- Steven R Feldman, MD, PhD
Steven R Feldman, MD, PhD
- Wake Forest University School of Medicine
Targeted phototherapy is the localized delivery of ultraviolet (UV) light to affected areas of skin using laser or nonlaser devices . 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 .
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.
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- 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.
- Mehraban S, Feily A. 308nm excimer laser in dermatology. J Lasers Med Sci 2014; 5:8.
- 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.
- Weichenthal M, Schwarz T. Phototherapy: how does UV work? Photodermatol Photoimmunol Photomed 2005; 21:260.
- Nickoloff BJ. Cracking the cytokine code in psoriasis. Nat Med 2007; 13:242.
- 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.
- 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.
- 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.
- Metz M, Ständer S. Chronic pruritus--pathogenesis, clinical aspects and treatment. J Eur Acad Dermatol Venereol 2010; 24:1249.
- Rivard J, Lim HW. Ultraviolet phototherapy for pruritus. Dermatol Ther 2005; 18:344.
- Hamzavi I, Lui H. Using light in dermatology: an update on lasers, ultraviolet phototherapy, and photodynamic therapy. Dermatol Clin 2005; 23:199.
- Buckland M, Smith JS, Hill D, Feldman SR. A review of localized office and home devices in the treatment of psoriasis. Journal of Psoriasis and Psoriatic Arthritis 2016; 2:22.
- Nolan BV, Yentzer BA, Feldman SR. A review of home phototherapy for psoriasis. Dermatol Online J 2010; 16:1.
- Tien Guan ST, Theng C, Chang A. Randomized, parallel group trial comparing home-based phototherapy with institution-based 308 excimer lamp for the treatment of focal vitiligo vulgaris. J Am Acad Dermatol 2015; 72:733.
- Simon JC, Pfieger D, Schöpf E. Recent advances in phototherapy. Eur J Dermatol 2000; 10:642.
- 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.
- McMichael AJ. Excimer laser: a module of the alopecia areata common protocol. J Investig Dermatol Symp Proc 2013; 16:S77.
- Al-Mutairi N, Al-Haddad A. Targeted phototherapy using 308 nm Xecl monochromatic excimer laser for psoriasis at difficult to treat sites. Lasers Med Sci 2013; 28:1119.
- 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.
- Heckman CJ, Chandler R, Kloss JD, et al. Minimal Erythema Dose (MED) testing. J Vis Exp 2013; :e50175.
- Mudigonda T, Dabade TS, Feldman SR. A review of protocols for 308 nm excimer laser phototherapy in psoriasis. J Drugs Dermatol 2012; 11:92.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Whitton ME, Pinart M, Batchelor J, et al. Interventions for vitiligo. Cochrane Database Syst Rev 2015; :CD003263.
- 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.
- Bae JM, Hong BY, Lee JH, et al. The efficacy of 308-nm excimer laser/light (EL) and topical agent combination therapy versus EL monotherapy for vitiligo: A systematic review and meta-analysis of randomized controlled trials (RCTs). J Am Acad Dermatol 2016; 74:907.
- 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.
- Lapolla W, Yentzer BA, Bagel J, et al. A review of phototherapy protocols for psoriasis treatment. J Am Acad Dermatol 2011; 64:936.
- 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.
- 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.
- Fikrle T, Pizinger K. [The use of the 308 nm excimer laser for the treatment of psoriasis]. J Dtsch Dermatol Ges 2003; 1:559.
- 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.
- PRINCIPLES AND MECHANISMS
- DEVICES FOR TARGETED PHOTOTHERAPY
- CLINICAL INDICATIONS
- DOSING AND TREATMENT REGIMENS
- COMBINATION THERAPIES
- TARGETED VERSUS FULL-BODY PHOTOTHERAPY
- SAFETY MEASURES
- SHORT- AND LONG-TERM ADVERSE EFFECTS
- SUMMARY AND RECOMMENDATIONS