UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Targeted phototherapy

Author
Steven R Feldman, MD, PhD
Section Editor
Craig A Elmets, MD
Deputy Editor
Rosamaria Corona, MD, DSc

INTRODUCTION

Targeted phototherapy is the localized delivery of ultraviolet (UV) light to affected areas of skin using laser or non-laser devices [1]. This treatment modality may be useful in some patients with psoriasis, vitiligo, and other inflammatory or lymphoproliferative skin conditions (table 1) involving a limited area of the body (<10 percent of the body surface area) or difficult-to-treat anatomical areas [2].

This topic will discuss the mechanism of action, clinical indications, treatment protocols, and side effects of targeted phototherapy. Psoralen plus ultraviolet A (PUVA), UVB, and UVA1 phototherapy are discussed separately.

(See "Psoralen plus ultraviolet A (PUVA) photochemotherapy".)

(See "UVB therapy (broadband and narrowband)".)

(See "UVA1 phototherapy".)

            

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Oct 13 00:00:00 GMT 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Aubin F, Vigan M, Puzenat E, et al. Evaluation of a novel 308-nm monochromatic excimer light delivery system in dermatology: a pilot study in different chronic localized dermatoses. Br J Dermatol 2005; 152:99.
  2. Mehraban S, Feily A. 308nm excimer laser in dermatology. J Lasers Med Sci 2014; 5:8.
  3. Garmyn M, Yarosh DB. The molecular and genetic effects of ultraviolet radiation exposure on skin cells. In: Photodermatology, Lim HW, Honigsmann H, Hawk JL (Eds), Informa Healthcare USA, Inc, New York 2007. p.41.
  4. Weichenthal M, Schwarz T. Phototherapy: how does UV work? Photodermatol Photoimmunol Photomed 2005; 21:260.
  5. Nickoloff BJ. Cracking the cytokine code in psoriasis. Nat Med 2007; 13:242.
  6. Novák Z, Bónis B, Baltás E, et al. Xenon chloride ultraviolet B laser is more effective in treating psoriasis and in inducing T cell apoptosis than narrow-band ultraviolet B. J Photochem Photobiol B 2002; 67:32.
  7. Bianchi B, Campolmi P, Mavilia L, et al. Monochromatic excimer light (308 nm): an immunohistochemical study of cutaneous T cells and apoptosis-related molecules in psoriasis. J Eur Acad Dermatol Venereol 2003; 17:408.
  8. Goldstein NB, Koster MI, Hoaglin LG, et al. Narrow Band Ultraviolet B Treatment for Human Vitiligo Is Associated with Proliferation, Migration, and Differentiation of Melanocyte Precursors. J Invest Dermatol 2015; 135:2068.
  9. Metz M, Ständer S. Chronic pruritus--pathogenesis, clinical aspects and treatment. J Eur Acad Dermatol Venereol 2010; 24:1249.
  10. Rivard J, Lim HW. Ultraviolet phototherapy for pruritus. Dermatol Ther 2005; 18:344.
  11. Hamzavi I, Lui H. Using light in dermatology: an update on lasers, ultraviolet phototherapy, and photodynamic therapy. Dermatol Clin 2005; 23:199.
  12. Simon JC, Pfieger D, Schöpf E. Recent advances in phototherapy. Eur J Dermatol 2000; 10:642.
  13. Chimento SM, Newland M, Ricotti C, et al. A pilot study to determine the safety and efficacy of monochromatic excimer light in the treatment of vitiligo. J Drugs Dermatol 2008; 7:258.
  14. Asawanonda P, Anderson RR, Chang Y, Taylor CR. 308-nm excimer laser for the treatment of psoriasis: a dose-response study. Arch Dermatol 2000; 136:619.
  15. Heckman CJ, Chandler R, Kloss JD, et al. Minimal Erythema Dose (MED) testing. J Vis Exp 2013; :e50175.
  16. Mudigonda T, Dabade TS, Feldman SR. A review of protocols for 308 nm excimer laser phototherapy in psoriasis. J Drugs Dermatol 2012; 11:92.
  17. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 5. Guidelines of care for the treatment of psoriasis with phototherapy and photochemotherapy. J Am Acad Dermatol 2010; 62:114.
  18. Asawanonda P, Nateetongrungsak Y. Methotrexate plus narrowband UVB phototherapy versus narrowband UVB phototherapy alone in the treatment of plaque-type psoriasis: a randomized, placebo-controlled study. J Am Acad Dermatol 2006; 54:1013.
  19. Ozkan I, Köse O, Ozmen I, Arca E. Efficacy and safety of non-laser, targeted UVB phototherapy alone and in combination with psoralen gel or calcipotriol ointment in the treatment of localized, chronic, plaque-type psoriasis. Int J Dermatol 2012; 51:609.
  20. Calzavara-Pinton PG, Sala R, Arisi M, et al. Synergism between narrowband ultraviolet B phototherapy and etanercept for the treatment of plaque-type psoriasis. Br J Dermatol 2013; 169:130.
  21. Kircik L, Bagel J, Korman N, et al. Utilization of narrow-band ultraviolet light B therapy and etanercept for the treatment of psoriasis (UNITE): efficacy, safety, and patient-reported outcomes. J Drugs Dermatol 2008; 7:245.
  22. Inzinger M, Legat FJ, Hofer A, et al. Short- to intermediate-term follow-up in patients treated with the combination of 311-nm ultraviolet B phototherapy and biological agents. Br J Dermatol 2014; 171:915.
  23. Lu-yan T, Wen-wen F, Lei-hong X, et al. Topical tacalcitol and 308-nm monochromatic excimer light: a synergistic combination for the treatment of vitiligo. Photodermatol Photoimmunol Photomed 2006; 22:310.
  24. Whitton ME, Pinart M, Batchelor J, et al. Interventions for vitiligo. Cochrane Database Syst Rev 2015; :CD003263.
  25. Lebwohl M, Drake L, Menter A, et al. Consensus conference: acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol 2001; 45:544.
  26. Lapolla W, Yentzer BA, Bagel J, et al. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol 2011; 64:936.
  27. Kampitak T, Asawanonda P. The efficacy of combination treatment with narrowband UVB (TL-01) and acitretin vs narrowband UVB alone in plaque-type psoriasis: a retrospective study. J Med Assoc Thai 2006; 89 Suppl 3:S20.
  28. Lebwohl M, Martinez J, Weber P, DeLuca R. Effects of topical preparations on the erythemogenicity of UVB: implications for psoriasis phototherapy. J Am Acad Dermatol 1995; 32:469.
  29. Fikrle T, Pizinger K. [The use of the 308 nm excimer laser for the treatment of psoriasis]. J Dtsch Dermatol Ges 2003; 1:559.
  30. Feldman SR, Mellen BG, Housman TS, et al. Efficacy of the 308-nm excimer laser for treatment of psoriasis: results of a multicenter study. J Am Acad Dermatol 2002; 46:900.