Phototherapy Adherence Dropped During COVID-19 Outbreaks

Cheng-Che E. Lan, MD, PhD

Credit: Wiley

A new study from Taiwan illuminates the impact COVID-19 had on dermatologic interventions including phototherapy.

In new data published this month, a team of Taiwanese investigators reported that approximately two-thirds of patients receiving phototherapy for any of their atopic dermatitis, psoriasis or vitiligo were lost to follow-up after a pandemic-related shutdown of practices. The findings give concern to investigators, who stressed the importance of consistent care and patient education on the matter of follow-up therapy.

Led by Cheng-Che E. Lan, MD, PhD, associate professor in the department of dermatology at Kaohsiung Medical University Hospital, investigators conducted their analysis of the pandemic’s impact on phototherapy sessions, with consideration to patient demographics and history of treatment adherence and attitudes toward care before and after a COVID-19 outbreak.

As a decades-long modality of care in dermatology, phototherapy efficacy per cellular response is dependent on frequent exposure and patient treatment adherence. “Consequently, regular visits to the phototherapeutic unit play a pivotal role on the eventual therapeutic success,” investigators wrote.

Lan and colleagues’ assessment focused on their institution’s temporary closure during a May – July 2021 COVID-19 outbreak that resulted in a government restriction on businesses and public gatherings.

“Entry restriction and travel warnings were imposed worldwide to reduce interpersonal connection and maintain social distance,” they wrote. “This unique interval provided us with an opportunity to study the changes in patient profiles due to the interruption of phototherapeutic service resulting from the COVID-19 pandemic.”

The team retrieved data for all patients who received ultraviolet (UV) phototherapy in the dermatology department between December 2020 – December 2021. Patient medical charts and demographic information, as well as their primary dermatology diagnosis being treated with phototherapy, were reviewed. The study period was divided into intervals of 5 months prior to the pandemic-related shutdown (PRS), 3 months during PRS, and 5 months after PRS.

A total of 981 patients were documented as visiting the phototherapy unit during the study period, classified as having any of 10 identified dermatologic conditions. Patients with atopic dermatitis (n = 143), psoriasis (n = 242) and vitiligo (n = 282) constituted a majority and were included in the analysis.

Investigators observed 67, 167 and 197 patients with atopic dermatitis, psoriasis and vitiligo undergoing phototherapy before PRS, respectively. Just 19 (28.4%), 70 (41.9%), and 78 (39.6%) resumed after PRS, respectively; the rest had stopped during the COVID-19 outbreak. When including patients who initiated phototherapy after PRS, patient totals were 76, 75 and 85, respectively.

On average, patients with atopic dermatitis, psoriasis or vitiligo received 2.28, 2.27 and 2.11 phototherapy sessions weekly prior to PRS, respectively. Those averages changed to 2.30, 2.00, and 2.06, respectively, after PRS.

“Surprisingly, our analysis revealed that patients diagnosed with these three types of dermatoses shared unexpected similarities when encountering the temporary closure of the phototherapeutic unit,” investigators wrote. “While the number of patients seeking for phototherapy before and after PRS was similar, only around 30%–40% of patients resumed phototherapy regardless of the nature of their conditions.”

The team concluded that COVID-19’s impact on phototherapy rates was “tremendous” among patients with atopic dermatitis, psoriasis, or vitiligo at their institution in Taiwan—resulting in a 15% lessened expected number of patients resuming the treatment after the lockdown.

“Innovative medications, intensive follow-ups, as well as comprehensive education are essential when addressing patients undergoing phototherapy during the pandemic as at least 15% of patients will not resume phototherapy due to the occurrence of unexpected situation caused by the infectious disease,” they wrote.

References

1. ^{Chu KY, Lan CCE. The impact of the COVID-19 surge on phototherapy in Taiwan: Focusing on the patient profile, adherence, and attitude before and after the surge. Skin Research and Technology. Vol 29 Issue 4. Published April 6, 2023. https://doi.org/10.1111/srt.13314}