Kristina Callis Duffin, MD, points out important information from her lecture Phototherapy on Saturday, November 5, 2022, at the PA/NP Elevate-Derm Conference in Tucson, Arizona.

In this video

In conversation with PA Douglas DiRuggiero, Dr. Duffin tackles the practical problem so many clinicians face: phototherapy keeps getting recommended, but most offices don't have a unit and it's hard to find nearby. Her answer for patients who want serious, medically prescribed treatment is prescribed home narrowband UVB i— "by far the best option." She warns against commercial tanning, which is 95 to 100% UVA with a clear association with melanoma, especially in young women, and notes natural sunlight is real but "tough to meter" i even though psoriasis often shows a seasonal, summer-improving pattern.

She describes the sweet spot for full-body units i patients with mostly trunk and extremity disease and thinner plaques, since narrowband UVB doesn't penetrate thick plaques deeply. Phototherapy is also a strong fit for patients who want to avoid systemics or biologics, including those pregnant, breastfeeding, or planning pregnancy, because it's very safe and easy to stop and start. On combining topicals, she has patients moisturize before the booth but avoid applying active topical agents right beforehand, since the light can deactivate them.

  • For serious, medically prescribed treatment, home narrowband UVB is "by far the best option" i the same UVB delivered in the office.
  • Avoid commercial tanning: units are 95 to 100% UVA with a clear melanoma association, especially in young women; sunlight helps some patients seasonally but is hard to dose.
  • Best candidates for full-body units have mostly trunk and extremity disease with thinner plaques; thick plaques don't get enough UVB penetration.
  • Phototherapy is very safe and easy to start and stop i a good choice for patients avoiding systemics or biologics, and for those pregnant, breastfeeding, or planning pregnancy; three times weekly for 12 weeks can match biologic-level efficacy.
  • Combining class I steroids with UV isn't a real contraindication; have patients moisturize before the booth but not apply active topicals right before light, which can deactivate them.