Uraemic pruritus responsive to broadband ultraviolet (UV) B therapy does not readily respond to narrowband UVB therapy

Sir, Uraemic pruritus has long been reported to be responsive to classical broadband ultraviolet B (BBUVB) therapy.1 Furthermore, it is usually the last resort in recalcitrant uraemic pruritus. Since narrowband UVB (NBUVB) was proved to be more effective in psoriasis, safer than PUVA and well tolerated,2 it has been successfully tried and proven useful in many other indications such as atopic dermatitis,3 photodermatoses4 and vitiligo.5 However, a literature search in Medline does not reveal any reports regarding the effect of NBUVB on uraemic pruritus. We decided to try NBUVB treatment with a 39‐year‐old uraemic female, who had been readily responsive to BBUVB therapy. The difference in phototherapeutic effects between BBUVB and NBUVB were quite impressive. A 39‐year‐old female had a history of hypertensive crisis with retinopathy 3 years previously. Chronic renal insufficiency was noted incidentally at that time. Because of symptoms of uraemia (nausea, vomiting and fatigue) and severe electrolyte imbalance, haemodialysis was started 2·5 years ago. Generalized pruritus had occurred prior to haemodialysis and was not improved significantly thereafter. Antihistamines and emollients did not alleviate the itch. Three courses of intense phototherapy (five times a week) have been given ever since. The first course of phototherapy consisted of eight sessions of BBUVB therapy (daily doses: 30, 40, 50, 60, 70, 80, 90 and 100 mJ cm−2, with significant improvement at the third dose; remission period 7 months). The second course of phototherapy started with NBUVB therapy (daily doses: 200, 240, 290, 350, 420 and 500 mJ cm−2; cumulative dose 2000 mJ cm−2). After six sessions, the patient felt almost no improvement (itching score reduced from 8 to 7). BBUVB was resumed (starting dose 40 mJ cm−2, increment 25% to 20% decreasing). Significant improvement was noted at the fourth dose (cumulative dose 230 mJ cm−2; itching score reduced from 8 to 1). In total, 10 sessions of BBUVB at the second course were given and resulted in a remission period of 18 months. A third course of phototherapy with BBUVB, at the patient's request, was given recently (same regimen as in the second course, total 10 sessions). A good effect was achieved again but at a higher dose (significant improvement at eighth dose, cumulative dose 760 mJ cm−2, itching score reduced from 9 to 2).