Phototherapy

Phototherapy has been used for the treatment of psoriasis for decades and has proven safe and effective. In recent years, however, there have been changes in the treatment. The inpatient Goeckerman treatment, which was the standard treatment, has given way to outpatient therapy, usually without the addition of tar, and there has been evolution of the treatment to high-dose phototherapy and selective ultraviolet phototherapy. Maintenance phototherapy is another change, which is certainly appreciated by the patient who prefers to be free of psoriasis rather than occasionally clear of disease. Dermatologists are now using phototherapy in more diseases, prompted by some careful evaluation of its therapeutic spectrum. Mild to moderate atopic eczema can respond well to phototherapy, and it can also be useful in such diverse conditions as human immunodeficiency virus (HIV)-associated dermatoses and photodermatoses. However, this more widespread and intensive use of phototherapy has not been accompanied by critical evaluation of potential adverse effects, and there is a need for prospective study of the risk of cutaneous malignancy and the potential for photoaging changes induced by phototherapy. Prospective study of a large group of HIV-infected patients treated with phototherapy is also required, although this may be a difficult study to organize and implement. Dermatologists should be aware that other physicians also practice phototherapy for nondermatologic disease, such as depression and hyperbilirubinemia.