Benefits, Risks, and Treatment Options
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Light therapy, also known as phototherapy, involves using artificial UVB (ultraviolet light B) to treat a number of skin conditions, including psoriasis.
The therapeutic value of light lies in its ability to slightly suppress immune activity in the skin. “Psoriasis is an autoimmune condition where there is too much immune activity in the skin; treatment with light therapy turns down that overactive immune response,” says Elisabeth Richard, MD, assistant professor of dermatology at Johns Hopkins Medicine in Baltimore.
Reducing the immune response decreases the inflammation associated with psoriasis, and helps skin heal, explains Dr. Richard.
Dermatologists have been using phototherapy as a psoriasis treatment for over 100 years, making it a tried-and-true method, says Jeffrey Sobel, MD, a dermatologist at Tufts Medical Center in Boston. “Although it may not work for everyone, light therapy has been a very effective therapy for many of my patients,” he says.
Keep reading to find out what you need to know if you’re considering light therapy for psoriasis.
1. Light Therapy Can Involve up to 30 Sessions Scheduled a Few Times a Week Over Several Months
Typically a person undergoing phototherapy will expose their skin to UVB on a regular schedule — typically starting with a so-called “initial clearance series” of two to three times a week for three to four months, for a total of about 24 to 30 sessions, says Dr. Sobel. A dermatologist will determine the initial UVB dose by assessing the patient’s skin type, then gradually increase the amount.
There are different kinds of UVB equipment, according to the National Psoriasis Foundation (NPF), including small units for localized areas such as psoriasis on the hands and feet; full-body units; and hand-held units. An excimer laser, used to treat small, stubborn plaques, employs a high-intensity UVB beam, says the Foundation.
Patients wear protective glasses during the treatment as well as protective coverings for sensitive parts of the body such as the face and genitals.
2. Light Therapy Is Very Effective, Helping Most People With Psoriasis
“Light therapy works in about 80 to 90 percent of patients, and after an initial clearance series, those people will be about 80 to 90 percent better. It doesn’t work in everyone, but it works in most people, and it works quite well,” says Richard.
“If a patient tells me that their psoriasis tends to be improved by the sun, that gives me some clue that phototherapy will be an effective therapy for them,” says Sobel. “I also find that phototherapy tends to be most effective for people who have lesions that are more scaly and not very thick,” he says.
3. Your Psoriasis May Stay Clear for Many Months After a Course of Light Therapy
It does take some effort for a patient to commit to so many light therapy sessions, but for people who can make it work with their schedule, the benefits can be lasting, says Sobel.
“It’s one of the few therapies that you can take a break from once the skin looks good — most therapies are only effective while you’re using them,” he adds.
For phototherapy, the real payoff is that when you put in the work, your psoriasis will stay clear for up to seven to eight months or longer before you have to go through another course of light therapy or think about treating it with another type of therapy, says Sobel. “We call that remission,” he says.
4. Light Therapy May Carry the Same Risks as Sun Exposure
There are risks and side effects associated with light therapy, says Richard. “The main short effect of phototherapy is that if the dose is increased too rapidly, you can get a sunburn-like reaction. There are protocols in place to increase the dosing in a stepwise fashion to minimize that risk,” she says.
As far as long term side effects, light therapy can accelerate photoaging, which is premature aging of the skin, says Sobel. Photoaging causes things like an increase in freckling or dryness of the skin, he adds.
“Typically, psoriasis isn’t on the face, and so the light therapy doesn’t need to be used on the face, which is where we are typically most concerned about photoaging,” says Sobel.
Skin cancer is another concern with phototherapy. “While studies haven’t shown an increased risk of skin cancer, as with any UV exposure we do recommend that skin cancer screening be performed annually for patients who are on phototherapy,” says Richard.
“The type of light therapy that we offer for psoriasis — narrowband UVB — has not been linked to melanoma skin cancer, which is the type of skin cancer that can potentially be very serious and spread from the skin to other areas of the body and cause a lot of harm,” says Sobel.
5. Light Therapy Can Be Used Alone or Together With Other Psoriasis Treatments
Some psoriasis patients chose to use light therapy as monotherapy — that is, alone and not in combination with any other psoriasis treatments. “Some patients find phototherapy an attractive option because it’s a completely external therapy. People aren’t taking any injections or pills,” says Sobel.
There is a lot of data about the effectiveness of using light therapy in combination with other psoriasis treatments, he says. “This includes topical psoriasis medications, for example, like topical cortisone, as well as different oral medications. A medication called acitretin is probably the most common oral medication used with light therapy,” says Sobel. Acitretin is a pill that’s approved for psoriasis on its own, but when it’s combined with phototherapy it has a synergistic effect, meaning the two treatments work better and faster together than they each do individually.
Although you can combine biologic therapy for psoriasis with light therapy, it’s usually not necessary, says Sobel. “Biologics are usually able to successfully treat psoriasis without us needing to combine it with another therapy,” he says.
6. You Can Treat Your Psoriasis With Light Therapy at Home
Treating psoriasis with at-home light therapy can be a convenient and affordable option for some people, says Richard. “I recommend getting the equipment from a reputable vendor; there are several manufacturers that provide home phototherapy that require a medical prescription from a provider,” she says. Richard doesn’t recommend picking one equipment from an online vendor that doesn’t require a doctors’ prescription.
At-home light therapy should be performed under the supervision of a doctor, and as with in-office phototherapy, you should have a skin cancer screening each year, Richard says.
7. Tanning Beds Are Not the Same Thing as Phototherapy
Tanning beds don’t work as light therapy for psoriasis because although they may emit a little UVB light, they primarily emit UVA light. “Tanning beds are designed to tan you as opposed to being anti-inflammatory,” explains Richard.
“When people with psoriasis try to treat their condition with a tanning bed, in most cases they get about 20 percent better, but then the tan kicks in. The tan actually prevents or slows any further improvement that the light might provide,” Richard says.
8. Phototherapy Dosing and Effects on Skin May Differ for People of Color
Light therapy can be used safely and effectively in patients of all skin types, says Richard. However, phototherapy can cause hyperpigmentation (some patches of skin become darker than the surrounding skin) in Black patients and other people of color; people with darker skin should discuss the risks prior to treatment.
People of color with psoriasis may also need higher doses of phototherapy compared with white patients, and as a result, might often be undertreated by dermatologists who aren’t aware of this issue, according to the National Psoriasis Foundation.
The Joint American Academy of Dermatology–National Psoriasis Foundation provides guidelines for treating psoriasis with phototherapy that includes dosing recommendations for different skin shades.
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