Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis

May 7 2009

For patients with psoriasis, treatment with ultraviolet B (UVB) at home is as effective and as safe as conventional hospital based phototherapy, concludes a study published on bmj.com today.

Patients also find home UVB therapy less of a burden and are more satisfied with treatment, the findings show.

Psoriasis is a common, chronic inflammatory skin condition that causes significant disability to sufferers and their families. UVB treatment is safe and effective, but few patients in the UK ever receive it because of limited availability and time constraints (a course of treatment typically involves attending hospital three times each week for eight to 10 weeks).

Furthermore, most dermatologists believe that home phototherapy is inferior to hospital treatment and that it carries more risks, despite there being no evidence to support this.

So a team of researchers in the Netherlands compared the safety and effectiveness of home phototherapy with standard hospital based phototherapy. They identified 196 patients with psoriasis from 14 hospital dermatology departments. Patients were randomised to receive either home UVB phototherapy or hospital based phototherapy.

The home group used a phototherapy unit in their homes, while the hospital group received the treatment at their local hospital. Both treatment at home and at the hospital were applied according to standard routine practice. Disease severity after treatment was measured using recognised scoring scales. Side effects and total cumulative dose of UVB were also recorded.

Both groups completed questionnaires to assess the burden of treatment, quality of life and patient satisfaction for the two treatment settings.

The results show that home phototherapy is equally safe and equally effective as outpatient phototherapy, both clinically and in terms of quality of life. Patients treated at home reported a significantly lower burden of treatment and greater satisfaction with treatment.

And the majority of patients said they would prefer home UVB therapy over hospital based therapy in the future.

This study clearly shows that home UVB phototherapy is a good alternative that should be considered instead of the standard outpatient UVB phototherapy for patients with psoriasis, say the authors. They suggest that current guidelines should be updated to reflect this.

This study highlights an important gap in the provision of treatment for patients with psoriasis and it is timely to reassess conventional treatments such as UVB, writes Professor Alex Anstey from the Royal Gwent Hospital, in an accompanying editorial.

To make home based phototherapy become a reality, an economic assessment of different UVB service models is needed, he says. Meanwhile, healthcare commissioners should work with local dermatologists to improve access to UVB phototherapy services.

Experience in Germany, the US, the Netherlands, and Scotland confirms that it would be feasible and practical to implement home based UVB phototherapy, he concludes.