The dark side of the light: Phototherapy adverse effects

Abstract

Phototherapy is a valuable therapeutic tool in Dermatology, but there may be drawbacks. Acute and long-term adverse effects, of variable severity, include skin erythema, xerosis, pruritus, blistering, altered pigmentation, photoaging, and photocarcinogenesis. Despite concerns over the carcinogenic potential of ultraviolet radiation, most studies have not found an increased risk of non-melanoma or melanoma skin cancer in patients treated with ultraviolet B (broadband and narrowband) and ultraviolet A1 phototherapy. These are therefore considered reasonably safe treatment modalities concerning the development of skin neoplasms, although caution and further investigation are warranted. Photoprotective measures, such as avoidance of concurrent sunlight exposure and covering skin areas not afflicted with disease, or more modern strategies, including phytochemical antioxidants and exogenous DNA repair enzymes, can minimize the hazards of phototherapy. Patients submitted to phototherapeutic regimens should undergo complete, careful dermatologic examination regularly and lifelong.

The Effect of Phototherapy on Cancer Predisposition Genes of Diabetic and Normal Human Skin Fibroblasts

“…However, there have been problems noted with light treatments; for example, Valejo Coelho and Apetato [1] did a study on adverse effects of phototherapy which could lead to certain skin cancers. In addition, other studies from Wickremasinghe et al [2] and Frazier et al [3] have noted a significant increased risk of cancer in infants after neonatal phototherapy.…”

The 308‐nm excimer laser treatment does not increase the risk of skin cancer in patients with vitiligo: A population‐based retrospective cohort study

“…A few explanations were possible for our results. First, the 308nm EL treatment does not have carcinogenic potential as the previous studies for NBUVB showed no significant increment in skin cancers (Archier et al, 2012;Hearn et al, 2008;Valejo Coelho & Apetato, 2016). Second, EL treatment, which consists of irradiation of the depigmented lesions sparing perilesional skin, could prevent cutaneous immunosuppression and mutagenesis by UV irradiation in uninvolved skin.…”

“…There have been long‐standing concerns regarding the risks of skin cancer following phototherapy in patients with psoriasis and vitiligo. Previous studies reported an increased risk of skin cancer following photochemotherapy such as psoralens with ultraviolet A (PUVA) phototherapy (Stern & Laird, ; Stern et al, ; Valejo Coelho & Apetato, ). In contrast, the potential role of narrowband UVB (NBUVB) in photocarcinogenesis is still controversial, but recent studies suggested no significant association between NBUVB treatment and skin cancers (Archier et al, ; Hearn, Kerr, Rahim, Ferguson, & Dawe, ; Valejo Coelho & Apetato, ).…”

“…phototherapy (Stern & Laird, 1994;Stern et al, 1984;Valejo Coelho & Apetato, 2016). In contrast, the potential role of narrowband UVB (NBUVB) in photocarcinogenesis is still controversial, but recent studies suggested no significant association between NBUVB As for the role of phototherapy in patients with vitiligo, there were two cohort studies which investigated the risk of phototherapy in the development of skin cancer in patients with vitiligo.…”

Estimation of Calcidiol Level in Serum of Atopic Dermatitis Patients before and after NB-UVB Phototherapy in Comparison to Oral Vitamin D Therapy

“…It puts forefront the possibility of using oral calcidiol in the management of AD patients, as it yielded results that appeared to be comparable to that of NB-UVB that is regarded as the most efficacious, well-tolerated treatment option for AD [2,23]. This could be of particular value as it overcomes the compliance problem that is commonly faced while using phototherapy [24], and has a higher safety profile when the side effects of phototherapy [25], or even topical steroids [26] are considered. The use of oral calcidiol in the management of AD has been proven before to be successful [9,22,[27][28][29][30].…”