Narrowband UVB Phototherapy Effective According to Patients with Psoriasis, Eczema

Evangelos Christou

Credit: The Topol Review

Narrowband UVB (NB-UVB) phototherapy is reaffirmed as effective among multiple ethnicities for those with moderate-to-severe psoriasis and eczema, recent findings suggest, with improvement in patient-reported outcome measures (PROMs) being higher among those with psoriasis versus eczema.¹

This new research—led by Evangelos Christou of the Guy's Hospital St John's Institute of Dermatology in London—was conducted to evaluate PROMs for the purposes of enhancing the phototherapy delivery’s efficiency and expanding upon the overall awareness of its use on patient outcomes. To do so, the investigators designed digital phototherapy-specific questionnaires for patients.

“These were administered via text message before initiation and after completion of phototherapy,” Christou and colleagues wrote. “We present a single-centre observational cohort study of psoriasis and eczema patients treated with Narrowband UVB (NB-UVB) phototherapy between March 2021 and December 2023.”

Background and Design

The research team provided NB-UVB phototherapy, with a wavelength range of 311–312 nm, at a rate of 2–3 times each week, beginning treatment at 70% of the minimal erythema dose and raising it by increments of 20%. Discontinuation of this process occurred when subjects’ skin became clear or virtually clear, though this did not occur in cases of eczema where the process was gradually reduced until cessation.

Questionnaires were filled out by participants, including questions related to demographics, clinical data, and PROMs. The Patient Oriented Eczema Measure (POEM) was used to assess severity among those with eczema. Other PROMs included the 5-point Patient Global Assessment (PtGA) to evaluate perceived disease activity, scores on the Dermatology Life Quality Index (DLQI), and the 11-point Itch Numeric Rating Scale (INRS).

The questionnaires were filled in prior to treatment by a total of 379 individuals, with 221 reporting diagnoses of psoriasis, 158 reporting diagnoses of eczema, and all of which being given NB-UVB phototherapy. 97 subjects, 72 with psoriasis and 25 with eczema, were included in the final analysis after filling out both pre- and posttreatment questionnaires.

For their comparison of PROMs scores prior to and following treatment, the investigators used Wilcoxon signed-rank tests and Vargha–Delaney A effect sizes. They considered a p-value of less than .05 as statistically significant.

Trial Findings

NB-UVB phototherapy was reported to lead to significant quality of life improvements for those with psoriasis, as evaluated by the DLQI. The research team noted decreases in impact of the condition from a moderate level prior to treatment to no impact following treatment (P < .001).

Achievement of a 4-point DLQIA improvement was identified among 80.6% of subjects with psoriasis, and consequently deemed clinically significant. The team also highlighted reductions in severity of disease following NB-UVB as shown by PtGA scores, noting 75% of participants with psoriasis reported an at least a 2-point improvement (P < .001).

The severity of itch reported by subjects was shown to drop significantly, with the investigators reporting dips to levels labeled as moderate to mild following treatment (P < .001) among 52.8% of individuals with psoriasis. This was seen in the 4-point improvement observed in subjects’ INRS scores.

Among individuals with eczema, NB-UVB therapy was shown by the research team to have similarly improved life quality, diminishing the skin condition’s impact from as reflected in participants’ DLQI scores (P < .001). The team noted that around 64% of subjects with eczema achieved an improvement of 4 points in DLQI score.

The investigators reported that severity of this disease was also diminished significantly following phototherapy. Specifically, they found that PtGA scores dipped from moderate to mild (P < .001) and POEM scores dipped from mild to moderate levels (P < .001).

In fact, around 36% of those in the eczema cohort had a 2-point or greater PtGA improvement. Additionally, the research team highlighted that 72% of those with eczema reported a 4-point POEM improvement.

Furthermore, the team found that severity dipped substantially from moderate to mild-to-moderate following phototherapy (P = .007), adding that 52% and 40% of those with eczema reported a 2-point and 4-point INRS improvement, respectively.

“Overall, our study reaffirms the effectiveness of NB-UVB phototherapy in a multi-ethnic patient cohort with moderate-to-severe psoriasis and eczema under real-world conditions, showing high improvement rates comparable to other systemic treatments,” they concluded. “Notably, the improvement in PROMs was higher in psoriasis compared to eczema.”²

References

1. ^{Christou E, Kastrisiou M, and Ferguson J (2024). Assessing the efficacy of narrowband UVB phototherapy using digital patient questionnaires and patient-reported outcome measures (PROMs): An observational cohort study of patients with psoriasis and eczema. JEADV Clin Pract. https://doi.org/10.1002/jvc2.535.}
2. ^{Chu AWL, Wong MM, Rayner DG, Guyatt GH, Díaz Martinez JP, Ceccacci R, et al. Systemic treatments for atopic dermatitis (eczema): systematic review and network meta-analysis of randomized trials. J Allergy Clin Immunol. 2023; 152(6): 1470–1492.}