Efficacy of Phototherapy in Psoriasis
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In this interview, Dr Tina Bhutani discusses the benefits and limitations of phototherapy for treating psoriasis, emphasizing its effectiveness across different psoriasis types and its coverage by insurance plans, while noting that newer biologics and systemic therapies have influenced its usage.
The Dermatologist: What are the main benefits and limitations of phototherapy for treating psoriasis?
Dr Bhutani: The main benefit of phototherapy is that it tends to work well in all types of psoriasis. And with a technician who is apt at dosing phototherapy and making sure it is being delivered correctly, we can be confident in telling our patients that it is going to help their psoriasis. Another advantage of phototherapy is that it is usually covered by most medical plans, even Medicare and Medicaid plans and government health plans, whereas we often have trouble getting systemic agents authorized for these patients, or it takes a lot of effort. In those cases, phototherapy can also be a great option. Some of the limitations are mainly around scheduling. Most of the time, it requires patients to come into the office 2 or 3 times a week, and this might be inconvenient for many patients and may not be possible. However, we also have home phototherapy available, and we now have evidence and data to show that home phototherapy is not only safe, but it can also be really effective, even for patients who have never done phototherapy in office before. With a little education, picking the right patient for home phototherapy is an option, and in that way, it takes away a lot of the inconvenience of in-office phototherapy.
The Dermatologist: In which patient population is phototherapy most effective for managing psoriasis?
Dr Bhutani: We know that phototherapy is effective for plaque psoriasis, but we also have evidence that it works for guttate psoriasis, and it can work for inverse disease. There are some conditions where we would not want to treat patients with phototherapy, such as pustular psoriasis or erythrodermic psoriasis, those with a history of skin cancers, and patients who have autoimmune conditions or photosensitive disorders. As far as different patient populations, phototherapy works well across the board if it is being dosed optimally. And we know that, for example, patients with darker skin tones might need more phototherapy or more light compared to patients with lighter skin tones.
The Dermatologist: How has the role of phototherapy evolved with the advent of newer therapies?
Dr Bhutani: I think it is a great time for patients with psoriasis because we have so many treatment options. However, with the advent of new systemics and biologics, we have seen a decline in the use of phototherapy. Obviously, these new treatments are very effective. Some of them are very safe, and they are often much more convenient than patients coming into the office to get phototherapy. But I think there are still a lot of patients who prefer phototherapy over medication that they have to put inside their body.
The Dermatologist: How can dermatologists optimize the use of phototherapy for psoriasis in their practice?
Dr Bhutani: I think the biggest tip is to offer phototherapy in your office. If it is in your office and an option for patients when you are providing all the options to them, many of them will opt for phototherapy. Currently, we have a lot of people working remotely from home and I have many patients who prefer phototherapy because it gets them out of the house a couple of times a week. Consider investing in a phototherapy box for your practice or talking to the leadership where you work to see if phototherapy can be utilized. Reimbursement for phototherapy may be available in your state, which can be beneficial for practice health.
