SUBJECTS

methodS

Results

ConclusionS

LARKO AND SWANBECK (1979)

Patients with long-standing severe psoriasis (n=28)

Home phototherapy consisting of daily high-dose BB-UVB with induction of slight erythema. No concurrent use of antipsoriatic medication was permitted.

Efficacy: Complete remission of psoriatic lesions was observed in 20 of the 28 patients studied with 6.5 weeks (45 exposures) of treatment. Two of the 28 patients experienced no improvement in psoriatic lesions.

Adverse effects: 25 of 28 patients experienced some degree of phototoxicity, resulting in alteration of dosage schedule.

Jordan et al (1981)

Patients with extensive, recalcitrant psoriasis (n=56)

Home phototherapy with portable broad-spectrum UVB emitting source without induction of erythema. Patients were concurrently treated with topical coal tar.

Efficacy: Clearance of psoriatic lesions was achieved in 55 of 56 patients after 8 weeks of UVB treatment.

Adverse Effects: No significant phototoxic episodes were reported in any of the patients.

Resnik et al (1993)

Patients with patch and early plaque stage mycosis fungiodes (n=31)

Home phototherapy consisting of erythemogenic doses of UBV, delivered with single panel of Westinghouse FS40 fluorescent lamps). Each body irradiated separately and treatment was time-consuming

Efficacy: Complete clinical and histopathologic clearance with prolonged remission was achieved in 28 of the 31 patients treated. In general, phototherapy was well-tolerated.

Adverse Effects: Minor phototoxic episodes occurred as dose was increased, but was not great enough to warrant cessation of treatment. Phototherapy was without significant photodamage or photocarcinogenicity.

Home UVB phototherapy may be an appropriate therapeutic option for the treatment of patients with early mycoses fungiodes

Sjovall and Christensen (1994)

Patients with chronic hand eczema (n=26).

Treatment consisted of high output UV-B irradiation delivered by Handylux 4-5 times per week for approximately 10 weeks at home or at outpatient clinics in patients.

Efficacy: 15 patients were treated as outpatients and 11 at home. Two of the outpatient subjects dropped out. No patients demonstrated complete clearance. Overall, 18 of 24 were much improved and 6 of 26 were improved. In the home treatment group, 7 of 11 were much improved and 4 were improved. In the outpatient group, 11 of 13 were much improved and 2 were improved.

Adverse Effects: Side-effects included burning and stinging were dose-dependent. Patients using topical corticosteroids for a long time were more prone to side-effects.

High dose UV-B in is effective and offers opportunity to treat patients with chronic, recalcitrant hand eczema at home.

Cameron et al (2002)

Patients with a variety of photoresponsive diseases, including chronic plaque psoriasis (n=23) guttate psoriasis (n=1), atopic dermatitis (n=4), granuloma annulare (n=2), lichen planopilaris (n=1), and psoriasiform dermatitis (n=1)

Home NB-UVB phototherapy using TL-01 unit with accurate dosimetry.

Efficacy: Of the 23 psoriasis patients included, complete clearance was achieved in 18 and moderate improvement was observed in 3. Clearance was achieved in the patient with guttate psoriasis. Of the 4 patients with atopic dermatitis treated, 1 had minimal residual activity and 3 showed marked/moderate improvement. Of the two patients with granuloma annulare, 1 demonstrated minimal residual activity, and the other had moderate clearance. The patient with lichen planopilaris demonstrated marked improvement and the patient with psoriasiform dermatitis had moderate clearance.

Adverse Effects: Adverse effects included erythema: 62% of patients experienced Grade 1 erythema, 42% Grade 2 erythema, and 26% Grade 3 erythema. No cases of Grade 4 erythema were reported.

UVB TL-01 is a useful practical development that is similar to outpatient treatment. It is safe and cost-effective.

YELVERTON ET AL (2008)

Patients with moderate-to-severe plaque-type psoriasis with PASI >12 (n=27)

Treatment with narrow-band UVB phototherapy three times per week (with exposure time based on skin type and response) in combination with oral acitretin daily (25 mg dose daily modified as needed). Concurrent topical regimens and emollients were permitted. Efficacy assessed with PASI and DLQI at 2, 4, 8, and 12 weeks of therapy.

Efficacy: Twenty-two patients completed the study. Prior to treatment, mean baseline PASI was 18.6. This decreased to 13.9 after 12 weeks of combined therapy, representing a 22% improvement. DLQI responses demonstrated increased quality of life and a high level of satisfaction with treatment.

Adverse Effects: Mild alopecia and photosensitivity were reported in all subjects. Elevated triglyceride level was increased in several subjects and necessitated decrease in acitretin dose in 4 patients.

Home phototherapy with narrow-band UVB and oral acitretin is effective and well-tolerated in patients with psoriasis. Subjects were interested in continuing therapy after completion of study.

KOEK ET AL (2009)

Patients with psoriasis who were eligible for narrow-band UVB phototherapy (n=196).

A pragmatic, single-blind, randomized clinical trial comparing NB-UVB home phototherapy using a TL-01 unit and standard NB-UVB outpatient phototherapy. Primary outcome was effectiveness which was assessed by the proportion of patients with ≥50% reduction of the baseline PASI or SAPASI (called PASI 50 and SAPASI 50), the reduction in median scores on PASI and SAPASI, and the proportion reaching PASA/SAPASI 75 and 90. Secondary outcomes were quality of life, burden of treatment, patients’ preferences and satisfaction , dosimetry and short-term side effects.

Efficacy: Of the patients treated at home, 82% and 70% reached SAPASI 50 and PASI 50, respectively, compared with 79% and 73% of the patients receiving outpatient treatment. SAPASI and PASI decreased by 82% and 74%, respectively, in patients undergoing home phototherapy compared with 79% and 70% for patients treated with outpatient phototherapy. Treatment effect (defined by mean reduction in PASI and SAPASI scores), total cumulative doses of UVB, side-effects, and increase in quality of life were similar between the two groups. The burden associated with treatment was significantly lower for patients in the home phototherapy group compared to the outpatient group.

Adverse effects: Similar in the two groups and included burning sensation, mild and severe erythema, and blistering.

Home UVB phototherapy is equally safe and effective (in terms of clinical resolution and improvement in quality of life) compared with standard outpatient UVB phototherapy. Additionally, home UVB phototherapy demonstrated a lower burden of treatment and associated greater patient satisfaction.