The efficacy and safety of phototherapy in geriatric patients: a retrospective study

Abstract

BackgroundWhile phototherapy is a well-established treatment for many dermatoses, data from the literature regarding its use in elderly patients are quite limited.ObjectiveIn this study, we aimed to determine the phototherapy indications in geriatric patients and to evaluate the effectiveness and reliability of phototherapy in this group.MethodsThis study included 95 patients of 65 years of age and older who were treated in our phototherapy unit between 2006 and 2015. The data for this study were collected retrospectively from patient follow-up forms in the phototherapy unit.ResultsPhototherapy was administered to 28 (29.5%) patients for mycosis fungoides, 25 (26.3%) patients foplaque type psoriasis, 12 (12.6%) patients for palmoplantar psoriasis, 12 (12.6%) patients for generalized pruritus, and 18 (19%) for other dermatoses. Of the patients, 64.2% had received a narrowband UVB (NB-UVB), 21.1% oral psoralen UVA (PUVA), and 14.7% local PUVA treatment. A complete response was achieved in 76.9-85.7% of the mycosis fungoides and in 73.71-100% of the psoriasis vulgaris patients treated with NB-UVB and PUVA, respectively. All the patients with generalized pruritus were treated with NB-UVB, and 80% of these patients achieved significant improvement. The erythema rate was found to be 0.43% per session for NB-UVB treatment and 0.46% per session for PUVA treatment as a side effect.Study limitationsThe limitations of our study are that it was retrospective and the remission durations of the patients are not known.ConclusionThis study showed that phototherapy is effective and reliable in the elderly population with proper dose increases and close follow-up.

The Efficacy and Safety of Narrowband Ultraviolet B Phototherapy in Geriatric Patients: A Retrospective Study

“…The median number of sessions was 42 sessions, and the median cumulative dose was 66.8 J/cm 2 . 6 In our study, PASI 75 was achieved by 52.4% patients, with the median number of sessions of 24 and median cumulative dose of 30.1 J/cm 2 . The lower treatment response in our study was likely to be due to a high number of patients that were lost to follow-up, which was 33.3%.…”

“…The finding that was quite different in the current study was vitiligo being the second most common indication (26.5%), whereas none of the two aforementioned studies had patients with vitiligo. [6][7] The study by Bulur et al in psoriasis patients revealed that PASI 75 was achieved by 73.7% of patients. The median number of sessions was 42 sessions, and the median cumulative dose was 66.8 J/cm 2 .…”

“…5 Presence of comorbidities and polypharmacy that commonly accompany geriatric patients also require clinicians to give a lot more consideration when deciding therapy compared to the adults. To our knowledge, there are only 2 studies that evaluated phototherapy specifically in geriatric population, which are a study in Turkey by Bulur et al 6 and in the United Kingdom by Powell et al 7 Bulur et al found that mycosis fungoides was the most common indication for phototherapy in geriatric patients, presenting in 29.5% of 95 included patients, and followed by psoriasis, pruritus, and lichen planus. 6 Powell et al reported 51% of 37 included patients were diagnosed with psoriasis, followed by eczema, nodular prurigo, and pruritus.…”

“…To our knowledge, there are only 2 studies that evaluated phototherapy specifically in geriatric population, which are a study in Turkey by Bulur et al 6 and in the United Kingdom by Powell et al 7 Bulur et al found that mycosis fungoides was the most common indication for phototherapy in geriatric patients, presenting in 29.5% of 95 included patients, and followed by psoriasis, pruritus, and lichen planus. 6 Powell et al reported 51% of 37 included patients were diagnosed with psoriasis, followed by eczema, nodular prurigo, and pruritus. 7 Similar to the current study, the most common indication for phototherapy in geriatric patients, was psoriasis (61.7% of 34 patients), followed by vitiligo and mycosis fungoides.…”

Is there still a role for UV therapy in itch treatment?

“…Sometimes, these patients lack specific skin lesions, and no obvious cause for their chronic (often generalized) pruritus (ie chronic idiopathic pruritus) can be found. Phototherapy can effectively reduce itching in these elderly patients (by up to 80%) and has a minimal risk of acute side effects if the proper UV doses are applied and patients are closely monitored during UV treatment courses . Long‐term side effects, such as the acceleration of skin ageing or higher skin cancer risk, especially in patients with a history of excessive, lifetime sun exposure or who have already received the highest advised cumulative number of UV treatments (around 150‐200 treatments of PUVA or 300 for NB‐UVB), however, have to be considered.…”