Survey of phototherapy practice by dermatologists in Australia

Abstract

A postal survey was sent to all dermatologists in Australia to determine current phototherapy practices. Questionnaires were returned by 158 (57%) of 277 dermatologists, of whom 112 (71%) provided phototherapy. Large variations existed in attitudes and practice, including indications, contraindications, dosage schedules, equipment maintenance, response to adverse events, and follow-up arrangements. Cumulative ultraviolet (UV) doses for psoralen and UVA (PUVA) were not calculated by 21%, while 30% did not calculate cumulative doses for UVB. Written informed consent was not obtained by 32%. Phototherapist dermatologists reported 25 patients developing melanoma following PUVA. Only 30% of Australian dermatologists organize regular follow up of patients after phototherapy. Australians have the highest rates of melanoma and non-melanoma skin cancers in the world, because of their ancestry and high solar exposure. This makes it inappropriate for Australian dermatologists to rely entirely on foreign safety data when assessing the risks and benefits of phototherapy in Australian patients. There is a need for standardized Australian guidelines that can be prospectively assessed to ensure phototherapy is used to maximize efficacy and minimize risks in Australian patients, given their unique ancestral mix and outdoor lifestyle.

Adverse Events Leading to Discontinuation of Phototherapy: An Observational Study

“…There are few reports about AEs and interruption of photo therapy in clinical practice. In our setting, NBUVB was the main phototherapy modality, accounting for 76.9% of treatments, which is consistent with the most recent clinical guidelines and several national and international publications (14)(15)(16)(17). The main dermatosis treated in our phototherapy unit is psoriasis, which is also in line with the existing literature.…”

Perfil Epidemiológico dos Pacientes em Tratamento na Unidade de Fototerapia do Serviço Dermatologia de um Hospital Universitário

“…11 Com relação a maior prevalência do vitiligo na amostra estudada, há concordância com os estudos Casara et al e Ujihara et al 11,12 A segunda dermatose mais prevalente em nosso estudo foi micose fungoide, o que difere dos estudos que avaliaram a prevalência das dermatoses tratadas com fototerapia e que apresentaram como segunda dermatose mais prevalente ou até a primeira, a psoríase. 11,12,[14][15][16] A justificativa para tal fato, é a disponibilidade de outras modalidades terapêuticas no tratamento da psoríase, permitindo que outras dermatoses beneficiem com a fototerapia, dada a limitação no número de vagas para o tratamento com fototerapia, no setor. [11][12][13] Para submeter-se a fototerapia é necessária a disponibilidade de tempo e/ou condição social do paciente, mas em alguns casos essa é a única opção de tratamento seja por contraindicações a outras terapias coadjuvantes ou por limitadas opções terapêuticas.…”

Role of phototherapy in the era of biologics

“…In Australia, a nationwide survey of practicing dermatologists published in 2002 showed that 71% of respondents provided phototherapy, and among them, almost 90% had their own treatment facilities. 7 In France, the number of UV treatments administered annually increased by 12% from 2007 to 2010dnearly a decade after biologics were first introduced; however, follow-up data (2013-2016) saw a decline of the same by 15%, which was attributed to delays in initiation of biologic therapy. 8 Although clinical inertia was suggested as a reason for this delay, 8,9 it is also worthwhile to consider the fact that many guidelines do not endorse biologics as first-line agents, and a stepwise approach is still advocated.…”