Taking
psoriasis treatment to the patient: development of a home TL-01
ultraviolet B phototherapy service.
Br J Dermatol. 2002 Nov;147(5):957-65.
Cameron H, Yule S, Moseley H, Dawe RS, Ferguson J.
A study into home phototherapy treatment for psoriasis.
Photobiology Unit, Department of Dermatology, University
of Dundee, Ninewells Hospital and Medical School, Dundee DD1
9SY, U.K.
BACKGROUND: While most patients requiring phototherapy
can attend for hospital-based out-patient ultraviolet (UV) B
therapy, a significant number cannot attend because of
geographical, work, economic and other reasons. OBJECTIVES:
To determine whether there was a need for home phototherapy
in the Tayside area and, if so, to establish protocols and
then to assess if such a service would be workable. METHODS:
patients referred from dermatology out-patient clinics in
Tayside for narrow-band UVB (TL-01) phototherapy completed a
pilot questionnaire that was followed by a two-phase
project. In phase 1, patients with psoriasis were trained to
use the home phototherapy equipment (HopE) within the
hospital department under nursing supervision while a
teaching package and protocols were developed. In phase 2,
home phototherapy was made available for patient use in the
community, supported by a specialist home phototherapy
nurse. Waldmann UV100 home therapy units were used, with
accurate dosimetry. Detailed treatment records were kept and
questionnaires were used to assess acceptability and costs
of therapy.
RESULTS: Fifty-two pilot questionnaires were completed.
Forty-two per cent of respondents found hospital
phototherapy inconvenient and 75% felt phototherapy at home
would be helpful. In phase 1, seven of 10 patients trained
to use the HopE completed therapy with the HopE unit alone,
reaching minimal residual activity (MRA) or clearance in a
median of 18 exposures (median dose 10.38 J cm-2). In phase
2, 32 courses of home phototherapy were given to 30
patients. Of 23 with psoriasis, 18 reached clearance or MRA
in a median of 22.5 exposures (median dose 9.84 J cm-2).
Although self-reported erythema rates appeared higher than
expected, all post-treatment questionnaire respondents would
choose home phototherapy over hospital therapy if required
in the future. CONCLUSIONS: UVB (TL-01) home phototherapy is
a useful practical development that has fulfilled a need in
our catchment area. Where appropriate training and support
teams are available it appears to be similar in
effectiveness to hospital therapy, to be safe and to be
cost-effective for patients.
pMID: 12410707 [pubMed - indexed for MEDLINE]
Home phototherapy: report on a workshop of the
British photodermatology Group, December 1996.
Br J Dermatol. 1999 Feb;140(2):195-9. Related Articles,
Links
Sarkany Rp, Anstey A, Diffey BL, Jobling R, Langmack K,
McGregor JM, Moseley H, Murphy GM, Rhodes LE, Norris PG.
Department of Dermatology, Addenbrooke's Hospital,
Cambridge, UK. phototherapy is a popular and effective
treatment for many patients with skin diseases. However,
repeated journeys to hospital for phototherapy can be
inconvenient and expensive. If it were available, many
patients might prefer home-based phototherapy as long as it
was safe and effective. Indeed, many psoriasis patients
already self-treat with ultraviolet A sun beds at home. This
report represents a consensus view from a British photo
dermatology Group workshop held in December 1996, the
purpose of which was to examine the potential role of
home-based phototherapy in dermatological practice. We
conclude that home-based therapy represents a suboptimal
treatment with greater attendant risks than phototherapy in
a hospital environment. The level of medical supervision of
the home treatment is crucial to its safety and
effectiveness. Until further studies are forthcoming, home
phototherapy should be largely restricted to those with
overwhelming difficulties in attending hospital.
PMID: 10733266 [pubMed - indexed for MEDLINE]
An assessment of potential problems of home
phototherapy treatment of psoriasis.
Cutis. 1996 Jul;58(1):71-3.
Feldman SR, Clark A, Reboussin DM, Fleischer AB Jr.
Department of Dermatology, Bowman Gray School of Medicine
of Wake Forest University, Winston-Salem, North Carolina
27157-1071, USA.
Very little has been reported about how patients use home
ultraviolet B (UVB) phototherapy. A survey of thirty-one
patients who were prescribed a home UVB phototherapy unit to
treat psoriasis was performed as a pilot study of home UVB
phototherapy usage; twenty-two patients responded.
Generally, respondents reported home UVB phototherapy to be
very helpful for their psoriasis. We conclude that home UVB
is an effective and appropriate treatment for many patients
with psoriasis, but screening and education of candidates
for home UVB phototherapy is important to ensure compliance
with the treatment program.
PMID: 8823554 [pubMed - indexed for MEDLINE]
Phototherapy at home is the perfect solution for chronic
skin disease management. Home phototherapy provides
convenient, better results and saving in both time and
money. |