Care for the Management of Psoriasis with Phototherapy
Publication Date: July 1, 2019
Last Updated: March 14, 2022
Recommendations for NB-UVB
NB-UVB phototherapy is recommended for adults with plaque psoriasis as monotherapy. (A)
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The recommended starting dose for NB-UVB phototherapy for adults with generalized plaque psoriasis should be based on the MED or determined by using a fixed dose or skin phototype protocol. (A)
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During the treatment phase, 3-times/wk dosing of NB-UVB phototherapy for adults with generalized plaque psoriasis is recommended. (B)
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Short-term PUVA monotherapy is more efficacious than NB-UVB for treatment of psoriasis in adults. (B)
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Though less effective, NB-UVB is preferred to PUVA monotherapy for the treatment of psoriasis in adults because of enhanced safety, convenience, and cost savings. (A)
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NB-UVB is recommended over BB-UVB monotherapy for adults with generalized plaque psoriasis. (A)
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NB-UVB monotherapy is recommended for patients with guttate psoriasis, regardless of age. (A)
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Home NB-UVB phototherapy is recommended for appropriate patients with generalized plaque psoriasis as an alternative to in-office NB-UVB phototherapy. (B)
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NB-UVB phototherapy is recommended for pregnant women with generalized plaque psoriasis and guttate psoriasis. (C)
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Concomitant topical therapy with vitamin D analogues, retinoids, and corticosteroids during NB-UVB phototherapy can be used safely with a potential to improve efficacy. (B)
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Combination therapy with oral retinoids and NB-UVB phototherapy is recommended for appropriate patients with generalized plaque psoriasis who do not respond adequately to monotherapy. (B)
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Long-term combination therapy with cyclosporine and NB-UVB phototherapy is not recommended for adults with generalized plaque psoriasis because of increased incidence of skin cancer. (C)
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Combination therapy with apremilast and NB-UVB phototherapy can be considered for adult patients with generalized plaque psoriasis who do not respond adequately to monotherapy. (C)
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Genital shielding is recommended in all patients during NB-UVB phototherapy to reduce the risk of genital skin cancer. (C)
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Eye protection with goggles is recommended during NB-UVB phototherapy to reduce the risk of UVB-related ocular toxicity. (C)
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NB-UVB should be used with caution in patients with a history of melanoma or multiple nonmelanoma skin cancers, history of arsenic intake, and/or prior exposure to ionizing radiation due to the potential risk of photocarcinogenesis. (C)
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Women of childbearing age receiving NB-UVB phototherapy should take folate supplementation. (B)
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Maintenance phototherapy can be considered to maintain clinical response. (B)
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Recommendation Grading
Overview
Title
Care for the Management of Psoriasis with Phototherapy
Authoring Organizations
American Academy of Dermatology
National Psoriasis Foundation
Publication Month/Year
July 1, 2019
Last Updated Month/Year
January 31, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
This section covers the use of phototherapy in the treatment of psoriasis in adults
Target Patient Population
Patients with psoriasis
Inclusion Criteria
Adolescent, Adult
Health Care Settings
Ambulatory, Outpatient, Radiology services
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D011565 - Psoriasis, D010789 - Phototherapy
Keywords
psoriasis, phototherapy
Source Citation
Supplemental Methodology Resources
Methodology
Number of Source Documents
155
Literature Search Start Date
January 1, 2008
Literature Search End Date
December 31, 2017