acute (UVA1) and chronic (NB-UVB) cases. Phototherapy is generally considered to be safe and well tolerated, with a low but established percentage of short-term and long-term adverse effects, with the most common being photodamage, xerosis, erythema, actinic keratosis, sunburn, and tenderness. A carcinogenic risk related to UV radiation has not been excluded. Phototherapy also has some limitations related to costs, availability, and patient compliance. In conclusion, phototherapy is an optimal second-line treatment for AD. It can be used as monotherapy or in combination with systemic drugs, in particular corticosteroids.

Narrowband ultraviolet B (NBUVB) phototherapy in children with moderate to severe eczema: a comparative cohort study.

Darne S, Leech SN, Taylor AEM.
Br J Dermatol. 2014;170(1):150-6.

Atopic dermatitis can usually be controlled with appropriate skin care and topical steroids or topical calcineurin inhibitors. However, more severe disease can disrupt the life of a child and his or her family. All too often, parents receive repeated courses of systemic steroids, which can cause HPA axis suppression and growth retardation. Systemic immunosuppressives also have undesirable side effects. This study shows that NB-UVB is a useful alternative for childhood atopic dermatitis, with few side effects. Compared with alternatives, it is cost effective and well tolerated, and, most likely, underutilized.

Light Therapy – Overview

For 20 years, light therapy has been used successfully to treat patients with skin diseases such as psoriasis, vitiligo and eczema. Physicians base light therapy dosing on published guidelines such as those established by the American Academy of Dermatology. Doctors consider the patient’s diagnosis, skin type and the individual’s response to therapy. For many chronic skin diseases, UVB (Ultraviolet B) is the phototherapy treatment of choice.

Light Therapy – Safety

During treatments, the Clarify handheld is placed directly on affected areas. Light is focused precisely on the treatment area, minimizing UV delivery to areas that don’t need it. If the device is lifted off the skin, light emission automatically pauses. For added safety, UV protective glasses are provided with each system and are highly recommended. Clarify also recommends treatments be performed indoors in a location away from children or pets to minimize exposure to others. Any concerns? CarePartners are available to help.

Light Therapy – Combination Therapy

On occasion, light therapy is the first and only method for treating a skin disease. More often, it is prescribed by physicians in combination with topical and oral medications.