Home phototherapy

Author: Anoma Ranaweera B.V. Sc; PhD (Clinical Biochemistry, University of Liverpool, UK), 2013.


What is home phototherapy?

Phototherapy is the use of light or other forms of non-ionising electromagnetic radiation in treatment. The light or radiation is produced by a medical device commonly referred to as a phototherapy unit.

The most commonly used medical lamps in phototherapy units emit a narrow band of ultraviolet (UV) radiation, which reduces or eliminates various skin diseases, at least temporarily.

Home phototherapy is a relatively safe and effective non-drug option for the self-treatment of skin disorders in the privacy and convenience of a patient's home. Phototherapy should be controlled and supervised by an experienced physician. However, not all dermatologists agree to oversee home phototherapy because of the potential for adverse reactions.

Treatment can be delivered to the skin of the whole body or it can be precisely targeted to affected areas to minimise exposure of uninvolved skin.

Home phototherapy

Indications for home phototherapy

Skin conditions treated by home phototherapy may include:

Home therapy is not suitable for all patients with these skin conditions and results vary.

Home phototherapy devices

Home phototherapy units range from hand-held and table-top devices for spot treatment of small areas of affected skin to cabinet or “walk-in” units for patients requiring full body treatment.

Well-known companies providing home phototherapy units include Daavlin, UVABiotek (Hudson Falls, NY, USA), Solarc Systems Inc (Ontario, Canada) and National Body Corp (Ohio, USA). These companies provide full-body wrap around and single panel systems, plus hand/foot units.

Unregulated home phototherapy devices are also marketed online. Their safety and efficacy are unknown.

Benefits of home phototherapy

  • Home equipment manages dosage for the patient and prevents unauthorized use.
  • Incorporates software for physician control of dosimetry.
  • Precise targeting minimizes exposure of uninvolved skin areas and facilitates controlled and rapid treatment.
  • Is cost-effective.
  • Has narrowband UVB, broadband UVB and UVA radiation options.
  • High output lamps shorten treatment times.
  • Easy to operate patient interface.
  • Accommodates patients of any body type, skin color or size.
  • Eliminates time consuming trips to the phototherapy clinic.
  • Makes it easier to keep to a treatment schedule – fewer missed visits and better results.
  • Allows patients to go directly from the shower or bath to the lights. This improves the treatment’s effectiveness.
  • In the USA, device purchase is covered by many health insurance plans.

How often are treatments taken?

Psoriasis

Initially, treatments to clear plaque psoriasis are taken 3 to 5 times per week. Your doctor may recommend stopping treatment once the psoriasis is clear. Some patients will continue treatment less frequently during a maintenance regime.

Vitiligo

Treatments for vitiligo are usually taken twice per week, never on consecutive days because of the risk of burning the white skin. Treatment times are typically short.

Other skin conditions

Eczema and other less common skin diseases require physician guidance for treatment times and duration.

How long does it take to get results?

This depends on the skin condition.

In psoriasis, typically improvement is evident after about 10 treatments and it is uncommon to require more than 20-30 treatments to clear the skin. When the psoriasis recurs, your doctor may recommend another course of phototherapy. Phototherapy can be combined with topical and systemic medicines if required.

In vitiligo, effectiveness is assessed after 16 weeks or at least 30 treatments. If repigmentation is noted, it may be continued for many months but should be discontinued if progress slows.

Is a physician’s approval necessary for a home light therapy unit?

Like any other FDA-regulated medication or procedure, USA regulations state that phototherapy light systems used to treat psoriasis, eczema, vitiligo or other light-responsive conditions may not be sold to or by anyone without a valid prescription from a doctor.

Safety of home phototherapy

Home phototherapy is potentially hazardous, as UV radiation damages the skin and can cause serious burns (like sunburn). Excessive exposure to UV radiation may also lead to long-term skin ageing and skin cancer including melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).

Burning is more likely in fair-skinned people with Fitzpatrick skin types 1 and 2 compared to darker skinner people with Fitzpatrick skin types 4, 5 or 6. Burning is also more likely in people taking certain photosensitising medications including common antibiotics and anti-inflammatory medications. Tell your physician the names of all your prescribed and over-the-counter medicines before you start treatment, and check with your doctor if you start a new medication while undergoing home phototherapy.

Home therapy can be safe if dosing is carefully controlled. Side effects reported by one study included red skin (erythema, in 36%), blisters (1%), itch (8%), and dryness (1%).

Safety features in newer home phototherapy units include:

  • a key-locked ON/OFF switch to prevent unauthorized use
  • a built-in controlled prescription timer (CPT) that ensures that the equipment can only be used for a certain number of treatments as prescribed by the doctor between office visits
  • a fail-safe feature that disables the unit in the event of malfunction.

Such innovations make home phototherapy an appropriate option for many patients. Response to treatment and adverse events must be monitored carefully by your doctor.

 

Related Information

References:

  • Nolan BV, Yentzer BA, Feldman SR et al. A review of home phototherapy for psoriasis. Dermatology Online Journal 2010; 16 (2): 1
  • Haykal KA, DesGroseilliers JP. Are narrow-band ultraviolet B home units a viable option for continuous or maintenance therapy of photoresponsive diseases? J Cutan Med Surg 2006; 10(5):234-40.
  • Rajpara AN, O’Neill JL, Nolan BV et al. Review of home phototherapy. Dermatology Online Journal 2010;16 (12): 2
  • Koek MB, Buskens E, Van WH et al. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ 2009;338:b1542
  • Koek MB, Buskens E, Bruijnzeel-Koomen CA, et al. Home ultraviolet B phototherapy for psoriasis: discrepancy between literature, guidelines, general opinions and actual use. Results of a literature review, a web search, and a questionnaire among dermatologists. Br J Dermatol 2006 Apr;154(4):701-11.
  • Yelverton CB, Kulkarni AS, Balkrishnan R, et al. Home ultraviolet B phototherapy: a cost-effective option for severe psoriasis. Manag Care Interface 2006 Jan;19(1):33-6.
  • Wind BS et al. Home vs. outpatient narrowband ultraviolet B therapy for the treatment of nonsegmental vitiligo: a retrospective questionnaire study. British Journal of Dermatology 2010; 162 (5): 1142-1144.

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