Psoriasis guidelines reflect rise of NB-UVB, targeted and home therapies – Dermatology Times

The latest American Academy of Dermatology-National Psoriasis Foundation phototherapy guidelines incorporate several advances in efficacy, safety and patient convenience that were unavailable a decade ago.

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Weve come a long way in the field of phototherapy over the last 10 years, says M. Alan Menter, M.D. He is chairman of dermatology at Baylor University Medical Center, co-chair of the AAD Psoriasis Guideline Workgroup and founder of the International Psoriasis Council.

To produce the phototherapy guidelines, Dr. Menter and co-authors reviewed available data regarding previous phototherapy modalities, along with newer technologies including narrowband UVB (NB-UVB). With a wavelength of 290 to 320 nm, NB-UVB offers greater specificity and targeting for psoriasis and eczema than does broadband UVB (BB-UVB, 290 to 400 nm).

Formerly the mainstay of phototherapy, BB-UVB has been replaced by newer modalities. As monotherapy for adults with generalized plaque psoriasis, guidelines state, BB-UVB provides less efficacy than does NB-UVB, oral psoralen plus UVA (PUVA) or topical PUVA. Very few dermatologists still use oral PUVA, says Dr. Menter, although it works well for resistant psoriasis.

Now we also have intense electrodes and dye lasers, which are smaller lamps that penetrate much better for focal areas such as thick psoriasis patches on the elbows or knees, he says. Such technologies include excimer lasers (308 nm), targeted NB-UVB (311 to 313 nm) and pulsed-dye lasers (PDLs).

Whichever technology one chooses, guidelines emphasize the need to tailor dosing to the patients skin type. For example, minimal erythema dose (MED) testing with NB-UVB should begin at 250 mJ/cm2 for patients with skin types I and II, versus 350 mJ/cm2 for types III and IV.

Whereas Goeckerman therapy was a difficult, messy and time-consuming combination of light therapy and tar treatment, Dr. Menter says, physicians can supplement NB-UVB with concomitant topical therapies such as vitamin D analogs, retinoids and corticosteroids to potentially boost efficacy.

Disclosures:

Dr. Menter reports no relevant financial interests.

References:

Elmets CA, Lim HW, Stoff B, et al. Joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management and treatment of psoriasis with phototherapy. J Am Acad Dermatol. 2019;81:775-804.

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Psoriasis guidelines reflect rise of NB-UVB, targeted and home therapies - Dermatology Times