Treatment with ultraviolet B (UVB) is as effective and safe when given at home as it is when delivered in hospital, Dutch researchers have found.
Although UVB therapy is an effective and safe treatment for psoriasis, few patients in the UK ever receive it because of limited availability and time constraints. When it is delivered in hospital, the patient must attend three times a week for eight to ten weeks.
Most dermatologists believe home therapy is inferior to hospital treatment and that it carries more risks, although there is no evidence to support this view.
Researchers in the Netherlands randomised 196 patients with psoriasis to receive either home UVB phototherapy or hospital based phototherapy. Both groups completed questionnaires to assess the burden of treatment, quality of life and patient satisfaction for the two treatment settings.
The results published in the BMJ showed that home phototherapy is equally safe and 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.
In an accompanying editorial, Professor Alex Anstey from the Royal Gwent Hospital in Wales said: “With new potent, but costly, biological treatments now widely available for moderate to severe psoriasis, it is timely to reassess conventional treatments such as UVB. It would be inappropriate for patients to receive these new and expensive treatments when the infrastructure to deliver well established cheaper treatments, such as UVB, is lacking.
“Dermatologists should reflect on the shortcomings of current phototherapy services, where many patients are excluded because they live too far from their local unit. The case for home provision of UVB phototherapy for psoriasis is most persuasive in sparsely populated areas.”
Experience in Germany, the US, the Netherlands, and Scotland has confirmed that it would be feasible and practical to implement home based UVB phototherapy.
“Now that safety and efficacy concerns have been tackled, an economic assessment of different UVB service models is needed,” Professor Anstey added.