PD11 Home phototherapy: one centre’s experience over the last 12 years

Abstract

Phototherapy remains an important second-line treatment for inflammatory dermatoses. The Dermatology GRIFT report and BAD guidelines for narrowband ultraviolet B (NB-UVB) highlight convenience and availability as important factors for access, and approaches that improve patient access should be a priority. Home phototherapy for psoriasis was first reported in 1979. A 2009 randomized control trial confirmed it as safe, effective and cost-effective. Despite this, uptake in the UK has been poor. Our department has offered home NB-UVB since 2014. The service now consists of 18 home units (11 Waldmann 100L and 7 Daavlin Series 7). This is for adult patients unable to access phototherapy due to work or childcare commitments or travel. Specialist nurses provide training and remote supervision of the patient throughout the course of treatment. In-house transportation services are used. In total, 259 courses of treatment have been initiated. Treatment cessation in 10 was due to poor response (7), symptomatic erythema (2) and flare of polymorphic light eruption (PLE) (1). Of the 176 patients who had psoriasis, 80% achieved clear or minimal residual activity within 30 exposures. Other conditions included eczema (62), PLE hardening (11), pruritus (3), chronic idio­pathic urticaria (3), prurigo (2), pityriasis lichenoides chronicus (1) and vitiligo (1). The incidence of symptomatic erythema is 1.6%. Patient satisfaction has been consistently high. Medical physics check the unit on return for mechanical or electrical faults and make irradiance measurements. Issues have included cable faults and loose connections on the base. Control panels on two Waldmann units have needed replacing. Fewer than five patients reported electrical faults, but these have not been replicated at the hospital. One patient avoided returning a unit (over 12 months). Further interrogation demonstrated no inappropriate use. The home electricity cost for a course of treatment is estimated to be £20. Home phototherapy is effective and safe and offers a valuable complement to hospital-based services.