Practice of phototherapy in the treatment of moderate-to-severe psoriasis.

This chapter will discuss the entire spectrum of phototherapy, including narrowband UVB photo-therapy, broadband UVB phototherapy, PUVA, targeted excimer laser phototherapy, and combination treatments. Phototherapy can range from simple treatments in a UVB phototherapy box, with or without concurrent use of various tar preparations, to more elaborate modalities in which the intensity of UVB radiation applied varies according to different anatomical regions. Combining PUVA or UVB phototherapy with topical and systemic agents can also enhance phototherapy. Certain forms of phototherapy, such as the traditional Goeckerman regimen of using black tar daily with UVB light, induce a prolonged remission. Outpatient phototherapy is usually reserved for patients whose disease is not adequately controlled with topical medications, including steroids, vitamin D analogues, tazarotene, tar, or anthralin. It is also indicated for patients with such extensive psoriasis that topical therapy is nearly impossible. Additionally, phototherapy may be an excellent option for patients with specific medical problems for whom systemic medications such as methotrexate, cyclosporine, or biological agents may not be suitable. For patients with generalized psoriasis, phototherapy is a reasonable first choice among the available options because of its superior systemic safety profile in comparison to systemic or biological agents. As with all other forms of psoriasis therapy, it is essential to consider the impact of the treatment on the patient's lifestyle when selecting the treatment plan. Important points to consider when initially discussing phototherapy are the patient's employment schedule, commitment, flexibility, location of the phototherapy unit, and transportation.