The 2019 joint American Academy of Dermatology and National Psoriasis Foundation phototherapy treatment of psoriasis guidelines comprehensively updates dermatologists and other providers on the state-of-the art use of various light modalities to treat psoriasis patients.
The update addresses modalities ranging from well-established approaches such as narrow band phototherapy to more novel approaches such as photodynamic therapy (PDT), according to an author of the guidelines published September 2019 in the Journal of the American Academy of Dermatology (JAAD), Joel M. Gelfand, M.D., MSCE, professor of dermatology and epidemiology and director of the Psoriasis and Phototherapy Treatment Center at the University of Pennsylvania Perelman School of Medicine, Philadelphia.
“The most important point of these guidelines is the fact that despite all the exciting new therapies available for psoriasis, phototherapy remains a safe, viable, effective option for our patients,” according to guidelines author Mark Lebwohl, M.D., Waldman Professor and Chair of the Kimberly and Eric J. Waldman department of dermatology at the Icahn school of medicine at Mount Sinai, New York. “For patients who want a therapy that has been used safely for a century or when comorbidities limit the use of systemic therapies, phototherapy is a safe, effective, accessible therapy.”
AMONG THE RECOMMENDATIONS
U.S. and Canadian psoriasis experts reviewed the literature from early 2008 to late 2017 focusing on the ultraviolet (UV) light-based therapies. Of special importance, guidance on dosing of officebased narrowband UVB phototherapy was updated from 2009 guidelines, which should result in better treatment outcomes for patients,” Dr. Gelfand says.
Narrowband UVB therapy’s starting dose and the dosing schedule are based on skin type. For example, the recommended initial narrowband UVB dose for patients with skin types I and II is 300 mJ/cm2, while it’s 800 mJ/cm2 for psoriasis patients who are skin types V and VI. And the guidelines recommend treating patients with narrowband UVB two or three times per week for proven efficacy, which doesn’t expose patients to more-than-needed UVB radiation and avoids increased risk of UV-induced erythema.
Dr. Lebwohl served as a consultant for Allergan, Almirall, Arcutis, BoehringerIngelheim, Bristol-Myers Squibb, CastleBiosciences, Leo Pharma, Menlo Therapeutics, Mitsubishi Pharma, Neuroderm LTD, Pfizer, Promius/Dr Reddy, Theravance Biopharma, and Verrica Pharmaceuticals, receiving honoraria; as a principal investigator or investigator for
AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Celgene Corporation, Eli Lilly and Company, Incyte Corporation, Janssen Research and Development/Johnson & Johnson, Leo Pharma, Medimmune, Novartis Pharmaceuticals Corp, Ortho-Dermatologics, Pfizer, Inc, SCIDerm, UCB, and ViDac Pharma receiving grants and/or research funding; and in another role for Corrona, Inc. Facilitation of International Dermatology Education, and the Foundation for Research and Education in Dermatology, receiving honoraria.
Dr. Gelfand served as a consultant for AbbVie, BMS, Boehringer Ingelheim, Dermira, Dr Reddy, GlaxoSmithKline, Janssen Pharmaceuticals, Menlo Therapeutics, Novartis Pharmaceuticals Corp, Pfizer, Regeneron, Sanofi US Services, UCB (DSMB), and Valeant Pharmaceuticals North America LLC, receiving honoraria; as a consultant for BMS, receiving fees; as a speaker and/or faculty educator for CME supported by Eli Lilly and Company, receiving fees; as a principal investigator for AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly and Company, Janssen Pharmaceuticals, Novartis Pharmaceuticals Corp, Ortho Dermatologics, Pfizer, Inc, Regeneron, and Sanofi/Sanofi US Services, receiving grants/research funding; as an investigator for Sanofi, receiving grants and/or research funding; as an advisory board member for Sanofi US Services, receiving honoraria; as a data safety monitoring board member for Coherus Biosciences and Merck& Co, Inc, receiving honoraria. In addition, Dr. Gelfand has received payment for CME work related to psoriasis that was supported indirectly by Lilly and Company, Ortho Dermatologics, and Novartis; served in another role for Elsevier, Inc, receiving no compensation; served in another role for Eli Lilly and Company and UCB, receiving fees; and served in another role for Resiquimod, receiving patent royalties or other compensation for intellectual rights.
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(3):775-804.