Single Course of NBUVB Phototherapy Reduces Prescription Burden
Some of the more interesting phototherapy research comes from Scotland. Having, in practice, adopted narrowband UVB phototherapy some five plus years earlier than in North America, they have many years of excellent, prospective, record keeping coupled with a stable population with a high incidence of both psoriasis and non-melanoma skin cancer. As an example, some of the strongest research detailing the lack of carcinogenic risk in narrowband phototherapy patients has come from the Scottish Cancer Registry and Photonet database, as reported by the University of Dundee group.
A newly reported prospective study from the same group looks into both the efficacy of narrowband phototherapy in psoriasis, and the effect on prescription rates following a single course of therapy. Although the strong efficacy results (75% of patients reached “clear/minimal disease”) are not wholly unexpected, the investigation of prescription rates is novel and unique.
Some 1700 psoriasis patients were selected, and their prescription records from 12 months prior to and 12 months following a single course of narrowband phototherapy (not to exceed 16 weeks, but averaging around 9 weeks) were analyzed. A typical course of therapy involved 21-37 treatments, which is consistent with what has been reported by other narrowband psoriasis studies.
A significant effort was made to reduce confounding variables in that many psoriatic patients were being treated for a number of commodities. If anything, the study design appears overly conservative, as it would have been expected that by 12 months after a single course of narrowband phototherapy, a significant portion of patients would have relapsed and required new treatment interventions.
Overall, the rate of patients requiring steroid creams dropped by 24%, those requiring psoriasis specific topicals dropped by 31%, and the number requiring antihistamines dropped by 38%. As mentioned above, these numbers would likely have been higher if the follow-up period was reduced, or a subsequent course of phototherapy had been offered.
One of the more interesting results is the decrease in antihistamine prescriptions from 22.4% to 14% within the study cohort. This apparently only speaks to actually prescribed antihistamines, and in light of the variety of over-the-counter antihistamine preparations also available, may under report this treatment effect. The study’s authors surmise that this reduction in antihistamine use is correlated to pruritus either related to their psoriasis, or to unrelated comorbid pruritus that would also be reduced following UVB phototherapy.
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 Hearn, et al. Incidence of skin cancers in 3867 patients treated with narrow-band ultraviolet B phototherapy.. Br J Dermatol. 2008 Sep;159(4):931-5. doi: 10.1111/j.1365-2133.2008.08776.x.
 Foerster, et al. Narrowband UVB treatment is highly effective and causes a strong reduction in the use of steroid and other creams in psoriasis patients in clinical practice. PLoS One. 2017 Aug 3;12(8):e0181813. doi: 10.1371/journal.pone.0181813. eCollection 2017.
 Halasz. Narrowband UVB phototherapy for psoriasis: results with fixed increments by skin type (as opposed to percentage increments). Photodermatol Photoimmunol Photomed. 1999 Apr;15(2):81-4.