Phototherapy: Uses in the Era of Biologics

• side effects of phototherapy with NBUVB:

1. In the treatment of Psoriasis: no increase in incidence of BCC (Basal Cell Carcinoma), SCC (Squamous Cell Carcinoma) or Melanoma. Slight increase in incidence of BCC when treatment combined with PUVA.
2. in the treatment of Vitligo: long term Side Effects SE unknown, but risk of NMSC (Non melanoma skin cancer), probably safe for short term use.

• Biologics:

1. PASI 75 improvement: NBUVB and PUVA are as effectve as infliximab (Remicade), adalimumab (Humira) and ustekimumab (Stelara). But treatment with biologics for the duration of a year is at least 50 times more expensive. The most cost-effective treatments (efficiency) are NBUVB, PUVA (as well as methotrexate).
2. To summarize NBUVB treatment is: effective, known (decades of experience with this treatment) and cheaper but the disadvantage is that treatment sessions need to be repeated 2-3 times a week. However, the long term side effects of biologics are not known, and they are quite expensive

• UVA1 is used for the treatment of morphea, systemic sclerosis, scleredema, atopic dermatitis, urticaria pigmentosa (mastocytosis) and, CTCL (Cutaneous T cell Lymphoma). It acts by inducing collagenase (MMP 1:  Matrix Metalloproteinase 1) and cell apoptosis. It is the first line treatment for sclerodermoid changes. It is well tolerated but induces pigmentation of the skin. Short term use safe but long term side effects are not known

Source of information: Lim H. Advances on Photodermatology. 2012 (02) – 20th Regional Conference of Dermatology (RCD) – Manila, Phillipines