Shedding Light on Little-Used Phototherapy

Phototherapy is significantly underutilized, in part because it isn’t adequately taught during core dermatology training, according to a study in Photodermatology, Photoimmunology & Photomedicine.

When health policy experts are seeking examples of broken aspects of the system, they could easily point to the lack of use of phototherapy, which can be safer, more effective, and less costly than expensive biologics for treating certain dermatologic conditions, yet often sits on the sidelines.

Phototherapy, also referred to as light therapy or heliotherapy, has been shown to be safe and effective in treatment of psoriasis, acne vulgaris, eczema, and neonatal jaundice, among other conditions. A 2013 study in the Journal of Cutaneous Medicine and Surgery found that not only was phototherapy safe and effective, it was one of the most effective treatment options for psoriasis. It has also been tested, with varying degrees of effectiveness, in patients with seasonal affective disorder.

Yet, despite the fact that good clinical evidence is indicated, particularly for dermatology conditions, its use remains limited. The Photodermatology, Photoimmunology & Photomedicine study included a survey of US-based dermatology residents to determine their current level of training with phototherapy and their comfort level working with it. The study controls were two other common dermatologic therapies, botulinum toxin and radiation therapy. Responses were tabulated and comparisons made using Fisher's exact test and Cochran-Armitage Trend Test.

A total of 88 residents responded to the questionnaire. The survey delineated between in-office and home use of phototherapy, finding that 42% of respondents reported not receiving didactic education on prescribing in-office therapy, and 81% of respondents hadn’t been given instruction on home phototherapy. Therefore, not surprisingly, 29% of respondents indicated that they not comfortable prescribing in-office phototherapy, with 76% uncomfortable prescribing home phototherapy. By contrast, residents were well educated on and comfortable prescribing botulinum toxin (only 13% had not received didactic education on botulinum toxin). Dermatologic residents were even less comfortable prescribing radiation therapy, with 91% not comfortable prescribing it.

The survey mirrors findings from the 9^th Annual Dermatology Chief Residents’ Meeting in 2011 and published in the Journal of Dermatology Treatment in terms of the lack of training and comfort prescribing phototherapy. That study also pointed out that even when dermatologists do prescribe home phototherapy, patients also did not adhere to the therapy, due in part due to lack of reimbursement and in part to lack of full and clear instructions from dermatologists.

The study authors suggest that strengthening and updating curriculum on the effectiveness of phototherapy is one important step forward—one that could significantly benefit patients in the long run.