Phototherapy and DNA Damage: A Systematic Review.

Phototherapy has gained popularity in the recent decades for the treatment of various immune-mediated dermatological conditions since it is more-cost effective and less toxic compared to systemic therapies. This systematic review aims to inform dermatology providers of the risks and benefits of phototherapy, especially in patients at risk for malignancies. Ionizing energy from phototherapy results in DNA photolesions, namely of cyclobutane pyrimidine dimers (CPDs) and 6-4 photoproducts (6-4PPs). Without adequate repair, these mutations increase the risk for carcinogenesis. Additionally, phototherapy can also indirectly cause DNA damage through the formation of reactive oxygen species (ROS), which damage of several structural and functional proteins and DNA. When choosing a phototherapy modality, it also important to take into consideration the side effect profiles associated with each modality. For instance, a 10-fold higher dose of NB-UVB is required to produce a similar amount of CPDs compared with BB-UVB. Patients who undergo UVA with psoralen (PUVA) can be susceptible to developing skin malignancies up to 25 years after receiving their last treatment. It would behoove providers to consider optimal radiation dosage given each patients' level of skin pigmentation and potential for photoadaptation. Additionally, there are measures have been proposed to minimize deleterious skin changes, such as a 42-degree Celsius heat treatment using a 308nm excimer laser prior to UVB phototherapy and low frequency, low intensity electromagnetic fields along with UVB. However, as performing routine skin exams, remain paramount in the prevention of phototherapy-induced neoplasia.

Annual Trends in Medicare Part D Prescription Claims for Dupilumab 2017 to 2019.

Disease control for moderate to severe atopic dermatitis (AD) has been primarily achieved with phototherapy and non-specific immunomodulators, cyclosporine, and methotrexate. These treatments have, however, been associated with many unfavorable side effects.

Phototherapy trends in dermatology 2015-2018.

BACKGROUND: Trends in phototherapy utilization including its main clinical indications were last characterized by Luersen et al. for the time period of 1997-2010. In this study, we update data on the use of phototherapy in the United States from 2015 to 2018. METHODS: We queried the National Ambulatory Medical Care Survey (NAMCS) data on the number of phototherapy visits as well as demographics and associated dermatoses. RESULTS: There were approximately 1.31 million outpatient phototherapy visits during the study period with a decreasing trend over time. Leading indications for phototherapy were dermatitis not otherwise specified (NOS), (25.7%) followed by atopic dermatitis (AD) (11.7%), and pruritus (9.7%). CONCLUSION: There is a downtrend in the use of phototherapy from 2015 to 2018. Psoriasis is no longer the main indication for phototherapy, which may be due to the advent of highly effective novel biologics.